I/O

You Can Now Order STI Tests Online to Take in the Comfort of Your Own Home

Telemedicine companies think the onerous process of in-office testing dissuades patients

Photo: Kwanchai Lerttanapunyaporn/EyeEm/Getty Images

BBack in my college days, I was a volunteer at GHAP, Columbia University’s queer health program — and, more specifically, the wing of the student health center that was responsible for providing HIV testing and education. As part of my volunteer work, I provided counseling to students prior to their HIV tests, chatting with them about their sexual histories and identities, their behaviors and choices, and potential strategies for risk reduction.

The counseling I did was part of New York state’s legal requirements for HIV testing, which mandate counseling prior to receiving the test. But it was also representative of the dominant mode of thinking at the time about reproductive and sexual health care. HIV testing, along with other STI testing and sexual health care services, was seen as a prime opportunity to connect with people who might otherwise be disconnected from the health care system. Once you’d gotten them through the clinic doors, the thinking went, you could connect them to education and prevention resources, as well as take time to chat about their behavior and encourage risk reduction. Without that in-person visit — or that legally mandated counseling — some providers feared patients might miss out on crucial services.

Almost two decades later, however, that thinking has begun to change. While some providers still see in-person visits and counseling as an essential component of reproductive health care, others worry that onerous requirements can function as a kind of gatekeeping, serving mainly to discourage potential patients from seeking needed care. Patients who’ve dealt with discrimination from providers, who live in remote areas far from quality providers, or whose busy schedules make it hard to get to the clinic may not be willing to jump through hoops to access health services — a fact that becomes more troubling when you consider that these people are often the vulnerable patients who may be the most in need of services like STI testing.

Rather than upping the requirements associated with reproductive health care, some providers are focused on reducing barriers to access. Reproductive health care telemedicine startup Nurx recently added full-panel STI testing to its slate of services, except in New York, where legislation doesn’t allow at-home collection and testing. Although over-the-counter STI tests have been available for a few years, telemedicine has made them much more accessible: If you’re anxious about your STI status, you no longer need to make an appointment with your doctor, head to your local clinic, or hope your drugstore has kits in stock. You just need to go online and order an at-home testing kit.

STI testing was a natural extension of Nurx’s existing services. From its beginnings as an online birth control pill supplier, Nurx has expanded into offering clients at-home HPV screenings and pre-exposure prophylaxis (PrEP) for consumers concerned about HIV prevention. “We listened a lot to our existing users, who were asking for [STI tests],” says Jessica Horwitz, vice president of clinical services at Nurx. She notes that birth control pill and PrEP users are likely more interested in seeking out regular STI testing.

The company’s sales data suggests that hunch was correct. According to Horwitz, within a week of the launch, Nurx had sold several hundred kits, many purchased by people in places where access to STI testing is thin on the ground. Horwitz adds that Nurx’s first STI kit customer was a 30-year-old woman from Georgia. After purchasing her comprehensive testing kit, she messaged the company to thank them for providing the service — in her hometown, the woman explained, there was no other way to access STI testing services. (Currently, 40% of Nurx’s birth control patients are based in the nine Southern states it currently serves; a 10th Southern state, Kentucky, debuted on the platform on July 23.)

It’s not just telemedicine startups that are experimenting with new ways to deliver these essential reproductive health care services. In rural and conservative states, where residents have limited access to full-service reproductive health care or feel anxious about accessing such services in person, sexual and reproductive health clinics are rethinking what it means to serve their communities.

“We’re also trying to innovate service delivery so that we can reckon with the real barriers that our patients face.”

At Maine Family Planning, abortion pills and transgender health care services are available through the clinic’s telemedicine platform; although STI testing has not yet been added, community organizer Cait Vaughan says the organization is open to the possibility. “We’re trying to innovate service delivery so that we can reckon with the real barriers that our patients face,” Vaughn explains, barriers that can include a busy schedule, remote location, or discomfort or anxiety about receiving in-person care.

Despite fears that making it easy for patients to access reproductive health care from the comfort of their homes might erode the quality of care, the health care providers I spoke with are confident their patients are still getting access to everything they need — and, in some cases, might even be receiving better care than they would in the clinic. “Not being in the same place allows for [more openness]” about a sensitive subject like sex, Vaughn notes.

And in many cases, the choice isn’t between receiving care in a clinic or at home; it’s between receiving care at home or not receiving it all. Katy Leopard, assistant director of the Memphis-based clinic Choices, explains that in some cases, requiring a clinic visit “can be a nonstarter to receiving the care.” Patients who’ve been traumatized by negative health care experiences are often uninterested in accessing in-person care. Giving them the option to access care online may be the only way to reach them at all.

“It is almost a little paternalistic,” says Leopard of the long-standing belief that seeing a doctor in person is the only way to receive quality health care. “It’s not like our patients don’t know and understand [their health care needs]… I think there can be benefits to coming in [to a clinic], like connecting with support services. But there are creative ways of making that happen.”

“We come from a long feminist legacy of trusting patients,” Vaughan says. “At the heart of it, we’re trying to continue to trust our patients.” An organization that is truly committed to caring for its patients is one that is able to meet them where they’re at. When it comes to reproductive health care, that increasingly means using telemedicine to bridge a gap of a few — or a few hundred — miles.

OneZero columnist, Peabody-nominated producer, and the author of Faking It: The Lies Women Tell About Sex — And the Truths They Reveal. http://luxalptraum.com

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