Los Angeles City Beat - FRONTLINES
Check Yourself
By Deam Kuipers
December 14, 2006

SxCheck.com is a new route to fast and confidential testing for HIV – and a new model for online medicine

Porn legend Dr. Sharon Mitchell knows what it takes to be successful in the fight against HIV and AIDS. As the founder of the Adult Industry Medical (AIM) Health Care Foundation, she instituted a culture of safety by routinely testing adult film stars for HIV and other pathogens and sharing those results (by mutual agreement) among sexworkers. She also favored a DNA testing method that will show a positive HIV test within 10 days of possible infection – the fastest available. Now she wants to bring a more private version of that health-conscious culture to the public, with her online testing site, SxCheck.com

The idea is brilliant in its simplicity: Those who want to be tested for HIV or for any common STD, from chlamydia to urinary tract infections, visit the website and buy the test panel they want. The site then refers them to a map of labs belonging to LabCorp, a network maintaining 36 primary testing locations and 1,300 draw sites nationwide. Clients go to the nearest location, submit their samples, and within one to four days, depending on the test, a secure link to their results is sent via e-mail. There is no public exposure, no insurance company involvement, and no visit to the doctor.

“It’s perfect for people who are more private and don’t want to go to a doctor’s office or to a county health clinic to get tested. There are tons of people who just don’t like to be public like that, or for whatever reason can’t go to these clinics,” says Mitchell from her office in Van Nuys.

Which is exactly what worries some health officials.

“We tend to, in the county health department, and the state, prefer to give the results to people in person – especially if they’re HIV positive,” says Sophia Rumanes, acting director of the Prevention Services Division at the Office of AIDS Programs and Policy at the L.A. County Health Department. SxCheck.com is a new site, and Rumanes was not familiar with it, so her comments were made to general questions rather than critiquing the site specifically.

“When people do get diagnosed as HIV positive, they have a lot of questions,” Rumanes adds. “We want to be able to link them up so they can access care services and treatment services. There are usually some emotional issues. Some people need that social support when getting news like this, so we tend to want to give that in person.”

Mitchell says the site was designed with this in mind, and is staffed by doctors and counselors with resources for those who receive positive tests. Those who do are not just sent their link but called on the phone and directed to doctors for further care: either county facilities or nonprofits if they are short of funds, or to private doctors if they can afford it. Rumanes points out that there are some clinics currently which give positive HIV results over the phone, but it’s not optimal.

Anonymity, Mitchell points, also has its limitations: As of April 2006, California is one of several states where HIV results are now “reportable,” meaning they must be reported to the state by both doctors and labs who perform these tests. She and her partner in the site, Doug Wightman, have worked for six months just to clarify the disclosure laws in each state. Rumanes notes that HIV results are only one such test: all STDs, hepatitis, some cancers, and other diseases also must be reported by law in California.

For her part, Mitchell is simply interested in getting more people tested more often. The key to its usefulness is that secure link to your test results. Keep it to yourself. Share it with others. Show it to a lover, or even a john.

“This is a good test for swingers, for people who are very sexually active. For instance, escorts,” Mitchell notes. With cell phone web access, anyone looking to score can pull up their latest test results, and show them to a partner on the spot. “This gives everyone more security, and it catches HIV cases as soon as possible.”

SxCheck.com isn’t cheap – an HIV test is $49.95 and an Everything Panel will run you $497.95 – but it is pushing what Mitchell and others consider to be the most progressive and useful testing regimen. Mitchell has favored the use of a PCR (Polymerase Chain Reaction) DNA test that can give HIV results within 10 days of possible infection. The window of effectiveness for the more-common Elisa test is six weeks to six months, and the PCR DNA test will give a positive even if the client is already on anti-retroviral drugs, which sometimes mask a positive using the Elisa test.

SxCheck.com, however, takes it one step further, creating a new treatment model that has raised some eyebrows. If a client tests positive, SxCheck.com will arrange for a prescription or a doctor or clinic that can provide the prescription. The cost is all out of pocket, so insurance companies do not get this information and it cannot affect your future eligibility or premiums. This is bound to stir some controversy, but that’s nothing new to Dr. Mitchell, who has appeared in over 2,000 adult films and has a doctorate in human sexuality from the Institute for the Advanced Study of Human Sexuality in San Francisco.

“If you test positive for chlamydia or gonorrhea, we’ll call in a prescription to your local pharmacy,” she says. “And if you’re partnered or married, we’ll send enough for them, too. We treat you no matter what your situation or your health status.”

All the prescriptions are written by doctors certified for the states in which the prescriptions are filled, says Mitchell, but that’s not the only issue.

“The California Medical Practice Act requires physicians to have a relationship with persons with whom they are prescribing controlled substances [prescription drugs],” says Karen Nickel, chief of the Laboratory Field Services Branch, California Department of Health Services. This implies that doctors would have to see the patient in person.

“Typically the things that we test for on our site, we can handle,” says Mitchell. “If someone is positive for Hepatitis B, something that can’t be medicated, and they’re infectious, we would call them by phone and tell them that they need to go to their county health department, which we have all the resources to help them find. Or they need to go to a physician. We have nonprofit resources for people who don’t have money, depending on where you are.”

Still, could online medicine be a model for the future? SxCheck.com is only a month old, and Mitchell says so far the response has been very good. Many are not ready for a world where the doctor is only on the other end of a URL, and there are legalities involved, too. Even if the site’s convenience makes it a runaway success, the friendly doctor hasn’t quite been relegated to the drive-thru, or virtual medicine. Not yet, anyway.