HIV Testing
Should You Get Tested for HIV?
The Centers for Disease Control and Prevention (CDC) estimates that 1,106,400 persons are living with HIV (range: 1,056,400 – 1,156,400) in the United States. Of those persons, approximately 1 in 5 (21%) do not know they are infected. Because they do not know they are infected, these persons are unable to benefit from care related to their HIV disease. In addition, some of these people may unknowingly be transmitting HIV to other people. The Indiana State Department of Health (ISDH) strongly encourages people who are at risk for HIV to be tested regularly. Whether or not to take the HIV antibody test, however, is a personal decision that only you can make for yourself. Here are some things you may wish to consider:
- Knowledge is power.
- If you find out that you are HIV-positive (infected with HIV), you and your healthcare provider can better plan early treatment and intervention, improving your chances of slowing down the progression of the disease.
- If you test negative, you may feel less anxious.
- By knowing your status, you can find out whether or not you can infect others, and what precautions you might take to prevent transmission to other people.
- Regardless of the result, testing tends to increase your commitment to overall good health habits. If you test positive, you can learn more about HIV and be proactive in taking care of your health.
What Are HIV Antibody Tests?
As the body fights viruses, the immune system creates antibodies to that virus. HIV antibody tests do not measure or detect the virus itself but instead look for your body's reaction to the virus - the presence of antibodies to HIV.
Rapid Tests
OraQuick®Advance Rapid Testing for HIV has become one of the most prominent ways that people receive HIV tests today. In as little as 20 minutes, you can find out your HIV status.
Rapid tests look for antibodies to HIV, not the virus itself. A rapid test is administered by sampling the oral mucosa (the mucous that is in your mouth) and putting it through a test to see if HIV antibodies are present.
Some people may think that, since the test uses the mouth to test for HIV, that HIV can be transmitted to other people through saliva, spit and/or oral mucosa via kissing, sharing utensils, or sharing glasses. This is FALSE.
A rapid test runs for 20 minutes, after which you will receive a result. Rapid tests are extremely accurate. All persons with a positive (reactive) result will be administered a confirmatory test.
OraSure Test
The OraSure® HIV antibody test uses a sample of oral mucus obtained with a specially treated cotton pad that is placed between the cheek and lower gum for two minutes. It is similar to the rapid oral test; the only difference between the two is the amount of time that it takes to receive
your results. The sample is sent to a lab, where it undergoes an ELISA procedure. All positive samples undergo a Western Blot confirmatory test (using the same pad).
Western Blot
The Western Blot is a confirmatory test: it is only performed if a rapid test is positive. The Western Blot can be positive, negative, or indeterminate. Indeterminate tests are neither positive nor negative. An indeterminate result usually means that a person has just begun to seroconvert at the time of their test. In the rare cases in which this occurs, the person will need to be retested, usually about one month later. False positive results are extremely rare with the Western Blot, so it confirms (proves) that HIV antibodies are present.
Window Period
The "window period" is the time it takes for a person who has been infected with HIV to react to the virus by creating HIV antibodies. This is called seroconversion.
During the window period, people infected with HIV have no antibodies in their blood that can be detected by an HIV test, even though the person may already have high levels of HIV in their blood, sexual fluids, or breast milk.
"Antibodies generally appear within three months after infection with HIV, but may take up to six months in some persons."
This CDC definition of a three to six month window period has been commonly used for a number of years.
- The three month window period is normal for most of the population. Many people will have detectable antibodies in three or four weeks. Very, very rarely (i.e., only a few cases ever), a person could take six months to produce antibodies.
- You may be anxious to be tested soon after an encounter which you perceive to be risky (for a discussion of what behaviors put you at risk for HIV and which ones do not, see one of our counselors).
Although HIV may not be detected by a test during the window period, HIV can be transmitted during that time. In fact, a person is often most infectious during this time (shortly after they have been exposed to HIV).
Test Results Counseling
Test results counseling involves giving an HIV result to a person, interpreting those results, or reinforcing an existing plan for reducing risk of future transmission and/or re-infection, explaining the “Duty to Warn” partner notification laws, and providing referrals for medical, emotional and social support.
The Indiana “Duty to Warn” law states that all HIV positive persons must inform all past, present and future sex and/or needle-sharing partners of their HIV status before engaging in behavior deemed to transmit the virus. In addition, donating blood, plasma, organs, and body tissue is prohibited.
A positive (reactive) result means:
- You are HIV-positive (carrying the virus that causes AIDS).
- You can infect others who come into contact with your blood, semen or vaginal fluid. You should take necessary precautions to avoid transmitting HIV to others.
A positive result does NOT mean:
- You have AIDS.
- You will necessarily get AIDS.
- You are immune to AIDS, even though you have antibodies.
A negative (non-reactive) result means:
- No HIV antibodies were found in your blood at this time.
A negative result does NOT mean:
- You are not infected with HIV (you may still be in the "window period").
- You are immune to HIV.
- You have a "resistance" to infection.
- You will never get HIV.
Informed Consent
HIV testing is voluntary and free of coercion. Written informed consent with person’s signature is mandatory before any testing is preformed. Information regarding consent may be presented orally or in writing and use language the person can understand.
Confidential Testing
Confidential testing means a named – linked test where the person signs name to the consent form. Persons who are tested confidentially and are found to be infected with HIV are reported to the Indiana State department of Health so they can better track the extent of the disease in the population as a whole.
Duty to Warn
All persons with a HIV test result confirmed positive, will be counseled as to their duty to notify past and present sex and/or needle-sharing partners, including any spouse (defined by Public Law 104-146 as "any individual who is the marriage partner of an HIV-infected person or who has been the marriage partner of that person any time within the 10-year period prior to diagnosis of HIV infection) of HIV status so they may arrange medical care. The HIV-infected person has the duty to notify all future sex and/or needle-sharing partners of their HIV positive status prior to engaging in behavior which may put them at risk per Indiana law.
Name - Based Reporting
Indiana law requires those who are infected with HIV to be reported by name to local public health officials. Fortunately, public health reporting by name has been in place for many years for other communicable diseases and this information has been successfully protected by public health officials. More than 80 other diseases and conditions are currently required to be reported by name in Indiana, including Hepatitis, Tuberculosis, Syphilis and Chlamydia.
It is important to note that only public health officials have access to the information that is reported; employers and insurance companies do not. Indiana law includes provisions that ensure the highest degree of confidentiality of name-based HIV data and have severe penalties for inappropriate disclosure of that information. In addition, stringent laws exist at the federal, state and local levels to protect persons with HIV and AIDS from discrimination in housing, employment and public services.
Partner Notification
Partner Counseling and Referral Services (PCRS) - allow persons who have tested positive to get assistance in notifying previous sex or needle sharing partners that they may have been exposed to HIV. Through these services you will receive counseling about how to notify partners yourself or you can have a Disease Intervention Specialist (DIS) do it for you. The disease intervention specialist will ask for the names, addresses, e-mails and/or phone numbers of other people (contacts) with whom you have had sex or shared needles.
The health department will then try to locate each contact to tell them that they have been exposed to someone with HIV and could be at risk. They will advise these contacts to be tested for HIV. The health department does NOT disclose the name of the person who has tested positive, but in some cases, it may be obvious to the contact, particularly if he/she has had sex with only one or few other people.