HIV Counseling and Testing: Facts, Issues, and Answers
New Choices: HIV and AIDS Medical Care Offers Vital Benefits
There are clear benefits to early medical attention for infection with the human immunodeficiency virus (HIV), the virus that causes acquired immunodeficiency syndrome (AIDS).
If you are infected with HIV, the virus slowly weakens your ability to fight illness. But medical treatments, including medicines and earlier use of medications, can help your body resist the virus. They do this by slowing the growth of HIV and delaying or preventing certain life-threatening conditions.
For example, some medicines can prevent the type of pneumonia that is a common problem for people who have HIV or AIDS. Doctors can also find out when your immune system begins to weaken. By evaluating your immune system on a regular basis and vaccinating you against bacterial pneumonia and influenza, doctors can help you avoid illnesses related to HIV infection and treat them more effectively when they occur. Without the help of medical care your body may develop serious illnesses more quickly. For pregnant women, medical treatment with AZT (zidovudine) may reduce the chances of your baby being infected with HIV.
It is important that you consider these medical options as you decide whether to seek counseling and testing for HIV infection. Deciding whether to seek counseling and testing can be very hard. Your choice can have a major impact on your life. Medical options have increased the benefits of counseling and testing. This brochure gives you the information you need to understand these benefits and consider them with other issues important to you. Use this brochure to make the choice that is right for you.
What Is HIV, and How Do I Become Infected?
HIV, the human immunodeficiency virus, is the virus that causes AIDS. HIV is mainly transmitted by contact with the blood, semen, or vaginal fluids of infected people. The HIV-infected person can infect others, even if no symptoms are present.
HIV is transmitted by:
What Happens If I Become Infected With HIV?
Being infected with HIV does not always mean you have AIDS. Being infected means the virus in your body for the rest of your life. Therefore, you can infect others if you engage in behaviors that can transmit HIV. You can infect others even if you feel fine and no symptoms of illness are present. You can infect others even if you do not know you are infected.
HIV weakens your body's immune system. This means that HIV infection can make your body more and more vulnerable to other illnesses and infections over time. Early symptoms may include tiredness, fever, diarrhea, enlarged lymph nodes, loss of appetite, or night sweats. People with HIV infection can develop many different health problems. These include severe pneumonia, several forms of cancer, damage to the brain and nervous system, and extreme weight loss. These conditions signal the onset of AIDS, the most serious stage of HIV infection. Virtually all people with HIV infection will develop AIDS, but, with treatment, the HIV infection can usually be slowed and the onset of AIDS can be delayed.
How fast does HIV infection develop into AIDS? In some people, AIDS-related illnesses may develop within a few years. Without treatment, half of HIV infected people will develop an AIDS-related illness within 10 years. To stay healthy for as long as possible, it is important to learn your HIV status, obtain medical advice, monitor your health, and consider your treatment options.
The Best Way To Know Whether You Are Infected: HIV-Antibody Counseling and Testing
You cannot tell by looking at someone whether he or she has HIV infection. Someone can look and feel perfectly healthy and still be infected. Many people who have HIV infections do not know it. Neither do their sex partners.
The HIV-antibody test is the only way to tell whether your are infected. When any virus enters your body, your immune system responds by making proteins called antibodies. Different viruses cause the body to make different antibodies. You make antibodies to HIV when you have HIV infection. The HIV-antibody test detects HIV antibodies in your blood. It tells you whether you are infected with HIV. The test does not tell you if you have AIDS or when you will get AIDS. HIV antibodies are a sign of infection, but, unlike antibodies for many other infections, they do not protect your body from disease. They do not protect you from AIDS, do not make your immune, and do not prevent you from giving HIV to someone else.
The HIV-antibody test should always include before-test and after-test counseling. This counseling is to help you understand your result, how to protect your own health, and (if you are infected) how to keep from infecting other people. It is a central part of the testing process whether you are infected or not.
Should I Seek HIV Counseling and Testing?
If you have engaged in behavior that can transmit HIV, it is very important that you consider counseling and testing. The following checklist will help you assess your degree of risk.
There is evidence that HIV, the virus that causes AIDS, has been in the United States at least since 1978. The following are known risk factors for HIV infection. If you answer yes to any of these questions, you should definitely seek counseling and testing. You may be at increased risk of infection if any of the following apply to you since 1978.
If you have had sex with someone and you didn't know their risk behavior, or you have had many sex partners, then you have increased the chances that you might be HIV infected. If you plan to become pregnant, counseling and testing is even more important. Without treatment, HIV-infected women have about a one-in-four chance of infecting their baby during pregnancy or delivery. Medical treatment can reduce this to about a 1 in 12 chance.
Reasons For Seeking Counseling and Testing
People consider counseling and testing for a number of reasons, some of which may apply to you:
Reasons For Not Seeking Counseling and Testing
People may not seek counseling and testing for a number of reasons. For instance, if they are certain they have never engaged in behavior that could infect them with HIV, or had a blood transfusion, they do not need to be counseled and tested. Other reasons are less clear-cut. For instance, they think the stress of a positive test result -- and the issues it would raise among family members, friends, and sex partners -- would be more harmful than not knowing if they are infected. Perhaps they fear that others may find out their result without their permission. They might also be concerned about discrimination; some people have been denied housing, jobs and insurance because they have HIV infection.
Many people are troubled by these concerns. You should decide for yourself whether these concerns outweigh the benefits of testing and early medical attention. The latest medical knowledge gives added weight to the benefits of knowing if you are infected. If you have any doubts about what you should do, get counseling. Then you can decide whether to go ahead with testing. However, if you decide NOT to be tested you should prevent the transmission of any possible HIV in your body to sex or needle-sharing partners.
Understanding the HIV Counseling and Testing Process
It is very important that you understand the confidentiality policies of the testing center. Ask your testing counselor how they will protect your test results. Most counseling and testing centers follow one of two policies:
If you wish to be tested, ask your health department, doctor, or the CDC National AIDS Hotline (1-800-342-AIDS) about the location of facilities near you.
Deciding Where To Go For Counseling and Testing
Depending 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, and your doctor's office. In making your choice, you may want to consider these factors:
At some centers, such as doctor's offices or clinics, information about your test result may become part of your medical record and may be seen by healthcare workers, insurers, or employers. Your status may become known to your insurance company if you make a claim for health insurance benefits or apply for life insurance or disability insurance. If any health care provider proposes to test you for HIV antibodies, discuss the reasons and the potential benefits before deciding whether or not to take the test.
You can call the CDC National AIDS Hotline (1-800-342-AIDS) to get the address of places where you can get counseling and testing. Do not go to a hospital emergency room to be counseled and tested. You should go to an emergency room only if you have a health problem that demands urgent attention. Also, do not give blood at a blood donation center as a way to get tested for HIV antibodies. Blood donation centers are not HIV-antibody counseling and testing centers and should not be used as such.
The Process Of Counseling and Testing
You should be given materials to read before you enter a group or private session with a counselor or doctor. He or she might ask why you want to be tested. Your counselor should also ask about your behavior and that of your sex partner(s). This will help your counselor and you to determine whether testing is appropriate for you. If testing is appropriate, your counselor or doctor should:
If these questions are not covered, or if you have any other questions, ask them. You should come prepared with questions that have been on your mind. Also ask your doctor or counselor how you will be told of the test result. If your test result is negative, the post-test counselor will talk to you about how to avoid behaviors that will put you at risk.
You have the right to refuse any medical procedure, to be fully informed about it, and to agree to it. You should be asked to read a statement saying that you have been informed about the HIV-antibody testing procedure, you understand it, and you consent to have it done.
The Blood Test
A small amount of blood will be drawn from your arm, taken to a lab, and tested. The time it takes to get results back varies in different areas. It can take anywhere from a few days to a few weeks.
The Waiting Period
This period of days or weeks 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 you finish the process and find out the test result in spite of your anxiety.
It is also important that until you return for your result and post-test counseling you act as if you were infected and could transmit the virus. In other works, don't have unprotected sex or don't have sex at all and don't share needles.
When your result arrives, you may be asked to return to the counseling and testing center to receive the information in person. Everyone tested should receive counseling, whether the result is positive or negative.
Counseling After the Test
Your counselor should tell you your 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 your result is negative, your counselor may discuss retesting if, during the 6 months before your test, you engaged in any behaviors that might have infected you. You may be infected but your body may not yet have produced enough antibodies for the test to detect. Since it takes time for your body to develop antibodies, you may need to be retested.
If your test is positive, your counselor will tell you what this means for you. Any questions you have should be answered and your counselor will refer you for follow-up health care, support services, or further counseling. Your counselor will also talk to you about telling your sex and/or drug-using partner(s).
Type Of Tests
The ELISA (Enzyme-Linked Immunosorbent Assay) is a screening test that is widely used. It can be performed relatively quickly and easily. If a reactive (so called "positive") result occurs, the test is repeated to check it.
If an ELISA test yields two or more reactive results, a different test such as the Western blot is used to confirm these results as positive for HIV antibodies. The Western blot is more specific and takes longer to perform than the ELISA. Together, the two tests are more than 99.9 percent accurate. Further evaluation can be done if results of repeated ELISA and Western blot tests are unclear. Your testing facility should do the ELISA twice on the same blood sample and confirming test such as the Western blot if the ELISA tests are repeatedly reactive.
The Meaning Of Your Test Result
A negative result means that no HIV antibodies were found in your blood. Your condition is called seronegative. This usually means you are not infected.
Testing negative does not mean you are immune to HIV. No one is immune to HIV. Even if you test negative, there are steps you should take to protect your health and the health of your sex and/or drug-using partner(s). Do not engage in behaviors that can transmit HIV. These behaviors include having sexual intercourse with an infected person or sharing needles or syringes with an infected person. Your post-test counselor will discuss these behaviors with you.
There is a small chance that you may be infected, even though you tested negative. It takes time for the body to develop HIV antibodies after infection. Almost all people develop HIV antibodies within 3 months, but it can take up to 6 months after infection for some persons. If you engaged in behavior that can transmit the virus during the 6 months just before your test, you may be infected but still test negative because your body may not yet have produced antibodies. To be sure, you must be retested at least 6 months after you last engaged in behavior that can transmit HIV.
Once in a while, test results are unclear. The lab cannot tell whether they are positive or negative, even if the test has been performed correctly. If this happens to you, it is important that you discuss this with your counselor or doctor, and, if appropriate, be tested again. 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. If you do test positive, you should discuss with your counselor or doctor whether retesting a new blood sample is appropriate.
A positive result means antibodies to HIV were found in your blood. This means you have HIV infection. Your condition is called HIV-positive, or seropositive. You will most likely develop AIDS, but no one can know when you will get sick. Within 10 years after infection, about half of untreated people have developed AIDS. However, prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions.
If your test result is positive, there are a number of important steps you should take immediately to protect your health.
You should take steps to protect the health of others:
You should tell anyone with whom you have had unprotected sex (vaginal, anal or oral) or shared needles since 1978 that you are (and they may be) infected with HIV. It is especially important that you tell current and recent partners. Health professionals can tell your sex and/or drug-using partner(s) for your or help you tell them yourself. All of your present and past partners should be referred for counseling and testing. If they are HIV positive, prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. Also, they may unknowingly infect others. You have an important role to play in helping stop the spread of HIV infection.
Telling people about your test result can be a very sensitive matter. You may want to discuss it with your testing counselor. They can assist you in telling your sex or drug-using partners If you choose to tell your partners yourself, do not make accusations. Be prepared for partners to become upset or hostile. Urge them to be counseled and tested as soon as possible. You may want to give them a copy of this brochure.
Being infected with HIV is not only a health matter. It raises financial and social issues as well. One of these issues is insurance. These issues should be discussed with a qualified counselor. Your ability to pay for health care can effect your access to monitoring and treatment. If you do not have health insurance or if you depend upon Medicaid, you may need special assistance to get treatment. As of 1994, four drugs that act to slow HIV have been approved for use in the United States. More drugs are being tested. To find out about experimental treatments, call the AIDS Clinical Trials Information Service (1-800-TRIALS-A, that is, 1-800-874- 2572), Monday through Friday between 9 a.m. and 7 p.m. Eastern time. Centers that offer experimental drug treatments for AIDS- related illnesses may not be available everywhere. Some people who do not understand AIDS may avoid persons who they know are infected with HIV. Some people who are infected have been targets of discrimination in employment, housing and insurance. Some have been deeply hurt by the reactions of friends and family members. You should be prepared to encounter uncomfortable reactions and to deal with these issues. However, the Americans with Disabilities Act (ADA) can protect you from many forms of discrimination, especially on the job, having a place to live, and getting services available to the public. Here are answers to some questions you may have about HIV- antibody counseling and testing. Part of the America Responds to AIDS brochure series, this brochure has been prepared by the Centers for Disease Control and Prevention, U.S. Public Health Service. The Centers for Disease Control and Prevention is the Federal agency responsible for the prevention and control of diseases, including AIDS, in the United States. U.S. Department of Health and Human Services
Being infected with HIV is not only a health matter. It raises financial and social issues as well. One of these issues is insurance. These issues should be discussed with a qualified counselor.
Your ability to pay for health care can effect your access to monitoring and treatment. If you do not have health insurance or if you depend upon Medicaid, you may need special assistance to get treatment.
As of 1994, four drugs that act to slow HIV have been approved for use in the United States. More drugs are being tested. To find out about experimental treatments, call the AIDS Clinical Trials Information Service (1-800-TRIALS-A, that is, 1-800-874- 2572), Monday through Friday between 9 a.m. and 7 p.m. Eastern time. Centers that offer experimental drug treatments for AIDS- related illnesses may not be available everywhere.
Some people who do not understand AIDS may avoid persons who they know are infected with HIV. Some people who are infected have been targets of discrimination in employment, housing and insurance. Some have been deeply hurt by the reactions of friends and family members. You should be prepared to encounter uncomfortable reactions and to deal with these issues. However, the Americans with Disabilities Act (ADA) can protect you from many forms of discrimination, especially on the job, having a place to live, and getting services available to the public.
Here are answers to some questions you may have about HIV- antibody counseling and testing.
Part of the America Responds to AIDS brochure series, this brochure has been prepared by the Centers for Disease Control and Prevention, U.S. Public Health Service. The Centers for Disease Control and Prevention is the Federal agency responsible for the prevention and control of diseases, including AIDS, in the United States.
U.S. Department of Health and Human Services
This article was provided by U.S. Centers for Disease Control and Prevention. Visit the CDC's website to find out more about their activities, publications and services.