Q&A with Nurx Advisor Christopher Hall, MD

At Nurx we’re lucky to have Christopher Hall, MD, MS, as a Senior Medical Advisor. An Infectious Disease specialist, lab director, and expert on HIV and other sexually transmitted infections, Dr. Hall has played a crucial role in creating the new Nurx STI Home Test Kits (launching in just a few weeks), and he helps shape our PrEP- and STI-related care, especially around the PrEP Home Test Kits. We sat down with Dr. Hall to hear his take on HIV and STI testing from his experiences both as a consumer and as a provider, and discovered what he wishes everybody would do to protect themselves.

So much has changed for the better in HIV prevention and treatment since you began your medical career, but is there an aspect of the epidemic that hasn’t changed as much as you’d like?

One thing that’s improved but not completely resolved is the stigma around HIV. It still drives the way people approach testing, and there’s a sizeable number of people who because of stigma are reticent to access available testing services and, in particular, walk into a brick-and-mortar clinic or discuss their level of risk with their primary care provider. It turns out many folks seek a high level of privacy and autonomy to get tested regularly, and that’s why the Nurx STI Home Test Kits are so important. They really meet people where they are, both literally and psychologically, because even though we’ve come so far in how we think and handle HIV, that stigma is still with us.

Do you remember your first HIV test?

Very clearly, because it was a scary experience. It was 1989, and I was a young gay man who had landed in New York City in the middle of the AIDS epidemic. HIV was still essentially a death sentence, and I’d seen it kill my friends and neighbors ever since I’d come out 5 years earlier. I remember sitting in my doctor’s small Chelsea waiting room, paralyzed with fear, and certain that I had become HIV-positive. The doctor was stern and not at all comforting or reassuring. But the worst part was the interminable wait for results, which back then took longer than a week. While I waited for the results I blamed myself, questioned things I had done, and played out the ways I would try to cope  if I received what I then imagined was the death sentence of HIV.

How did you feel when you got the results?

I was shocked and of course relieved to learn that I’d tested negative for HIV. But honestly this ritual was so exhausting that I only got tested three more times over the following 25 years. And much of that time included periods when I was an MD myself, and/or was well informed about HIV testing. So much of that time I was in the dark as to my actual status and the best way to protect myself, which was avoidable and intractably anxiety-laden.

Do you think it’s common for people to avoid getting tested, even when they know they should?

Absolutely. Even though I am now an educated and healthcare-engaged person, at times I’ve been hesitant to go to a clinic or community-based center for regular testing. In my particular case, personal anxiety has persisted despite professional knowledge and wherewithal — which is a reflection of just how idiosyncratically and pervasively HIV-related stigma manifests. Bringing up personal STI/HIV risk with my own provider remains challenging, despite my years of training and specific expertise. Years of internalizing the stigma of HIV and shouldering personal fear of the disease have taken their toll, and that’s true for many people I know. Even though I routinely work to destigmatize HIV in work with patients and peers, our internal personal struggles often take a different course. Admitting that HIV stigma is real for me gives me better insight into what patients may be experiencing.

What excites you about the STI Home Test Kits that Nurx is about to launch?

First of all, the ability to do very high-quality lab tests for HIV and other STIs at home is an outstanding development. These home-based tests offer a level of quality and accuracy that heretofore wasn’t really available outside of the best STI clinics. But what really sets these test kits apart is the ability to test non-genital sites through simple self-administered throat and rectal swab tests. Studies show that if you only test urine, you miss infections in these other areas of the body, and many providers don’t even offer throat and rectal tests or understand the need for them, especially in non-urban or non-specialized settings.

What do you wish more people knew about their health?

I wish all sexually active people understood the importance of regular STI screening. Have your individual risk assessed and be tested on the schedule and frequency that’s recommended for you.

For women who are considering pregnancy now or in the future I’d emphasize the importance of STI screening well before you might get pregnant. STIs like syphilis are extremely dangerous to a fetus and to a healthy pregnancy, and we’re seeing a big rise in the rates of pregnant women with syphilis. And some STIs like Chlamydia can lead to infertility if they aren’t treated in time, but can be easily resolved if caught early.

What would you say to people who might feel nervous about home STI tests?

They should know that Nurx backs your testing up with unlimited access to a knowledgeable, expert provider who is non-judgmental and skilled at dealing with sensitive health issues. The Nurx medical team possesses a level of STI knowledge and expertise that you’re unlikely to find in most in-person medical settings. And because secure, bi-directional messaging is the primary means of communication between patient and provider, the whole process of getting your results, and arranging treatment if necessary, can be done on a patient’s terms and timeline. You won’t need to worry about waiting for a doctor or clinic to call with results when you’re in the middle of a work meeting, for example.

People also should know how reassuring it is to check the important issue of STI testing off of your list of day-to-day concerns. It goes a long way toward taking the stress out of having a healthy sex life!

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