In China, you can now add HIV testing kits to that list.
China is piloting the use of vending machines that sell HIV testing kits on university campuses. The goal is to reach students who may be reluctant to go to a clinic for a test because of the stigma of contracting HIV.
The experimental program began last year on five college campuses in the city of Beijing as well as Harbin, Guangxi and Heilongjiang provinces. Local media just recently publicized it. Users pay the equivalent of a little over $4 for a kit with a container for a urine sample that can be dropped off anonymously at a receptacle in the machine that dispenses the test. Users can check their results online in 10 to 15 days.
HIV/AIDS activists in China have lauded the vending machines as a positive step for encouraging more people to get tested.
"Helping people to run a test for themselves like a take-home pregnancy test would be very helpful," says Martin Yang, a program manager at the Beijing Gender Health Education Institute, one of the first Chinese nongovernmental groups to focus on issues related to gender, sexuality and sexual health.
In China, homosexuality is still a taboo — listed as a mental illness until 2001, forbidden from film scenes. Because of its association with homosexuality, HIV/AIDS is effectively a taboo subject as well. Official data show around 654,000 people in the country live with HIV or AIDS, though researchers believe the actual number is likely higher.
Patients with HIV or AIDS say they are routinely turned away from hospitals and clinics when they seek care, despite regulations that explicitly forbid that kind of discrimination. Last July, phone scammers blackmailed hundreds of people with HIV or AIDS after obtaining their personal information through a data leak and threatening to reveal their identities if they didn't pay up.
That societal stigma has made promoting HIV/AIDS awareness and testing extremely difficult.
"The most common psychological barriers given for not having HIV testing were perceived low risk of HIV infection and fears of being stigmatized for homosexuality," wrote the researchers for a paper on HIV/AIDS testing among "MSM" — men who have sex with men — who were migrants to Beijing from other parts of China.
So now Chinese health authorities are trying this vending machine tack to reach populations under 30, which experience higher rates of transmission than older age groups.
Such self-administered HIV tests are also available online. A search on Taobao, the Chinese e-commerce platform, turned up dozens of test brands costing around $15-$45 per kit. It was unclear how many had been approved by Chinese health authorities. Self-test kits operate in a gray area in China: The law states that the tests should be opened and used only in the presence of a medical professional.
The vending machine program is overseen by the National Center for AIDS/STD Control and Prevention (NCAIDS), which, according to Chinese media reports, is subsidizing the cost to keep it at about $4. NCAIDS did not respond to a request for comment, citing a lengthy approval process before it could talk to foreign media.
Whether the vending machine tests will be used is still uncertain.
Local media reports say fewer than 10 kits have been sold at the Harbin Institute of Engineering, one of the campuses chosen for the pilot, since the vending machines came into use last November.
"I think these kinds of method will yield some results but to what extent is still unclear. Right now, these vending machine test kits are not a significant channel for testing," says Liu Shi, program manager of the China AIDS Walk initiative.
Another challenge would be the time lapse between when a person contracts HIV and when they take a test, says Martin Yang of the Beijing Gender Health Education Institute. It can take up to several weeks for HIV to develop to a stage where it is detectable through a urine test.
But Dr. Chris Beyrer, a professor at the Johns Hopkins Bloomberg School of Public Health, sees potential benefits. Beyrer, who is not involved in this vending machine program, notes in an email that "there is always some window [of time]" before a test will react to an infection. But he adds: "The issue is that self-testing may reach people who are less likely to come into a clinic, so it may get to some people sooner in infection course and hopefully reduce onward transmission. So you have to look at this as ... the public health goal of getting people at risk to know their status, and for people at significant risk to regularize testing."