Introduction | What are the tests? | Who should be tested? | Will anyone find out I got a test? |What does a negative test mean? | What if it's positive? | Whom should you tell? | Reasons for taking the test. | Reasons for not taking the test.
Diagnostic Tests for HIVThe presence of HIV infection in a person is usually recognized by analysis of the blood for the presence of the antibody to HIV. The primary screening test for this is the Enzyme-Linked Immuno-Sorbent Assay (ELISA). The ELISA test is considered to be a very sensitive test meaning that it is exceptionally accurate for ruling out the presence of the antibody. If the test is negative there is no antibody present. Because there are virtually no false-negative results a single negative ELISA test is considered definitive in determining the lack of antibodies. Unfortunately the ELISA may indicate the presence of antibodies when they are not actually present. Therefore the test elicits a large number of false-positive results. If an ELISA test is repeated on a blood sample that has previously been shown to be ELISA positive the repeat test will be negative 70% of the time. Even if the second ELISA test is positive there is still a chance that the result is a false positive. A blood sample that tests positive twice with the ELISA is re-tested with more confirmatory laboratory tests such as the Western Blot.
There are other serologic tests used for confirmation such as IFA HIVAGEN RIA and RIPA. These tests are much more specific than the ELISA and elicit very few false-positive results. They're also more expensive to administer making them less desirable for screening purposes.
The recommended sequence for testing for HIV antibodies is as follows: (1) perform an ELISA on a blood sample. If negative the person is considered to be negative for HIV antibodies (the person may still have the virus but may have not yet produced antibodies). (2) If the ELISA test is positive another ELISA test is performed on the same blood sample. Again a negative result indicates that the person does not have antibodies (but still may have the virus). (3) If the person is positive on the second ELISA a Western Blot test is done on the same blood sample. Either a negative or positive result is considered definitive for HIV antibodies.
This testing sequence is exceptionally accurate with false-positive results occurring as few as 7 times per million assays. There are times however when the Western Blot cannot be interpreted as either positive or negative. Such cases can be the result of laboratory artifact the influence of other infections in the blood or the fact that the infected person is sufficiently early in the infection so as to have an antibody production below the threshold for determining a positive test result.
Persons with an indeterminate result on the Western Blot are generally re-tested in 1 to 2 months. Because there is some probability that such persons may be infected they should be instructed to behave as if they were infected (practice safer sex or abstinence avoid pregnancy and donating blood etc).
This three-step testing process avoids the possibility of falsely informing people that they are positive. The social psychological and legal implications can be profound. It is also important to not give any results until a positive a negative or an indeterminate result can be definitively given to avoid needlessly alarming the person.
The psychological reaction to a positive HIV antibody tests is usually severe. Upon hearing that the test is positive individuals may do or say things that have life-altering effects on their jobs health families and personal relations. If they must react to a test result it should be a definitive result.
It is important to note that the test does not directly determine the presence of the virus. This is an important consideration early in infection when the virus is present but the body has not begun producing antibodies. This period is called the 'window period' and may last as little as 4 weeks to as long as 6 months after infection.
In Bermuda your family doctor can help you decide if you should have an HIV anti-body test. Usually a doctor who is HIV-savvy will suggest such a test if he or she believes you may be at risk of exposure to the virus either through sexual contacts or through transfusion with un-tested blood and blood products. In addition you can go to the Hamilton Health Centre on Victoria Street. Anonymous Testing is NOT available in Bermuda as there is a risk of the patient not receiving proper pre- and post- testing counseling. However the Bermuda Department of Health maintains strict guidelines on confidentiality for ALL of their clients thus Confidential Testing is the only type of testing done in Bermuda.
More people have gotten an HIV-antibody test in the past year (2001) than in any other previous year with a majority of the testing being done on antenatal women. The chart below shows how the number of tests performed in Bermuda since 1997 have risen by category.
SOURCE Blood Donor Antenatal Women STI Clinic Other Total # of Tests
What are the HIV tests?
HIV antibody tests can tell if you have HIV antibodies in your blood. HIV tests are performed on a small amount of blood drawn from a vein in the arm. Two laboratory tests are used. The blood is tested first with the ELISA test. If the results are negative no further testing is done. If the results of the ELISA are positive the ELISA is repeated. If the second ELISA is positive then the Western blot test is performed. If this test is positive the person is considered infected with HIV.
Who should be tested?
Anyone who believes they have been exposed to HIV or whose lifestyle puts them at risk of exposure should be tested. HIV is passed from one person to another through sexual contact and through the blood. People are considered to be "high risk meaning they are more likely to be infected, if (1) they have sex with homosexual males, bisexual males, injection (IV) drug users, male or female prostitutes, or many different partners; (2) their sexual partner has had sex with someone in this group; (3) they inject drugs and share works" (e.g. needles syringes and cookers); (4) they have gotten other diseases from having sex; or (5) they had a blood transfusion or were given blood products between 1978 and March 1985. An unborn child whose mother has the AIDS virus can also be infected.
Will anyone find out about my test?
There are two procedures for HIV testing: confidential testing and anonymous testing. Confidential testing is like any other medical test - the results become part of your medical record. Insurance companies and employers may obtain a copy of your medical record with the results of your HIV antibody test if you give a release to see the records. Some countries allow anonymous testing in which the person does not give a name. Each person is assigned a code number and you must give the code to find out the test results. With anonymous tests the decision to tell anyone-even a doctor-is up to the individual.
Anonymous testing is not an option in Bermuda. All doctors and healthcare providers in Bermuda MUST report cases to the Department of Health. However to our understanding the information reported is statistical and confidential.
What does a negative test mean?
If your test results are negative it means no HIV antibodies were found in your blood. However it takes about 1 to 6 months after a person is infected for HIV antibodies to form. This means that a person recently infected can have a negative HIV test. If you are in a "high risk" category or suspect you may have been exposed to the AIDS virus you may want to be tested again 6 months after your last exposure. Even if your test is negative you and your partner(s) should protect yourself during sex by always using condoms from start to finish. You should not inject drugs but if you do you should never share works with anyone.
What if the test is positive?
A positive HIV test does not mean that you necessarily have AIDS now but you could have it in the future. We do not know whether everyone infected with HIV eventually develop AIDS. We know that some people have had HIV infection for several years and have not developed AIDS. It seems that by taking very good care of themselves-both physically and emotionally- many of these people are leading normal productive lives for many years with the HIV infection.
The main thing is not to panic. HIV infection is only part of your total life picture. Take care of your health see your doctor regularly seek emotional support from a trained counselor protect yourself and others from further exposure to the AIDS virus and continue with productive satisfying activities.
Whom should you tell?
Tell your doctor and dentist so they will be able to give you the best possible care. You should also tell your current and past sex partner(s) and encourage them to get tested. Discuss with them how you can protect each other. And if you have injected drugs you should tell anyone with whom you have shared "works."
It is important to have people to help you cope-friends relatives or other people who are HIV positive. But you should choose with care the people you tell. In spite of the tremendous efforts made in recent years to educate the public there are still many people with misconceptions about HIV infection and AIDS.
Some reasons for taking the test
For some people the issue may not be whether to take the test but when. This is because although there is still no cure for HIV infection new drugs to treat or delay illness in people with HIV are continually being researched. As time goes on it is increasingly likely that people who are diagnosed early with HIV infection can avoid serious illness through careful medical monitoring and the use of effective preventive therapies called early intervention. The regular check-ups and blood tests a doctor could provide might make it worth taking the test for a person who thinks he or she is likely to get a positive result. Similarly if you are ill and the chances are high that the illness is HIV-related taking the test may help your doctor to diagnose and treat you more quickly.
If you feel that you have been at risk of HIV infection knowing for sure that you are positive could mean that you are able to concentrate on looking after your health and making changes in the way you live in order to reduce the chances of getting ill.
If you are in a stable relationship where you or your partner have possibly been exposed to HIV infection and are worried about whether or not to practice safer sex taking the test may help you to decide what sexual activities are appropriate. If you test HIV negative you must still continue to practice safer sex until you know for sure that your partner is also HIV negative. If you or your partner is HIV negative the only way to stay negative is to avoid risky sex (or risky drug use) with other people. If the relationship ends then you have no guarantee that your next sexual partner will be HIV negative. Another important factor to consider is when one partner is HIV negative and the other is HIV positive.
If you are very anxious and concerned about your HIV status even if you are not sure if you have been put at risk taking the test may help to put your fears at rest. Some people may become so worried about whether or not they have HIV infection that taking the test seems to offer reassurance even if the test result is positive. You may want to think carefully about this. If you receive a positive test result how would you feel? If the test were negative would it really put an end to your fears? Some people take the test repeatedly even when the results are always negative. This might be because of their sexuality or difficulties in a relationship or other reasons.
If you are engaging in unsafe sex or drug use taking the test may encourage you to change your behaviour. If you are negative you will want to stay that way and if you are positive you will want to think about not passing the virus on to other people. You don't need to know your HIV status in order to practice safer sex.
Women who feel they may have HIV infection and want to have a baby could find that knowing their status helps to clarify the decision about whether to get pregnant or not. You should consult your doctor before choosing to have a baby. Also your partner should be tested to clarify his status.
Women who think they may have HIV infection should also take the test if they intend to breastfeed their baby. Taking the test will help decide if you want to continue breastfeeding - Breast milk in infected mothers has been shown to pass the virus to babies.
Some travel destinations require that you be vaccinated or immunized with a live virus. Knowing your HIV status to get the latest information on which vaccines are safe for you. Some countries require that foreign residents be tested for HIV infection. It is best to have such a test at home in Bermuda prior to travel if you think the test is likely to be positive.
Some reasons for not taking the test
Common reactions to a positive test result include anger shock confusion denial depression and acute anxiety. Some people find that the shock causes them to withdraw from society feeling numb while others feel desperate and may become suicidal. This is why it is important to have pre- and post-test counseling.
A test result is no substitute for safer sex behaviour. If you are HIV negative you will want to stay that way. If you are positive you will want to avoid infecting sexual partners or putting yourself at further risk of sexual infections through unsafe sex. If you take the test and receive a negative result you may be tempted to take risks because of a false sense of security. A negative test today means that you must always practice safer sex from now on.
Despite all of the information about HIV infection many people still feel that Iv can be contracted through social contact and are therefore afraid of people with HIV infection. Additionally they may harbour prejudiced views on people with HIV (such as gay men injection drug users people they perceive as promiscuous) and accuse these people of 'spreading the virus' or having only themselves to blame for contracting the HIV virus. Once you receive a diagnosis of HIV infection you must think carefully about whom to tell. Some people find that their friends relatives and lovers have been unable to cope with the knowledge that they have HIV and have rejected or isolated them. Others may find that the persons they have told have not kept the information confidential. Feeling secure that you have reliable support from people who are caring and sensitive to your needs and aware of the significance of confidentiality is very important. If you are unsure about whether or not you have such support then you may wish to reconsider the timing of taking the test until such support is in place.
People with HIV may experience severe discrimination in areas of housing education employment insurance and travel. Discrimination is not only unethical and unnecessary it is also extremely unhelpful in terms of our understanding of the prevalence of HIV and AIDS. So far much of what we know about HIV and AIDS has been learned because HIV-positive people have given their time energy and commitment to making more information available.