Window Period Post From HIV InSite - TheBody.com's Bulletin Boards

this was a response to a question about the conflicting answers one might get about the window. answered by the hiv prevention editor at HIV InSite. good site bytheway.

There are several problems I've had in answering this question to people's satisfaction, including my own.

1. In analyzing the probability of HIV transmission, it is not a good idea to make blanket statements such as everyone should test "x" months after possible exposure. I am guilty of this myself in saying that 3 months is conservative. There are simply too many factors involved and each situation needs to be analyzed on a case-by-case basis. I have since changed my mind about my three month statement, and have changed the text of the answer. More about this below.

Because there are so many factors, if I were speaking to someone face to face about whether they should retest and when, I would ask them a lot of questions about the particular incident that has put them at risk. Based on that, I would recommend a window period. If there was very little risk in the first place, then the chances of the person being infected are very small and the chance of having a long window period on top of that makes this so improbable that I would recommend a three month window period. If there was more risk, then I would recommend a longer window period.

Therefore in your case, from what you describe, being sucked by a woman and you had no sores on your penis, there is simply no risk, so I would not only agree with the GMHC, I would even say you did not need to be tested at all. I would, however, understand if you wanted to test anyway to help ease your anxieties, as long as you realize that there is no clinical basis for testing. If I was your counselor, which I am not, I would also try to see if there was anything about this particular woman that is causing you to worry.

In my experience working with clients, I realize that very little of testing is really about risk of transmission per se. For many people, not necessarily you, the test is a cleansing ritual, a modern form of the confessional in which people seek reassurance, guidance, and a sort of serological "absolution" for their transgressions. I try to explain this to clients who may be exaggerating their risk from a clinical standpoint, but have a lot of anxiety about AIDS nonetheless. I think hotlines focus too much on clinical issues such as transmission and too little on the relational and emotional context of AIDS related anxieties

2. There is important data on the window period that has not yet been published. Since it hasn't been published, I have to rely on the words of experts. I spoke to two researchers, Michael Busch and Glenn Satten about a cohort of 50 health care workers who had occupational infections. They described the results to me and I included these in my latest version of the window period question. This study has a very small sample and it's hard to compare occupational to sexual exposure since the mode of transmission is very different.

These researchers had some pretty scary things to say about the window period for two of the 50 people. While 48 people took an average of 46 days, for two it took longer than six months, They speculate that HIV can "hide" in lymph tissue near the point of entry, so that the infection is sort of latent in rare cases. A needle stick into a finger is very different than sexual exposure along a mucous membrane, so I don't know how relevant this is to exposure through sexual contact. However, they suggest that to be absolutely sure, a health care worker should get tested one year after exposure just to be sure. This information has caused me to think that, depending on the risk involved in a particular situation, the window period may be up to one year. Because longer window periods appear to be so rare, a three month test is very close in accuracy to a six month test. So for most people who have sexual risk, a three month window period is still adequate. The costs and benefits of waiting longer than threee months before testing or retesting at six months have to be weighed on an individual, case-by-case basis.

3. As a counselor who has counseled thousands of clients (in an actual clinic setting, not on the web), I've seen many people agonize over what I think is a very minor or non-existent risk. These clients are dealing with ethical or moral ambivalence over their behavior by projecting their anxieties onto HIV risk. As a result of this projection, I've seen many people develop a dependence on testing that can become compulsive. For example some people are never satisfied with a negative result even after years of testing. Confusion about the length of the window period feeds this anxiety and I hate to think that, in my attempt to help people, I may have added to the confusion myself.

Because there is some uncertainty about the window period, it is best to be cautious and recommend a fairly long window period. This may be why the CDC is holding to its guns at six months. The New York State Department of Health may be advocating three month window periods for reasons other than what is known scientifically about the length of the window period (which isn't much). For example, getting people tested and into services as soon as possible may be preferable than having everyone wait until six months after exposure. In places where there is a large incidence of HIV, it makes sense to promote more frequent testing. In areas with a lower incidences of HIV infection, there may be too little money to promote testing when the likelihood of finding a positive result is so small. So even policy and public health concerns can influence who says what about the length window period.

The need to be cautious about the length of the window period has to be balanced against the knowledge that this will prolong people's uncertainty and cause them to experience a sort of serological "limbo status." I want to be cautious, yet I don't want people to get tested unnecessarily or to add to their anxieties. If you tell someone to test at three months when you know they have little risk and they will probably want to test at six months anyway, then you will have caused someone to test twice without relieving their anxiety until the second test. This may sound paternalistic, but my motivation in telling people this is based on my experience as a counselor and seeing the suffering of people in the window period. These experiences necessarily influence my interpretation of the scarce scientific data on this issue.

Finally, the improvement in ELISA tests occured around 1989.

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