Update 12pm 1 April 2011.
I’m sure most readers will have figured out that this was nothing more than a bit of April Fools fun. But there is a slightly serious side to it, which is that we wanted to promote the fact that most STI testing these days is done through urine samples… so the scare stories about being poked and prodded down at the clinic shouldn’t put people off getting themselves checked out. And whatever your results are, be safe.
Given that a lot of the HIV prevention-related work I’ve done has involved working with stigmatised people and communities in general, it’s probably fair to say I’m particularly prone to questioning bio-medical strategies that are promoted as magic bullets for sexual health promotion. So I had a bit of a knee-jerk reaction when I heard that some pubs are piloting a scheme where toilet water is replaced with urine testing reagents, so that drinkers can basically get on-the-spot warnings that they may be infected by some STIs. The water turns a different colour once you pee in it, and you check that against a colour chart in the loo and, hopefully, if you need to, get yourself checked out and treated. I heard about it from a friend in Bath who had seen it in action, and Sexedukation has researched and written a blog post explaining what is going on.
My first reaction was to wonder about consent – it looks like you don’t have any choice but to have the test if you need to and relieve yourself. Surely this can be got around since it isn’t necessary to have this test in every stall/urinal, and they could be clearly labelled. But what about confidentiality – surely the result is available for the next person who comes in to see? And I’m guessing some people might rightly find the fact that the test is more accurate for women than men problematic (something to do with urine that travels a longer distance getting too aerated to give a good result) – this might further promote men’s sexual irresponsibility.
However, I think these issues can be got round… and if so, why not go for it? Getting toward a stage where people are systematically checked up might help destigmatise the whole area of sexual health, and it could be a good way of putting pressure on people who don’t go to the loo: just what have they got to hide?
Also, pub loos also tend to have condom vending machines so it’s a timely reminder to use condoms. And I certainly don’t buy the “anti-sex” argument that this scheme will just promote hook-ups, encourage people who get the all clear to go without condoms, or even lead to celebratory infection-free quickies in the toilets. I’ve also heard that there are the tired old concerns that because kids might use the loos this is yet another example of children being forced to grow up to soon. But I think that, if anything, by promoting awareness it will discourage unsafe sex; and careful communication of the fact that not all STIs are detected by the tests should be enough to stop people using negative results as an excuse for going bare-back.
Because I work in low-income countries I’ve also been wondering about the relevance of this scheme in other contexts. In desert environments, peeing and defecating in water historically tends to be a no-no as it contaminates a precious resource – and this norm still prevails in those cultures even when there is running water. And in many other contexts where I have worked, public loos are often poorly lit pit or squat latrines so it would be impossible for people to see what colour the water had changed. Moreover, with poor infrastructure and health systems I would worry that the reagents might not get replaced enough. Also a key part of the scheme is good information, but in places with high levels of illiteracy or even just places where people aren’t used to getting information via the written word, I’m just not sure it would work. So while I am interested to see the results of the UK pilot, none of this is much use to me in my own work.