HIV Testing

HIV Testing

Table of Contents

What Is an HIV Test?

An HIV test can tell you if you are infected with HIV, the virus that can cause AIDS. For some, getting tested for HIV can be scary. However, it can also be a very important way to say "yes" to your life and your health. The only way to know if you have HIV (to know your 'status') is to get tested. If you are worried because you think you may have been exposed to HIV, get tested. Then, if you learn that you are negative (not infected), you can stop worrying.

The bottom line -- it is important to know your HIV status and to get regular HIV tests. There are several types of HIV tests, which are described below.

Why and Whom to Test for HIV

Do you know your HIV status -- or your partner's HIV status? If not, it is important for you to get tested for HIV. Did you just have unprotected sex, use someone else's needle, have a condom break, or learn that a previous sexual partner is living with HIV (HIV+)? Are you pregnant or planning to become pregnant? These are also important reasons to get tested for HIV.

Getting tested for HIV is part of routine, regular health care in many countries. The Public Health Agency of Canada, for example, recommends that HIV testing be discussed as part of routine medical care. The US Centers for Disease Control and Prevention (CDC) now recommends testing all people ages 13 to 64, unless they have already been tested. It is also recommended that you get tested for HIV before beginning a new sexual relationship, regardless of your age. This is just as important for teens as it is for older adults.

The World Health Organization (WHO) makes different suggestions based on where you live. Where HIV is widespread, it recommends that HIV testing be offered to anyone who goes to a healthcare facility. Where HIV is less common, it suggests that HIV tests be offered to people who may be at higher risk of having been exposed to HIV.

Certain groups of people are considered at higher risk of HIV exposure and therefore should be tested for HIV at least once a year:

  • People who have multiple sexual partners or who have sex with someone who has multiple sexual partners
  • Sexual partners of people living with HIV
  • People who use injection drugs and their sexual partners
  • People who exchange money or goods for sex or drugs

It is also important to get tested for HIV when:

  • You are planning to become pregnant or learn you are pregnant
  • You seek treatment for a sexually transmitted infection or disease
  • You begin treatment for tuberculosis
  • You were born to a woman living with HIV

Where to Get Tested

There are many different types of places for you to get an HIV test. These include health clinics, private health care providers' offices, HIV testing centers, and health departments. There are also HIV tests you can order online or buy over-the-counter at stores that have pharmacies (e.g., CVS, Walgreens, Walmart). These tests are ones that allow you to collect a sample or complete a full rapid test (20 minutes) in the privacy of your home.

In the US, you can go to the National HIV and STD Testing Resources website or the website to find a testing site near you. You can also call the CDC's information line at 800-232-4636 or call your state's HIV/AIDS hotline (numbers listed here). To find services across the world, visit AIDSmap's e-atlas.

Which Test to Take and When to Take It

The type of test that is best for you depends on when you might have been exposed to HIV. Most tests, including rapid tests done at testing centers and rapid tests you can do at home, are tests that detect antibodies to HIV. Antibodies are proteins that your body makes to mark HIV for destruction by your immune system. The body takes one to three months and occasionally up to six months to develop antibodies to HIV. This three to six month period between getting HIV and the production of antibodies is called the "window period." Therefore, the results of tests that detect antibodies are only reliable one to three months after your exposure to HIV.

If your HIV test is negative in the window period you could still be infected with HIV. If you want to get tested before the window period has passed, there are tests that look for pieces of the virus itself. These pieces of the virus or viral particles are called antigens. If an HIV antigen is your blood, there are tests that can identify HIV infection as quickly as two weeks after exposure to HIV.

HIV Tests

There are a few tests to identify HIV. The first tests are screening tests. If the screening test is positive, a confirmatory test is done.

Screening Tests

Screening tests are used first. If an antibody screening test is negative for HIV and you are outside the window period, then you do not have HIV. If an antigen screening test is negative for HIV, then you do not have HIV. If your screening test comes back positive, you will need a second test to confirm or make certain that you are truly living with HIV.

Antibody Tests

Antibody tests are the most commonly used tests to screen for HIV. They look for the presence of antibody to the HIV virus in your blood, urine, or oral fluid (not your saliva). Antibodies are proteins that your body makes to mark a germ -- in this case the human immunodeficiency virus -- for destruction by your immune system. If you have been exposed to the HIV virus, your body will produce antibodies to HIV after three to six months. The period between infection and your body's production of HIV antibodies is called the "window period." Having a negative HIV antibody test after the window period means you are not infected with HIV.

There are several types of screening antibody tests:

  • Rapid HIV antibody test: uses blood or oral fluid; results are available in 20 minutes. The OraQuick in-home oral HIV test is now available online or over-the-counter for at-home use. Rapid HIV tests are also available in clinics and testing centers.

  • Home testing kit: is not so much a testing kit as a collection kit for use at home. It tells users how to put a drop of blood on a card that they then mail to a licensed laboratory. Some kits use an oral swab, which customers must swipe along their upper and lower gums to collect a sample. Customers have an identification number to use when calling the laboratory for results. The 'Home Access HIV-1 Test System' is one such test; it takes about a week to get results.

    It is important to know that at-home tests like the OraQuick and Home Access HIV-1 Test System do not provide in-person counseling or linkage to appropriate care and treatment for users who test positive for HIV.

  • Original blood tests: also called ‘third generation’ tests or enzyme immunoassay (EIA) tests, these tests look for antibodies. Results for an EIA can take up to two weeks. These tests are often no longer used where combined antibody-antigen tests are available.

Combined Antibody-Antigen Tests

Combined antibody-antigen tests (or 'fourth generation tests') combine antibody tests and antigen tests to screen for HIV. They are better at finding infection around three weeks while still preventing results that show a person is infected when they are not. Combined antibody-antigen tests are not rapid tests; they are processed in a laboratory.

Combined antibody-antigen tests use either blood or saliva, and are the recommended first-line test in the United Kingdom. New testing recommendations released by the CDC in June 2014 now list combined antibody-antigen tests as the first-line HIV test in the US as well.

Follow-Up or Confirmatory Tests

Any positive antibody or antibody-antigen test needs to be confirmed with a second test -- either another HIV antibody test or a test called the Western Blot.

  • HIV-1/HIV-2 antibody differentiation immunoassay: this test looks for antibodies in the blood; there are two versions that give results in an hour or less. It can tell if you have strain one (HIV-1) or strain two (HIV-2) of HIV, which can be important information for your provider to know when deciding what treatment is best for you. This test is now being used as the recommended second, or confirmatory test in the US.
  • Western blot: this test looks for antibodies in the blood

Viral Nucleic Acid Tests

These tests look for the presence of HIV's genetic material in the blood and can identify an HIV infection within two to three weeks of exposure. They are generally used in special circumstances, such as:

  • Babies born to mothers living with HIV: since babies carry their mother's antibodies in their blood for up to 18 months, traditional antibody tests would produce results that are not specific to the baby
  • Testing someone with a known recent exposure, before the HIV antibody can be identified in the blood
  • Testing people who have participated in an HIV vaccine trial: these people will already have HIV antibodies in their blood
  • Testing people for whom tests results have not been clear: for example, people who had a positive first test, and a negative second test (possibly because they were so recently infected)

Today's HIV drugs enable many people living with HIV to have long, healthy lives. Therefore, it is important for you to get proper care and treatment as soon as possible.

Getting Your Test and Its Results

If you have just been told you tested positive for HIV, it can feel like the worst news in the world. As upsetting as testing positive can be, you are better off knowing. Once you know you are living with HIV, you can take charge of your health and have the best chance to slow or prevent disease progression.

If you test positive for HIV, there are many things you can do to stay healthy. One important thing you can do is find a good health care provider. It is also important to begin taking HIV drugs, which will help keep your immune system healthy. The longer someone is living with HIV and does not receive treatment, the more likely she is to have a weakened immune system, and the harder the HIV drugs may have to work once she starts them. Learning about HIV and its treatment will help you make the best of your situation, as will setting up a support group or finding others who share your experience (see our community of women living with HIV at A Girl Like Me). For more information, see our Did You Just Test HIV+? article.

A person living with HIV who knows her status can also do things to protect the health of others. She can tell previous sexual partners that they might be at risk of HIV infection, practice safer sex to prevent spreading HIV, and take HIV treatment as prevention. In addition, if she is pregnant or wants to become pregnant, she can take steps to prevent her child from becoming infected. For more information, see The Well Project's articles on Pregnancy and HIV and Getting Pregnant and HIV.

Will People Find Out if I Test HIV+?

Laws about HIV confidentiality vary depending on the state and country in which you live. In the US, most states require that health care providers and testing clinics report the names of people living with HIV to that state's department of health. The state health department is required to keep that information confidential, and it is intended to help public health officials keep better track of the epidemic. Testing sites do not share your results with any other party, including your primary care provider or insurance company.

The federal HIPAA law (Health Insurance Portability and Accountability Act of 1996) also protects the confidentiality of your HIV status in the US. It prevents health care or social service providers from sharing your HIV test results without your written consent.

While you are required by US law to disclose your HIV+ status to sexual partners, you are under no obligation to disclose your status to friends, family, coworkers, or your employer. For more information, see The Well Project's articles, Disclosure and HIV and Understanding Your Rights and Responsibilities in the Workplace.

Taking Care of Yourself

Getting tested for HIV is one of the best things you can do for your health. If you test negative, you can stop worrying and have a wonderful opportunity to learn how to stay HIV-negative. If you just tested positive, it is common to feel angry, scared, confused, shocked, or depressed. These feelings are normal. Please get the help and support you deserve, and know that there are many things you can do to stay healthy, including taking HIV drugs.

If you need help, check out this website to find an organization near you, whether it is a support group, a health clinic, an HIV provider, or an AIDS service organization. You can also call the US national AIDS hotline at 1-800-CDC-INFO (1-800-232-4636; TTY: 1-888-232-6348), or the AIDSinfo hotline at 1-800-HIV-0440 (1-800-448-0440; TTY: 1-888-480-3739; outside U.S.: 1-301-315-2816). To find services across the world, visit AIDSmap's e-atlas.