The thought of getting an HIV test can be intimidating or scary. But with a little bit of knowledge about what to expect and basic information on HIV, you can be more confident and comfortable when you get tested. I recently spoke with Lynnette Ford, M.S.W., the vice president of Programs and Prevention Services at GMHC in New York. Lynette oversees their HIV testing center and shared her knowledge and advice for getting tested, particularly for first timers who may be nervous.
Warren Tong: What can people expect when they go to get an HIV test?
Lynnette Ford, M.S.W.: I would definitely say it's probably different for each individual place; however, when people who are testing for the first time walk into the facility here at GMHC, we make them feel comfortable. At most places, as soon as they walk into the center, they usually will be asked to complete an intake, which just asks for some basic demographic information and also some risk history, sexual and/or drug history: information that will be utilized to train the pretest counseling session.
Once they complete the intake, they are then called into a counseling room. They should always be called into a confidential space, whether it's a room (if they're at a facility) or, if it's in the community setting, aboard a mobile testing unit or a tent (if it's a beach-type of event or a park-type of event). A health fair where they're offering testing should definitely afford the client confidentiality.
During the pretest counseling session, the client should feel comfortable and be able to build a rapport with the counselor, with the counselor explaining to the client what is going to take place during the session. That means asking them personal questions, letting them know that if at any point they choose not to answer a question they have the right to do so, and explaining actually how HIV is transmitted -- asking them if they have any questions about how HIV is transmitted, and explaining that thoroughly. Depending on the type of test that is done, explaining the test.
WT: What kind of test do you use?
LF: Here at GMHC, we use the Alere fourth-generation Determine test. It's a 20-minute test, a very accurate test, [with regard to] what the test actually looks for. You [also] have the OraQuick test, which looks for antibodies in the window period. The OraQuick test can be [given] anywhere from one month up to six months for a select group of people, although most people will develop antibodies that are detectable by the OraQuick test at the two-month point.
For the Alere Determine, the window period is about 26 days. That test actually [also] looks for the antibodies for HIV, which is what your body would build up in response to the HIV infection being in your body, and also the actual germ or the antigen.
We explain what the test looks for. We explain the window period, making sure that the client understands that if they've had any potential risk behaviors -- condomless sex, sharing of needles, that type of thing -- and they are within the window period, we do recommend that they test outside the window period if they test negative.
WT: So, the window period is about four weeks after your encounter, before your body will develop the antibodies that the tests look for. What about post-exposure prophylaxis [PEP]?
LF: We also assess the client for post-exposure prophylaxis. When the client comes in, one of the first questions we ask is if they've had any unprotected or condomless sex within the last 72 hours. Or, you know, what brings them to us today -- with that being the second question. If the client reports that they've had condomless sex or another risk behavior within the last 72 hours, we do talk to them about post-exposure prophylaxis. That can be started within 72 hours of the possible exposure, and if the client is a candidate for that, we do do the HIV rapid test -- make sure that they're negative. And then, we refer them to one of our community providers that will be able to give them the prescription for PEP. And PEP is really effective in reducing conversion from negative to positive, if the client did, in fact, come into contact with the virus.
We ask that question at the very beginning even if they are not a candidate for [PEP] because they had a risk encounter beyond the 72-hour period. Oftentimes some clients are not aware of PEP, so we use that as an opportunity to educate them on that.
We explain the difference between HIV and AIDS. We talk about confidentiality. We talk about the need to provide a confirmatory test, if the client does test preliminary positive on the rapid test, explaining to them that it's done via standard venipuncture.
We talk to them about the linkage to care services that we offer if they test positive.
WT: Before we go into whether they test positive, for a testing center like GMHC, do people need to make an appointment or can they just walk in?
LF: Clients can actually make an appointment, or they can walk in. We have walk-in hours Monday through Wednesday and on Fridays. And then, we have an appointment day specifically for people who want to make an appointment, on Thursdays.
WT: What would you say to someone who's nervous about coming in or is not sure about getting tested?
LF: Well, if they call and they say that they're nervous about coming in, one of the things we do is normalize that feeling -- because we understand that testing for HIV can be very nerve-racking and anxiety producing. But, we also let them know that them taking the first step to be tested, we recognize that as a strength, and that people often feel nervous or anxious, normalizing that feeling. However, it is really important to know your status. Because if you know that you're negative, we can provide you with interventions and services to remain negative. If you test positive, we can provide you with services to assist you with living with HIV. But the important first step is knowing your status.
WT: How often should people get tested?
LF: If they are high risk at-risk for HIV infection -- individuals who may have multiple sexual partners, condomless sex with multiple partners and they're unaware of their sexual partners' status, or history of IV drug use, or current IV drug use, crystal substance use (like crystal meth), cocaine -- we recommend every three months. If they are at lower risk -- [in] a monogamous relationship, client partner is also being tested on a regular basis -- we recommend every six months.
But, you know, we recommend people get tested as often as they feel comfortable. However, HIV testing is not a prevention tool.
WT: So, if someone tests positive: What happens next? Do they get counseling? What are the next steps?
LF: Yeah. If someone tests positive, we have here a client navigation specialist who is able to talk to the client about the next steps within that process. The first thing we do is receive consent for the client to have their blood drawn to confirm the preliminary positive result.
We talk through their feelings; we ask them their plans for the next 24 hours. If the client is very emotional or is anxious, we have on-call mental health services that we're able to provide for the client.
We also have a buddy program that we're able to enroll the client in and that we've found to be really helpful for individuals who are newly diagnosed and really were not expecting to test HIV positive, where the buddy would provide them with emotional support and things like that.
We also link them to medical care. We try to get them a medical appointment within that visit, because we know there is often a drop-off at the point of testing preliminary positive and linking to care. So, we attend to their emotional and mental health needs. We talk about the next steps in the process, with the important thing being linking to medical care and the other supportive services that we offer -- the newly diagnosed group that we have here at GMHC and a variety of services for people who are newly diagnosed.
WT: Do you have any personal stories about giving a diagnosis that stand out to you? Maybe the first time you gave someone a diagnosis and what that felt like?
LF: Well, honestly, the first time I gave an HIV-positive result was probably about 15 years ago. I was new in the field. And I actually cried in the counseling session. I was working within substance abuse at the time, and I was new to the field. It was a young [man who has sex with men] of color. He had no idea that he was going to test positive. One of the things that we ask, always, during the pretest counseling session, is, "What do you think you would do if you test positive?"
You know, often people have a plan, but when it actually happens, it's like that plan is totally out the window. So, I actually cried in my session -- which was horrible and which was not the best thing to do, and I've since learned that. He ended up consoling me at that point. And during supervision with my supervisor at the time, I was open and honest and reported that I did become emotional in the session. We talked through that, and she provided me with guidance on [how] it's really about the client. You know, you have to really make sure that you're doing preparatory work so that you understand that your emotions can be projected onto the client and keep being self-aware of your emotions.
One of the things that we do here at GMHC is, whenever counselors do have clients who test positive, we always try to debrief them and really provide emotional support for the counselor, as well.
WT: What are some of the most common questions people ask when they come in?
LF: They usually want to know about the window period. I think, honestly, a lot of our clients are very aware of how HIV is transmitted. So, one of the questions we ask is, "Can you tell us the body fluids that HIV is found in?" And oftentimes clients know that information.
You still have clients who may think that HIV can be transmitted by mosquito bites, that it can be transmitted via saliva. So, we ask questions to ascertain their level of knowledge so that we can confirm and utilize a stunt-based approach [to determine] that they actually are answering correctly. But, then, we also use it to ascertain what misinformation they have and to correct that information.
I think clients -- it would definitely be questions about PEP and PrEP [pre-exposure prophylaxis]. For those clients who know about PEP, we often get questions about PrEP. We often get questions about: "What if I test positive? How long will it take before I develop AIDS?" You know: "What types of medications are there out there for people who are positive?"
We get a lot of questions related to, "If I test positive, will you notify my partner?" So, we talk about the notification through the Department of Health, and how that is confidential if the client wants to divulge who their partners are so that their partners can be tested.
We get a lot of questions related to sexually transmitted infections [STIs] and how those are transmitted. We also test for STIs here at the testing center. So, we always inform clients that if you have a sexually transmitted infection, other than HIV, it puts you more at risk for contracting HIV. So, it's important to be tested regularly for STIs, as well.
I would say those are the main questions.
WT: You mentioned misconceptions such as mosquitoes and saliva. Do you still hear a lot of HIV myths and misconceptions?
LF: We do. But I would say it's not as rampant as it used to be. I think that people are more aware of how HIV is transmitted, with the advent of the internet and being able to research and dispel those myths. Conversely, what I think happens is that people go online to find out if they may be HIV positive, and they think that they are, and they'll list [symptoms] -- because, you know, if you're sick, they always say, "Stay off the internet." So I think that's what happens.
But most of the clients that we see here at the center, honestly, are well-versed in HIV and HIV prevention techniques. I think that's a combination of just having access to the information; but also, we have a lot of people who continuously come to GMHC for their HIV testing needs. It's because we're a sex-positive, non-judgmental safe space for all people. They regularly come and they hear the messages. They get the education. And, they understand how HIV is -- and is not -- transmitted. I think that kind of helps dispel some of the myths, as well.
And then, oftentimes, we also tell clients, "The information that you have, share [it] within your social network so that your friends are aware of that information."
WT: Any last messages for National HIV Testing Day?
LF: I would definitely say for National HIV Testing Day, [if you're in New York], GMHC will be at the Walgreen's at 279-283 W. 125th Street, June 22-29, from 3 p.m. until 7 p.m., doing free, confidential HIV testing. We will also be open at our testing center, located at 224 West 29th Street, between Seventh and Eighth Avenues. Please feel free to walk in at our testing center, or go to any provider to be tested, because knowing your status is vitally important.
This transcript has been lightly edited for clarity.