For many, the idea of getting an HIV test can be scary. Some people might worry about their insurance; others might feel ashamed; and, still some might not even know they should get tested. As HIV tests are not normally done during a checkup, there are plenty of reasons why people choose not to get an HIV test. Yet still, the amount of people accepting HIV testing during “routine checkups or medical procedures” doubled between 1998 and 2002.

More and more people are opting to get tested for HIV and with good reason: testing lets you know your HIV status as well as if you can infect others. Early detection of the virus can also greatly improve a person’s health prospects. If you feel that you could have been exposed to HIV, the safest and smartest thing to do is to get tested—that way you can know your status, know your risks, and most importantly, know your options.

What is HIV?

HIV, otherwise known as the human immunodeficiency virus, is generally accepted as the virus that causes AIDS. AIDS (acquired immunodeficiency virus) is a chronic disease that, if left untreated, can possibly lead to death. Testing positive for HIV does not mean that a person has AIDS. In many cases, a person testing positive for HIV can live in perfect health for years without taking medication.

HIV works by infecting a type of white blood cell known as a CD4+ cell (also known as a T-lymphocyte, T-cell or T-helper cell). These cells are part of our immune system and help fight off infection. Gradually, HIV destroys more and more of these cells, making it harder for our bodies to produce enough of them to adequately fight off infection. An HIV+ person’s CD4+ count will usually be tested once every 3 – 4 months to measure the progression of the HIV virus and determine what medications, if any, are needed.

Why should I get tested?

There are many reasons to get tested for HIV, some of which are more obvious than others.

Some individuals, those that engage in ‘ high-risk behaviors,’ are at an elevated risk for HIV infection. Those who have had multiple sex partners, those who have had a recent sexually transmitted infection, those who have used needle-injection drugs such as heroin or steroids (especially if they share needles or other drug paraphernalia) and those who have received blood transfusions or other blood products before 1985 are all at elevated risk for HIV.

Other people that are more prone to HIV infection are those people who work in the medical industry or handle bodily fluids as a part of their job (though occupational transmission only accounts for a fraction of a percent of all HIV cases) and infants born to mothers with HIV.

Even if you do not see yourself in one of the groups mentioned above, it may still be important to get an HIV test. If you have ever been sexually active, it’s a good idea to get tested: you can never know the entire sexual history of someone with whom you have had sex. Likewise, if you intend to have sex with someone, it is important to know their HIV status. They may ask you for yours. Getting tested isn’t just safe, it’s practical.

What types of HIV tests are available?

HIV testing can be done by collecting a sample of blood, urine or by taking an oral swab. The blood test determines if there are HIV antibodies within the blood. The oral swab removes cells from the side of the mouth that can then be tested for HIV antibodies. The less common urine test is only given by a doctor when a blood and oral swab test is impractical or unwanted.

Each of these tests only looks for the presence of HIV antibodies and do not test for the presence of the virus. (HIV has not been found to exist in urine and only found in non-transmissible amounts in saliva.)

A sample must go through a series of different procedures that ensure the accuracy of the results before being deemed positive for HIV. The most common first procedure in HIV testing is the ELISA (enzyme-linked immunosorbent assay) test.

Since there are antibodies other than HIV that may cause the ELISA test to register a false-positive, a positive result is then put through a secondary test known as the western blot. Together, these tests have an accuracy rate greater than 99.5%.

Generally, tests that utilize ELISA and subsequent methods may take up to two weeks for results. For those that do not wish to wait so long, there are several rapid tests on the market that can give results within 5-30 minutes. The results of this type of test are about as accurate as results obtained from ELISA alone, so a positive result should be sent to a lab to be confirmed by additional testing.

Only one HIV-1 Home Collection Test System is currently approved by the FDA. The Home Access Express HIV-1 Test System is the only home HIV test that is legal on the US market. The test requires that a self-collected finger prick of blood be sent to a lab and tested. The individual must then call the company for results, post-test counseling and referrals.

Remember, all of the tests listed above test for HIV antibodies. While certain procedures exist that test for genetic material from the HIV virus ( viral load measurement tests), these are much more expensive and often less reliable in the detection of the virus than those that look for the antibodies. These tests are primarily used in monitoring an HIV+ individual or in determining the status of a baby born to an HIV+ mother (who may have HIV antibodies yet no virus).

How long should I wait before getting an HIV test?

There is a window period between the onset of HIV infection and when it appears on HIV tests. The reason for this period is that a certain amount of HIV antibodies need to be produced before a test can find them.

The window period is different for each individual but generally lasts about 3-4 weeks. In most cases, enough antibodies will be created within three months to show up on the test. In rare cases, it may take up to six months.

Even if you feel that you are within the window period, you may still get an HIV test; however, a follow-up test may be required to validate the results. Therefore, abstaining from any behavior that will expose you to the virus for three months will generally guarantee an accurate HIV antibody test.

Who can perform an HIV test?

Testing can be done at either a public health office, a sexual health clinic or at your doctor’s office. To find a testing center near you, you may call the National AIDS hotline at (800) 342-2437 or search for a clinic online.

Who can find out my results?

Based on where the HIV test is performed, the results may either be anonymous or confidential. It is recommended that you clarify what type of privacy your results will be given before taking the test.

While being tested anonymously, you are only identified by a personal number that will be used to receive your results. Anonymous results will still be reported to the Centers for Disease Control (CDC), but your name will not be attached.

While being tested confidentially, your name is attached to your results. There are very strict procedures in place to make sure your status is kept secret from anyone besides medical personnel and, sometimes, the state. Should you utilize insurance to pay for the test, the insurance company may require the status of your results as well.

What can I expect when I go in to get tested?

Generally, there are three segments to getting an HIV test: pretest counseling, the test itself and posttest counseling. All people tested for HIV should have access to support and counseling both before and after the test is completed.

Pretest (or preventative) counseling aims at helping you better understand the virus and the results of the test. During pretest counseling, you may be asked to assess your risk factor of contracting HIV and to make a plan to reduce that risk. By the end of pretest counseling, you should know your risks, know your support, feel more comfortable about getting the test and be ready to manage the results.

Pretest counseling is very important to help you deal with the anxiety and reality of getting an HIV test as well as to understand your sexual behaviors. Some places offer more thorough pretest counseling than others and you should feel free to ask the testing site whether they offer the amount of counseling that you need.

Some time after being counseled, your results will be presented to you as either negative, positive or (in rare cases) inconclusive.

• What does a negative result mean?

A negative result means that you have tested negative for HIV antibodies. Should you have abstained from any risky behaviors during the past six months, you do not have HIV. If you have engaged in any recent risky behavior, then you should be tested again. A negative result has nothing to do with your risk for HIV, so it still may be important to assess the risk factor of your behaviors.

• What does a positive result mean?

A positive result means that you have tested positive for HIV antibodies. The test would have been repeated several times to confirm the results. Therefore you are infected with the HIV virus though have not necessarily developed AIDS. Your sexual partners or those that you have shared drug paraphernalia with may also have been exposed to the virus and as such should be referred to HIV counseling and testing.

• What does an inconclusive result mean?

An inconclusive result can mean several things. The result may be related to several factors not pertaining to the HIV virus. The result may also indicate a very early stage of HIV infection. Most people who receive inconclusive results later test negative for the HIV virus. In the case of an inconclusive result, another test will usually be scheduled a few weeks later.

While receiving your results, you will be posttest counseled. During posttest counseling, a counselor will make sure that you both understand the results of the test and that you are informed of your current options.

If you test negative, the counselor may again explain to you the window period and remind you about risk reduction.

If you test positive, the counselor will answer any of your questions. He or she will be able to assist you in finding a doctor and other available sources that specialize in HIV treatment. The counselor will also be able help you find emotional support (often through community organizations or support groups) and help you in notifying others who may have been put at risk for HIV infection.

It is important to remember that there is a wide array of help designed specifically for people with HIV, and that the role of the counselor is to help one understand and find this help.

What now?

Some people think an HIV+ test result is the end of the world. Some people think it’s a death sentence. Time and research are proving that both of these ideas are untrue.

Research is constantly being performed to devise new and better ways of dealing with the HIV virus. The health prospects of an HIV+ individual are far better than they were at the onset of the virus, better than they were in the 90s and only continue to get better.

Today there are millions of HIV+ people worldwide who are able to live healthy and productive lives. Some people maintain their health through medical treatments while others rely on homeopathic treatments or no treatment at all.

Whether a person has HIV or not, the most important tool for a healthy life is knowledge. Know your HIV status and know the options open to you.