News that the rapid oral HIV test, OraQuick Advance, is turning out false positives has led many to question the reliability of the test and others to abandon it all together. The San Francisco Chronicle reported Dec. 9 that, according to the San Francisco Department of Public Health, 47 people who tested positive using the OraQuick Advance HIV test were, in fact, negative. The Los Angeles Times reported similar findings on Dec. 16 when the Los Angeles Gay and Lesbian Center said they have quit OraQuick because it produces too many false-positive results. In November, the L.A. Center found that 13 people in the city who tested positive for HIV from the oral swab test were not infected with the virus.

The L.A. Center is not the only facility scrapping the oral test. A major testing center in San Francisco, the UCSF AIDS Health Project, has also discontinued using the test.

What’s puzzling, however, is that the number of false positives popping up in L.A., San Francisco and New York is unique to those areas. In San Diego, for example – according to Dr. Wilma Wooten, deputy health officer with the San Diego County Health and Human Services Agency – out of the 2,010 OraQuick tests administered in San Diego County, 48 returned positive, and two of those were false positives. Two false positives out of 48 may still seem high, but not near the margin of error we’re seeing with our neighbors to the north.

Delores Jacobs, chief executive officer of San Diego’s LGBT Center, said that the agency responsible for testing at The Center is the County of San Diego HIV Testing and Counseling, and, in response to a telephone call she placed out of concern and to seek clarification on the OraQuick story, county officials told her there have been no false positive tests at The Center site since the beginning of the fiscal year. They further indicated there had only been one to two countywide in the same time frame, and that it appears that San Diego is not experiencing the difficulties that L.A. and San Francisco are.

San Diego County and the Centers for Disease Control and Prevention (CDC) have not taken action to discontinue use of the OraQuick test. Currently, people testing for HIV can choose between the rapid oral or rapid blood HIV tests. Those who test positive are retested using the Western blot or the immunofluorescent assay to confirm a positive result.

But critics of the OraQuick test say that because of the false positives the public will lose confidence in HIV testing, which otherwise could be avoided by using reliable means of testing.

The emotional damage of having a false positive – with the risk of a person who has tested positive potentially harming themselves or participating in self-destructive and dangerous behavior – is another concern.

Problems with the OraQuick test come at a time when the U.S. Food and Drug Administration is considering a request from drug maker Orasure Technologies to approve it for home use and over-the-counter sales. The high rate of false positives confirms that we are a ways away from reliable at-home testing – something that could dramatically change the way we screen ourselves and our sex partners for HIV.

But we should not write the test off completely. With safety nets in place to catch people who test positive, moves to dump the test are premature. We need to ask why cities such as L.A. and San Francisco are experiencing a higher rate of false positives than cities like San Diego – and what new insights can be learned about the nature of testing and perhaps HIV itself.