scarred about this
02/24/02 09:41 PM
hree or six months? A follow-up question on the window period.
Answered ny Nicolas Sheon, HIV InSite Prevention Editor
I had received oral sex from a woman and was concerned about hiv. I didn't notice any open sores on my penis
or cuts. The other thing I was confused about is the window period for hiv to show up. I had a Elisa test done at
3 months, it was negative. The GMHC (gay mens health crisis) in NYC say 3 months is long enough. But the
CDC says no way, 6 months. So the GMHC sent to me a 2 page paper that was sent to the NY state Dept. of
health. Itsaid two astounding things. 1) The Elisa test is more sensitive then it used to me and pick up hiv
For example, most antibodies show up within 4-6 weeks. And it goes on to say that if a person tests negative at
3 months then no further tests are needed. Anyway, in your web site, you counsel to your clients 3 months. Why
is that? You go on to say that 3 months is conservative, why is that? You also acknowledged that other
organizations still say 6 months. I'm sorry but I think this is wrong for the public. If a person here and there show
up positive after 3 months then I beleive the window should be possibly 5 or 6 months. Again why would your
HIV help desk tell people 3 months?? Do you really think that 3 months is anything but conservative. One final
question, do you agree with the NYS dept. of health? That at 3 months, virtually all will have detectable
antibodies? And why do others not change their policy. Thank You very much for your response.
I am sorry about any inconsistencies in my web postings regarding the length of the window period. The reason
for this is that my own understanding of this issue is still evolving as I learn more about the data on this issue. I
have revised the web posting for the question several times to reflect my current understanding. If I have to
choose between being inconsistent versus being dogmatic, I'd rather be inconsistent.
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,
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.
I have a question about this, these doctors speculated that HIV could hide in lymph tissue thus causing delayed seroconversion. If this happened then one wouldent show symptoms because HIV hasnt exactly infected the body yet, so if one is worried about symptoms then they shouldent be worried about HIV being dormant in there body? AM I right on this? Im scarred about an oral sex ecounter and worried because it this says that possibly HIV can hide in lymph tissue located near point of entry which would be my neck nodes. Any thoughts on this?
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