Oral Exam Whitman-Walker patients open wide for new oral HIV test.

As a small crowd fills the counseling room at the Whitman-Walker clinic's Elizabeth Taylor Center on a recent Saturday morning, the scene resembles the waiting area at the Bureau of Traffic Adjudication. Wearing somber expressions and clutching cups of latte, the clinic's guests have arrived for a normally painful ritual: HIV tests.

This crowd, however, will be spared the pin pricks, drops of blood, and vials. Whitman-Walker on Feb. 1 became the country's first AIDS clinic to use OraSure, a new HIV test that is administered orally. Developed by Epitome Inc. and distributed by Pittsburgh-based SmithKline Beecham, OraSure measures HIV antibodies found in blood by extracting a sample called "oral mucosal transudate."

The subjects wait for the staff to commence its presentation, a lengthy walk through HIV 101, before the tests begin. Today's presenter is Andy Keller, one of Whitman-Walker's army of approximately 75 testing and counseling volunteers. Keller quickly relaxes the room with the droll quips he throws into his presentation. When a slide pops onscreen that allegedly illustrates OraSure drawing antibodies into its cotton swab but looks more like a marshmallow suspended in a jellyish red, Keller deadpans, "That's the worst slide I have ever seen."

Keller eschews the customary diet of bullshit usually associated with organized sex education. "How do you eliminate risk?" he asks rhetorically. "You just don't do it," he replies. "Thank you, Nancy Reagan."

Instead, Keller offers a safer alternative to traditional fellatio—the "corn on the cob" or "harmonica" method. The audience snickers at the metaphors.

Next, Mr. Penis and Mr. or Ms. Anus get a friendly introduction. The former is a striking, purple life-size replica, but the latter appears to be made of a material similar to that of a pencil eraser, and Keller awkwardly makes the best of the demonstration.

As a member of the staff distributes an OraSure instrument to everyone—it actually looks like a mutant toothbrush—Keller jokes that all the phlebotomists will soon be out of work. That's the breakthrough: OraSure is self-administered and free of blood and needles.

"I feel like a flight attendant," says Stephen Kiosk, associate director of HIV testing and counseling at Whitman-Walker, as he stands before the subjects demonstrating the OraSure examination. At this point, Kiosk would normally be marching subjects one at a time through the blood-collection process. "The new test brings an increased comfort level," he suggests.

Oral testing has been slow to catch on, in part because prevention professionals are concerned that people will wrongly conclude that if you can test for HIV in the mouth, you can become infected by kissing. But the incredible convenience and portability of the process eventually won Whitman-Walker over.

"There is a significant portion of the community that is scared of blood," says Whitman-Walker communications coordinator James Millner. "They will literally avoid getting tested or, at the very least, become very stressed out about it."

After unwrapping the instrument, subjects insert the cotton swab, which is attached to a straight handle, between their cheeks and gums for two and a half minutes. Then the swabs are inserted into a small vial with a preservative and sent to the clinic's laboratory for testing.

Audience members shower Kiosk with compliments on the painless test. "The oral test brought so much relief," says a George Washington University undergraduate. "With everyone sitting there with this thing in their mouths, it's less heavy."

OraSure costs considerably more than the traditional blood exam, but Millner says the clinic willingly bears the added expense. One of OraSure's advantages, Millner says, is its portability: Now the clinic can go into neighborhoods and locations that would otherwise be shut off from the clinic's outreach program.

For instance, Whitman-Walker volunteers can take OraSure to a college campus and test roomfuls of students in minutes. "With three or four phlebotomists, it takes hours," says Millner.

Whitman-Walker also plans to administer the oral HIV test to intravenous drug users when the clinic transports them from their neighborhoods to the clinic's site on 14th Street. "People can actually be tested in the van," says Millner. A blood needle would be ill-advised in a truck rambling over the city's potholed streets.

Since OraSure is less technical than blood tests, volunteers require significantly less training to administer the test. That means the clinic can focus training resources on counseling, a specialty that requires significantly more expertise.

The clinic already has plans to work with a few churches in the area, as well as some civic groups in Southeast. Whitman-Walker managers, who fretted in the past over administering blood tests to mass audiences, aren't so worried about the oral test. AIDS testing loses a lot of its menace when you are in a roomful of folks sucking on medical lollipops.CP

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