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HIV Testing And Counseling
What Is HIV Testing?
HIV testing involves having your blood, urine, or saliva tested to see if you are infected with the human immunodeficiency virus (HIV), the virus that causes AIDS.
AIDS stands for acquired immunodeficiency (or immune deficiency) syndrome. It is a disease in which a virus attacks the body’s immune system that normally fights off diseases. Medication is available to help control AIDS symptoms, but currently there is no cure for AIDS.
HIV is transmitted through body fluids – primarily semen, vaginal fluids, and blood. People can get HIV in several ways:
- Having sexual relations with an infected person
- Sharing infected needles, such as through the use of illegal drugs
- Having a blood
transfusion , although today this is very rare - HIV can be transmitted from an infected mother to her unborn baby
- Babies can get HIV through an infected mother’s breast milk
- Accidentally getting stuck with a needle containing infected blood, such as in a healthcare setting
In the U.S. today, nearly one million people are believed to be infected with the HIV virus, according to the federal Centers for Disease Control and Prevention (CDC). However, many infected have never been tested for HIV and are not benefiting from medications that could keep them healthier longer.
It’s extremely important people know if they are infected with HIV for these reasons:
- HIV infection does not usually produce any symptoms; symptoms begin when HIV infection becomes AIDS. Because of this, a person may be a carrier of HIV without knowing it and may infect others.
- If HIV is detected and treated before it has developed into AIDS, a person’s long-term survival can be significantly increased.
What Is AIDS?
AIDS stands for acquired immunodeficiency (or immune deficiency) syndrome. It results from infection with a virus called HIV, which stands for human immunodeficiency virus. This virus infects important cells in the human body called CD4-positive (CD4+) t cells . These cells are part of the body’s immune system, which fights infections and various cancers.
When HIV invades the body, it begins to attack white blood cells called CD4+ t cells or t4 lymphocyte cells. Without these white blood cells, the immune system – which normally fights off infections – loses its ability to defend against diseases caused by bacteria, viruses, and other microscopic organisms. Without enough CD4+ T cells, the body becomes vulnerable to certain rare cancers.
There is no cure for AIDS, but medical treatments can slow down the rate at which HIV weakens the immune system. As with other diseases, early detection offers more options for treatment and preventing complications.
What Is The Difference Between HIV And AIDS?
The term AIDS refers to an advanced stage of HIV infection, when the immune system has sustained substantial damage. Not everyone who has HIV infection develops AIDS.
When HIV progresses to AIDS, however, it has proved to be a universally fatal illness. Few people survive five years from the time they are diagnosed with AIDS, although this is increasing with improvements in treatment techniques.
Experts estimate that about half the people with HIV will develop AIDS within 10 years after becoming infected. This time varies greatly from person to person, however, and can depend on many factors, including a person’s health status and health-related behaviors.
People are said to have AIDS when they have certain signs or symptoms specified in guidelines formulated by the
The CDC definition of AIDS includes:
- All HIV-infected people with fewer than 200 CD4+ t cells per cubic millimeter of blood (compared with counts of about 1,000 for healthy people)
- People with HIV infection who have at least one of many AIDS-associated conditions that are the result of the HIV attack on the immune system
AIDS-associated conditions include:
Opportunistic infections by bacteria, fungi, and viruses. Opportunistic infections are infections that are rarely seen in healthy people but occur when a person’s immune system is weakened.- The development of certain cancers (including cervical cancer and lymphomas).
- Certain autoimmune disorders.
Most AIDS-associated conditions are rarely serious in healthy individuals. In people with
Need To Know: How HIV Infection Is Not Spread Research indicates that HIV is NOT transmitted by casual contact such as:
In short, studies indicate that HIV transmission requires intimate contact with infected blood or body fluids (vaginal secretions, semen, pre-ejaculation fluid, and breast milk). Activities that don’t involve the possibility of such contact are regarded as posing no risk of infection. |
Facts About HIV Infection
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When To Have An HIV Test
The CDC recommends people should have an HIV test if they answer “yes” to one or more of the following questions:
- Having three or more sexual partners in the last 12 months
- Have received a blood transfusion prior to 1985, or have a sexual partner received a transfusion and later tested positive for HIV
- Not sure about one’s sexual partner’s risk behaviors
- Being a male who has had sex with another male
- Using street drugs by injection, especially when sharing needles and/or other equipment
- Having a sexually transmitted disease (STD)
- Being a healthcare worker with direct exposure to blood on the job
People should consider an HIV test if:
- They have engaged in an activity that has an HIV infection risk factor
- Knowing their HIV status would help them find the medical care to prevent or delay a life threatening illness
- Knowing the result of a test would help protect sexual partners
- The test would help them make decisions about pregnancy and childbirth
- Taking the test would resolve their anxiety over wondering if HIV infection is present
Need To Know: When first infected with HIV, a person may have no symptoms at all. Some people experience a brief flu-like illness a few weeks after becoming infected. These early signs of infections, including fever, headache, sore throat, swollen lymph glands, and rash are similar to those of more common illnesses. Therefore, people do not recognize they have been infected with HIV. Some people remain symptom-free for years but during this time they can spread the infection to others. After this time, more serious infections may occur, including rare cancers and pneumonia. As HIV progresses to |
The CDC recommends all patients coming for HIV testing have pre- and post-test counseling. Most counseling and testing centers follow policies of confidentiality and for many states anonymous testing. Anonymous testing means the person tested is the only one who will know the test result. The laboratory and even the healthcare provider does not know the person’s identity.
Counseling Procedures
Before a person has an HIV test, he or she should be given materials to read before entering a group or private session with a counselor or doctor. The healthcare professional may ask why you want to be tested. The counselor should also ask you about your background and sexual history. This will help you and the counselor determine whether HIV testing is appropriate.
If testing is appropriate, the counselor or doctor should:
- Describe the test and how it is done
- Explain AIDS and the ways HIV infection is spread
- Discuss ways to prevent the spread of HIV
- Explain the confidentiality of the test results
- Discuss the meaning of possible test results
- Ask what impact the test result will have
- Address the question of whom you might tell about the result
- Discuss the importance of telling your sex partner(s) and/or drug-using partner(s) if the result indicates HIV infection
If these questions are not covered, or you have other questions, ask them. Come prepared with questions that have been of concern.
Also ask the doctor or counselor how they report the test result. If the test result is negative, the post-test counselor should talk to you about how to avoid behaviors that will put you at risk.
Informed consent means that the patient has the right to refuse any medical procedure, to be fully informed about it, and to agree to it. Patients should be asked to read a statement saying that they have been informed about the HIV-antibody testing procedure, they understand it, and they consent to having it done.
What Are The Standard Types Of HIV Tests?
The main tests used for detecting HIV infection are blood tests:
- Enzyme immunoassay (EIA) This test is widely used by just about all HIV testing programs. It is highly accurate but no test is 100 percent accurate. Accuracy depends on following proper procedures as well as the person’s stage of infection. That is why all HIV testing programs use more than one test to confirm the presence of HIV.
- Enzyme-linked immunosorbent assay (ELISA)
- Western blot test, which is used to confirm the EIA/ELISA screening tests
In all of these tests, a small amount of blood is drawn from the arm and taken to the lab to be tested. The EIA and ELISA tests take from one to two weeks to complete, depending on where the test is performed. These tests check for the presence of antibodies to HIV; they do not check for the virus itself.
In addition to the standard blood tests for HIV, other tests are available:
Rapid HIV Test
A rapid test for detecting antibodies to HIV was first approved in the U.S. in 1996. This test produces very quick results, usually in 10 minutes, much faster that the standard HIV tests (EIA and ELISA) that are not available for one to two weeks. These rapid tests are increasingly being used because of the faster turnaround time.
The U.S. Food and Drug Administration currently has licensed only one rapid HIV test called the Single Use Diagnostic System for HIV-1 (SUDS™). Several others are in development. The availability of rapid HIV tests may differ from one place to another.
The rapid HIV test is an ELISA test. But instead of being analyzed in large batches along with other individual tests, the rapid test is analyzed alone. The slightly higher cost is outweighed by a fast result, which reduces the number of people who never return to find out their results.
If the result is negative a person can leave the testing site. However, if the rapid test is positive, other tests, including the Western blot, will be used to confirm the results before the person is told of the presence of HIV infection.
Home Test Kit
Consumer-controlled test kits (popularly known as “home test kits”) were first licensed in 1997. Although home HIV tests are sometimes advertised through the Internet, currently only the Home Access Express HIV-1 Test System manufactured by Home Access Health Corporation is approved by the U.S. Food and Drug Administration (FDA). The accuracy of home test kits other than Home Access – many of which are available online – cannot be verified.
The approved Home Access test kit can be found at most local drug stores. The testing procedure involves pricking your finger with a special device, placing drops of blood on a specially treated card, then mailing the card in to be tested at a licensed laboratory. Customers are given an identification number to use when phoning for the test results. Callers may speak to a counselor before taking the test, while waiting for the test result, and after getting the result.
Oral Test
Oral tests can be performed in a doctor’s office or clinic. To use an oral HIV test, the inside of the mouth is gently scraped and the saliva is tested for the presence of HIV antibodies. The result is as accurate as the blood tests because the saliva is tested using an EIA test and then a Western blot test if necessary.
It’s important to remember that saliva is not a medium through which the HIV virus is transmitted. Semen, vaginal fluids, and blood are the main body fluids by which the HIV virus is transmitted.
Urine-Based Tests
A urine-based test is also available for screening in a doctor’s office or clinic. However, it is somewhat less accurate than the blood or saliva-based tests. Like other tests, positive results must be confirmed with the Western blot test. A physician must order these tests, and the results are reported to the physician’s office.
Viral Test
Other tests that measure HIV in the blood directly are available:
- A p24
antigen test measures a specific protein of the virus in the blood. - An RNA viral load test measures the quantity of viral RNA in the blood. This test is often used to measure the effectiveness of drugs used to treat HIV infected people.
Need To Know: Polymerase chain reaction (PCR) is a new blood test that looks for HIV genetic information. It has very limited availability. It is expensive and labor intensive but the advantage is that the test can detect the virus even in someone who is newly infected. The FDA has indicated that the development and implementation of tests for HIV genetic material such as PCR is warranted. |
When The Results Come In
HIV tests can identify HIV antibodies in the blood as early as two weeks after infection, but the body may take up to six months to make a measurable amount of antibodies. The average time is 25 days. When HIV antibodies are present in your bloodstream, a person is HIV positive.
What If The Test Is Positive?
HIV-antibody test results are extremely accurate when proper procedures are followed. However, a very small number of people may test positive even though they are not infected. These are called false-positive results. Sometimes a false-positive result can occur, which is why additional tests are done.
If an ELISA test yields two or more positive results, a different test such as the
The
- Some medicines prevent the type of pneumonia that is a common problem for people who have HIV or AIDS.
- Doctors can track when a person’s immune system begins to weaken. By evaluating the immune system regularly and giving vaccinations against bacterial pneumonia and influenza, doctors can help an HIV infected person avoid illnesses related to HIV infection and treat them more effectively when they occur.
- For pregnant women, medical treatment with a drug known as
AZT may reduce the chances of a baby being infected with HIV.
Need To Know: People who test positive for HIV should follow these steps to help themselves and minimize the impact on others:
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What If The Test Is Negative?
A negative result means that no HIV antibodies were found in the blood. This condition is called seronegative and usually means the person is not infected. Rarely, a person who has undergone HIV testing can have a false-negative result, where the person tested negative even though HIV is present. To reduce the chances of a false-negative result, several tests are used.
Sometimes, someone who has tested negative can still be infected with HIV. It takes time for the body to develop HIV antibodies after infection. Almost all people develop HIV antibodies within three months, but it can take up to six months after infection for some persons.
Therefore, if a person has engaged in behavior that can transmit the
How To Information: Testing negative does not mean the person cannot get HIV in the future. No one is immune to HIV, so everyone should be sure to take steps to protect themselves from becoming infected in the future. Being aware of behaviors that increase the risk of infection and taking preventive measures can substantially reduce a person’s likelihood of becoming infected with HIV. Steps to take to protect yourself from HIV include:
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Where To Go For Tests And Advice
Deciding where to go for counseling and testing depends on the area where you live. There are different counseling and testing places from which to choose. These options include:
- Publicly funded HIV testing centers
- Community health clinics
- Sexually transmitted disease (STD) clinics
- Family planning clinics
- Hospital clinics
- Drug treatment facilities
- TB clinics
- A doctor’s office
If a person has his or her own healthcare provider, he or she may feel more comfortable with the staff who will counsel and offer testing. If the center can provide immune system monitoring and medical care to people infected with HIV, it might speed up the beginning of medical treatment.
Some counseling and testing centers offer special features. For instance, drug users can receive counseling, testing, and help for addiction at a drug treatment facility.
Need To Know: Keeping The Results Confidential At some centers, such as doctor’s offices or clinics, information about the test result may become part of a patient’s medical record and may be seen by healthcare workers, insurers, or employers. The insurance company may know the patient’s HIV status if he or she makes a claim for health insurance benefits or applies for life insurance or disability insurance. Ask the testing counselor how they will protect the test results. Most counseling and testing centers follow one of two policies:
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Some Things Not To Do
Do not go to a hospital emergency room to be counseled and tested. People should go to an emergency room only if they have a health problem that demands urgent attention.
Do not give blood at a blood donation center as a way to get tested for HIV
After Taking The Test
The waiting period between taking the test and learning the results can produce anxiety and tension. Some people decide during this time that they do not want to know their test result and never return to receive it. It is very important that everyone who is tested finishes the process and finds out the test result in spite of their anxiety.
It is also important that people waiting for results act as if they were infected and could transmit the
- Do not have unprotected sex
- Do not have sex at all
- Do not share needles
- Do not share razor blades or toothbrushes
- Do not donate blood or organs
Here is what to expect after the test result comes in:
- The counselor should inform you of the result and – regardless of whether it is positive or negative – how to protect your health and the health of others. He or she will review methods to prevent the spread of HIV.
- If the result is negative, the counselor may discuss retesting if, during the six months before the test, you engaged in any behaviors that might have infected you. Infection may be present but the body may not yet have produced enough antibodies for the test to detect. Since it takes time for the body to develop antibodies, you may need to be retested.
- If the test is positive, the counselor will tell you what this means. Any questions you have should be answered and the counselor will refer you for follow-up health care, support services, or further counseling. The counselor will also discuss telling sex partner(s) and/or drug-using partner(s).
HIV Testing: Frequently Asked Questions
Here are some frequently asked questions related to HIV and AIDS:
Q: Is infection with HIV the same thing as AIDS?
A: Infection with HIV means the person has been infected with the
Q: My neighbor is HIV-positive. Is it okay to visit him? Can I hug him?
A: HIV is spread primarily through blood, blood products, semen, and vaginal fluids – not casual contact such as hugging, or sharing utensils, towels or a toilet. You do not need to fear getting HIV by having casual contact with someone with the disease.
Q: I’ve been diagnosed with HIV but I don’t want to go to a doctor since I don’t think anyone can help me.
A: It’s true that modern medicine cannot make the HIV infection go away. However, there is much that can be done to help people with HIV, especially early on. Regular medical monitoring can track how you are doing and new medications can slow the progression of the disease. Vaccines can prevent you from developing diseases like pneumonia. There are counselors and support groups available to help. Remember, you are not alone.
Q: I am interested in a career in nursing but am afraid of getting infected with HIV. Are there precautions?
A: For more than a decade, the healthcare profession has adopted universal precautions that protect healthcare workers. These include wearing gloves and protective goggles when there is risk of exposure to blood and body fluids, properly using and disposing of needles and syringes and other safety measures. While there are still cases of people being accidentally stuck with needles, these efforts have greatly reduced the chances of being infected with HIV and other blood-borne illnesses, such as hepatitis. If you have concerns, talk to a person working in the field.
Q: I think I might have HIV but I’m worried other people will find out if I get tested. What should I do?
A: HIV tests can either be anonymous or confidential. In a confidential test, if the result is positive, the data will be shared with the state but your name will not be shared unless you give permission. In an anonymous test, no one knows your name. To find out if your state has anonymous testing, call the National AIDS Hotline (800-342-AIDS, or 800-342-2437).
HIV Testing: Putting It All Together
Here is a summary of the important facts and information related to HIV testing and counseling:
- When a person is infected with HIV, it may be several weeks before the person tests positive for HIV. That’s because it takes time to develop
antibodies to HIV, which is what the tests check for. - The most commonly used tests for HIV are the EIA and ELISA blood tests. While these tests take several days, a rapid test is now more commonly used.
- Any positive EIA or ELISA test result will be repeated and then confirmed with the
Western blot test before a person is told he or she is HIV positive. - The number of women infected with HIV is growing both in the U.S. and worldwide.
- HIV is spread through blood, blood products, semen, and vaginal fluids. It is NOT spread through casual contact, such as holding hands, hugging, coughing or sharing towels or bedding.
- Nearly one million people in the U.S. have HIV or
AIDS . Ninety five percent of new cases are in developing countries that are ill equipped to care for AIDS patients. - There is no cure for AIDS but several new medications can help delay the onset of AIDS and prevent infections. It may take several years for someone with HIV to develop AIDS.
- Anyone considering HIV testing should assess their lifestyle and risk factors that put them at increased risk for HIV.
- Testing for HIV should include counseling before and after the test.
HIV Testing: Glossary
Here are definitions of medical terms related to HIV and AIDS:
AIDS: Acquired immunodeficiency (or immune deficiency) syndrome, an advanced stage of a viral infection caused by the human immunodeficiency virus (HIV).
Antibodies: Proteins produced by the immune system to fight infectious agents, such as viruses.
Antigen: A substance that stimulates the production of antibodies.
AZT: An antiretroviral drug used to treat HIV infection; also called zidovudine.
CDC: Centers for Disease Control and Prevention, which is part of the U.S. federal government and focuses on preventing, researching, and treating communicable diseases, such as AIDS, tuberculosis and influenza.
CD4: A protein displayed on the surface of a certain human immune cells. HIV recognizes, attaches to, and infects cells bearing CD4 on their surface.
Condom: A sheath, usually made of latex, designed to cover the penis during sexual intercourse to help prevent pregnancy and reduce the risk of sexually transmitted diseases, including HIV.
Dental dams: Squares of latex, originally used for dental work, now commonly recommended for safe oral sex.
Enzyme immunoassay (EIA): A test used to detect HIV antibodies in a blood sample.
Enzyme-linked immunosorbent assay (ELISA): A test used to detect HIV antibodies in a blood sample.
Injection drugs: Drugs including heroin or morphine that are injected through a syringe and needle into a vein.
Opportunistic infections: Infections (rarely seen in healthy people) that that occur when a person’s immune system is weakened due to HIV, cancer, or drugs that suppress the body’s immune response.
Sexually transmitted diseases (STDs): Diseases caused by infectious agents that are transmitted through sexual contact, such as HIV/AIDS, chlamydia infection, syphilis, and gonorrhea.
Spermicide: A substance that deactivates sperm cells and is used for birth control.
Transfusion: The injection of whole blood, plasma, or another solution into a patient’s bloodstream.
Virus: A disease-causing microbe that can replicate only in the living cells of other organisms.
Western blot: A test used to diagnose HIV infection by detecting antibodies to HIV in a person’s blood; this test is commonly used to confirm a less-sensitive HIV antibody test.
HIV Testing: Additional Sources Of Information
Here are some reliable sources that can provide more information on HIV and AIDS:
The U.S. Centers for Disease Control and Prevention
1-800-311-3435
U.S. National Library of Medicine MedlinePlus
http://www.nlm.nih.gov/medlineplus/aids.html
FDA List of Licensed and Approved HIV Tests
http://www.fda.gov/cber/products/testkits.htm
AIDS.org
National AIDS Hotline operated by the Centers for Disease Control and Prevention
1-800-342-AIDS
1-800-344-SIDA (for Spanish)
1-800-AIDS-889 (TTY)
Centers for Disease Control AIDS Clearinghouse
1-800-458-5231
HIV/AIDS Treatment Information Service
1-800-HIV-0440
1-800-243-7012 (TDD/Deaf Access)