Ambiguity and Access: Louisville non-profit calls for legislation to clarify HIV self-testing regulation in Kentucky

Inequity increases the likelihood of worse health outcomes and steals agency from us all. 

Out-of-date restrictions on In-Home HIV test kits have created inequity in access to these tests for Kentuckians that can’t afford to buy them at the store or face stigma in their communities. The Social Practice Lab, along with researchers at Norton Healthcare, the University of Louisville, and the Pacific Institute of Research and Evaluation have recently highlighted how this outdated restriction affects organizations seeking to address health inequities in the Commonwealth. Here, we summarize their recent appeal from Director Michael Kopp. 

The Social Practice Lab is a non-profit that “invests resources into communities in order to address and narrow the health equity gap.” 

The Social Practice Lab, among other organizations engaging in HIV prevention and service programs in Kentucky, has faced cease-and-desist letters when providing In-Home HIV test kits in the past. Access to In-home HIV testing is an accepted strategy for informing and empowering individuals. In Kentucky, however, organizations looking to address the gap in access to in-home HIV test kits face regulatory confusion from the state.

Kentucky law KRS 367.175 prohibits “the sale, delivery, holding or offering for sale of any self-testing kits designed to tell persons their status concerning human immunodeficiency virus or acquired immunodeficiency syndrome or related disorders, and advertising of such kits” and is a Class C felony.

In-home self-test options provide agency and remove the stigma for individuals. The OraQuick In-Home HIV Test is the only FDA-approved HIV self-test kit available in the United States.

These tests can already be purchased from retailers, including Walmart, Target, CVS, and Walgreens across Kentucky. However, smaller programs have received cease-and-desist letters from the Kentucky Cabinet for Health and Family Services when offering delivery of at-home HIV test kit services. This places In-Home HIV Test Kits behind a barrier for those who cannot afford them. Paywalling public health and delaying care for the most vulnerable. 

These cease-and-desist efforts often threaten a loss of much-needed funding if a program’s funds are used for purchasing In-Home HIV Test Kits. The statute itself has never been used in charges against an organization, but the regulatory grey area is still used to threaten programs addressing access gaps for HIV testing. This statute has real-world, negative effects on health outcomes for LGBTQ individuals across Kentucky. 

Systemic barriers and unequal access are common in HIV testing and care globally and in the United States. These barriers include stigma and limited or absent testing and healthcare options. This is especially true for rural and underserved communities. This law is a political determinant of health for Kentuckians.

A clean-up bill focused on addressing the uncertainty of this statute can be a step forward for access to HIV testing services. This effort has many stakeholders across the state who support it. Kopp writes that there is “strong interest and legislative support for cleaning up this statute.” 

We have all seen broad acceptance of in-home testing throughout the COVID-19 pandemic. At the same time, HIV transmission rates have risen, in certain areas, as people deal with the ongoing barriers to equitable care that are an integral part of the US healthcare system. Individual agency is important in addressing the HIV epidemic. At-Home HIV Test Kits provide this agency. 

Diagnosis of all people living with HIV, as early as possible, is key to ending the HIV epidemic in the US. Groups like Louisville’s Social Practice Lab and it’s partners are hoping the Kentucky legislature can take a step towards this goal by cleaning up the ambiguity around KRS 367.175.