June 26, 2014
Getting an HIV test is the only way to know if you have HIV. This section answers some of the most common questions related to HIV testing, including the types of tests available, where to get one, and what to expect when you go to get tested.
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CDC recommends that health care providers test everyone between the ages of 13 and 64 at least once as part of routine health care. One in six people in the United States who have HIV do not know they are infected.
Behaviors that put you at risk for HIV include having vaginal or anal sex without a condom or without being on medicines that prevent or treat HIV, or sharing injection drug equipment with someone who has HIV. If you answer yes to any of the following questions, you should definitely get an HIV test:
If you continue having unsafe sex or sharing injection drug equipment, you should get tested at least once a year. Sexually active gay and bisexual men may benefit from more frequent testing (e.g., every 3 to 6 months).
You should also get tested if
Getting tested can give you some important information and can help keep you -- and others -- safe. For example,
Some people who test positive for HIV were not aware of their risk. That's why CDC recommends that providers in all health care settings make HIV testing a routine part of medical care for patients aged 13 to 64, unless the patient declines (opts out). This practice would get more people tested and help reduce the stigma around testing.
Even if you have been in a long-term relationship with one person, you should find out for sure whether you or your partner has HIV. If you are both HIV-negative and you both stay faithful (monogamous) and do not have other risks for HIV infection, then you probably won't need another HIV test unless your situation changes.
HIV testing during each pregnancy is important because, if your result is positive, treatment can improve your health and greatly lower the chance that you will pass HIV to your infant before, during, or after birth. The treatment is most effective for preventing HIV transmission to babies when started as early as possible during pregnancy. However, there are still great health benefits to beginning preventive treatment even during labor or shortly after the baby is born.
CDC recommends that health care providers screen all pregnant women for HIV, talk to them about HIV or give them written materials, and, for women with risk factors, provide referrals to prevention counseling.
Screening all pregnant women for HIV, and giving them the right medical care, helped decrease the number of babies born with HIV from a high of 1,650 in 1991 to 127 in 2011.
The immune system usually takes 3 to 8 weeks to make antibodies against HIV, but tests differ in how early they are able to detect antibodies. Although most HIV tests look for these antibodies, some look for the virus itself. The period after infection but before the test becomes positive is called the window period.
Deciding when to get tested therefore depends on when you may have been exposed and which test is used. You can ask your health care provider about the window period for the HIV test you are taking. If you are using a home test, you can get that information from the materials included in the packaging of the test.
A few people will have a longer window period, so if you get a negative antibody test result in the first 3 months after possible exposure, you should get a repeat test after 3 months. Ninety-seven percent of people will develop antibodies in the first 3 months after they are infected. In very rare cases, it can take up to 6 months to develop antibodies to HIV.
You can ask your health care provider for an HIV test. Many medical clinics, substance abuse programs, community health centers, and hospitals offer them, too. You can also
The most common HIV test is the antibody screening test (immunoassay), which tests for the antibodies that your body makes against HIV. The immunoassay may be conducted in a lab or as a rapid test at the testing site. It may be performed on blood or oral fluid (not saliva). Because the level of antibody in oral fluid is lower than it is in blood, blood tests tend to find infection sooner after exposure than do oral fluid tests. In addition, most blood-based lab tests find infection sooner after exposure than rapid HIV tests.
Several tests are being used more commonly that can detect both antibodies and antigen (part of the virus itself). These tests can find recent infection earlier than tests that detect only antibodies. These antigen/antibody combination tests can find HIV as soon as 3 weeks after exposure to the virus, but they are only available for testing blood, not oral fluid.
The rapid test is an immunoassay used for screening, and it produces quick results, in 30 minutes or less. Rapid tests use blood or oral fluid to look for antibodies to HIV. If an immunoassay (lab test or rapid test) is conducted during the window period (i.e., the period after exposure but before the test can find antibodies), the test may not find antibodies and may give a false-negative result. All immunoassays that are positive need a follow-up test to confirm the result.
Follow-up diagnostic testing is performed if the first immunoassay result is positive. Follow-up tests include: an antibody differentiation test, which distinguishes HIV-1 from HIV-2; an HIV-1 nucleic acid test, which looks for virus directly, or the Western blot or indirect immunofluorescence assay, which detect antibodies.
Immunoassays are generally very accurate, but follow-up testing allows you and your health care provider to be sure the diagnosis is right. If your first test is a rapid test, and it is positive, you will be directed to a medical setting to get follow-up testing. If your first test is a lab test, and it is positive, the lab will conduct follow-up testing, usually on the same blood specimen as the first test.
Currently there are only two home HIV tests: the Home Access HIV-1 Test System and the OraQuick In-home HIV test. If you buy your home test online make sure the HIV test is FDA-approved.
The Home Access HIV-1 Test System is a home collection kit, which involves pricking your finger to collect a blood sample, sending the sample to a licensed laboratory, and then calling in for results as early as the next business day. This test is anonymous. If the test is positive, a follow-up test is performed right away, and the results include the follow-up test. The manufacturer provides confidential counseling and referral to treatment. The tests conducted on the blood sample collected at home find infection later after infection than most lab-based tests using blood from a vein, but earlier than tests conducted with oral fluid.
The OraQuick In-Home HIV Test provides rapid results in the home. The testing procedure involves swabbing your mouth for an oral fluid sample and using a kit to test it. Results are available in 20 minutes. If you test positive, you will need a follow-up test. The manufacturer provides confidential counseling and referral to follow-up testing sites. Because the level of antibody in oral fluid is lower than it is in blood, oral fluid tests find infection later after exposure than do blood tests. Up to 1 in 12 people may test false-negative with this test.
RNA tests detect the virus directly (instead of the antibodies to HIV) and thus can detect HIV at about 10 days after infection -- as soon as it appears in the bloodstream, before antibodies develop. These tests cost more than antibody tests and are generally not used as a screening test, although your doctor may order one as a follow-up test, after a positive antibody test, or as part of a clinical workup.
When it's time to take the test, a health care provider will take your sample (blood or oral fluid) and you may be able to wait for the results (if it's a rapid HIV test). If the test comes back negative, and you haven't had an exposure for 3 months, you can be confident you're not infected with HIV.
If your test comes back positive, you will need to get a follow-up test, which the testing site will arrange.
Your health care provider or counselor may talk with you about your risk factors, answer questions about your general health, and discuss next steps with you, especially if your result is positive.
See "Will Other People Know My Test Result?" below.
A negative result does not necessarily mean that you don't have HIV. That's because of the window period -- the period after you may have been exposed to HIV but before a test can detect it. The window period depends on the kind of test that was used on your blood or oral fluid. For antibody tests, if you get a negative result within 3 months of your most recent possible exposure, you need to get tested again at the 3-month mark. For RNA tests or antibody/antigen tests, that timeframe may be shorter. Ask your health care provider if and when you need to be retested with a negative test result. And meanwhile, practice abstinence or mutual monogamy with a trusted partner, use condoms every time you have sex (and for every sex act -- anal, oral, or vaginal), and don't share needles and other drug equipment (works).
No. Your HIV test result reveals only your HIV status. HIV is not necessarily transmitted every time you have sex. Therefore, taking an HIV test is not a way to find out if your partner is infected. Ask your partner if he or she has been tested for HIV and about his or her risk behaviors, both now and in the past. Consider getting tested together, often referred to as couples testing.
If you had a rapid screening test, the testing site will arrange a follow-up test to make sure the screening test result was correct. If your blood was tested in a lab, the lab will conduct a follow-up test on the same sample. If the follow-up test is also positive, it means you are HIV-positive.
The sooner you take steps to protect your health, the better. Early treatment with antiretroviral drugs and a healthy lifestyle can help you stay well. Prompt medical care prevents the onset of AIDS and some life-threatening conditions.
Here are some important steps you can take right away to protect your health:
To avoid giving HIV to anyone else,
No. Being HIV-positive does not mean you have AIDS. AIDS is the most advanced stage of HIV disease. Proper treatment can keep you from developing AIDS.
See Basic Information About HIV and AIDS for more information.
Your test results are protected by state and federal privacy laws. They can only be released with your permission. Whether anyone can know about your test results or your HIV status depends on what kind of test you take: confidential or anonymous. Some states only offer confidential testing.
With confidential testing, if you test positive for HIV or another STI, the test result and your name will be reported to the state or local health department to help public health officials get better estimates of the rates of HIV in the state. The state health department will then remove all personal information about you (name, address, etc.) and share the remaining non-identifying information with CDC. CDC does not share this information with anyone else, including insurance companies.
For more information, see AIDS.gov's questions about Civil Rights, Legal Disclosure, Insurance, and the Workplace
Whether you share, or disclose, your status to others is your decision.
You can tell them yourself -- but if you're nervous about disclosing your test result, or you have been threatened or injured by your partner, you can ask your doctor or the local health department to tell them that they might have been exposed to HIV. Health departments do not reveal your name to your partners. They will only tell your partners that they have been exposed to HIV and should get tested.
Most states have laws that require you to tell your sexual partners if you are HIV-positive before you have sex (anal, vaginal, or oral) or share drugs. You can be charged with a crime in some states if you don't tell -- even if your partner doesn't become infected.
If you are under 18, however, some states allow your health care provider to tell your parent(s) that you received services for sexually transmitted infections, including HIV, if they think doing so is in your best interest. For more information, see the Guttmacher Institute's State Policies in Brief: Minors' Access to STI Services.
If you have health insurance through your employer, the insurance company cannot legally tell your employer that you have HIV. But it is possible that your employer could find out if the insurance company provides detailed information to your employer about the benefits it pays or the costs of insurance.
All people with HIV are covered under the Americans with Disabilities Act. This means that your employer cannot discriminate against you because of your HIV status as long as you can do your job. For more information, see AIDS.gov's Civil Rights.
HIV screening is covered by health insurance without a co-pay, as required by the Affordable Care Act. If you do not have medical insurance, there are places where you can get an HIV test at a reduced cost or for free. See "Where can I get tested?" above for more information.
If you have insurance, your insurer may pay for treatment. If you do not have insurance, or your insurer will not pay for treatment, government programs, such as Medicaid, Medicare, Ryan White Care Act treatment centers, and community health centers may be able to help if you meet their rules for eligibility (usually low income and/or disability). CDC is working with its federal partners to make sure that all people who need treatment can get it. Your health care provider or local public health department can direct you to HIV treatment programs.
See The Affordable Care Act Helps People Living With HIV/AIDS for more information.