Know the Ins and Outs of HIV Testing

There are clear advantages to knowing whether you are HIV-positive. The sooner you know where you stand, the faster you can change your behavior either to avoid infection or to reduce the chances you'll pass the virus to others.

But for many people, the question of whether to be tested for the virus that causes AIDS is not quite as straightforward as it sounds. And once you've decided to get tested, more questions arise: When should you be tested? How often? Where, and with what kind of test?

Who should get a test?

"I think we run into a bit of a struggle here," says Julie M. Scofield, executive director of the National Alliance of State and Territorial AIDS Directors. "We want the general public to feel concerned about the epidemic—it could happen to anyone. But when we look at the data, we're not really talking about anyone. There are people who are at greater risk."

According to Karlie Stanton, a spokeswoman with the Centers for Disease Control, the CDC recommends HIV testing for:

• pregnant women (treatment can greatly lower the chance of passing HIV to babies before, during, or after birth)
• people who are diagnosed with a sexually transmitted disease
• sexually active men who have sex with men, for whom the CDC recommends annual testing.

Beyond that, the agency advocates "open, honest dialogue" between people and their health care providers about behavior and circumstances that put you at risk for HIV, including:

• having unprotected sex—that is, vaginal, anal or oral sex without using a condom or other latex barrier
• having sex with multiple or anonymous partners, sharing needles or other injection equipment
• having received a blood transfusion or blood clotting factor between 1978 and 1985
• having unprotected sex with someone who falls into any of these categories.

"It's true we have less firm guidelines for who should be tested for HIV," says Ann Kurth, an assistant professor at the University of Washington School of Nursing who studies HIV and testing. "But the reality is if there's been any unprotected sex, you should consider testing."

When should I be tested?

"If someone has unprotected sex on a Friday night and they find out the next Monday that there's a chance their partner might have HIV, they might want to run right out and get tested," says Susan L. Fulmer, immediate past chairwoman of the HIV/AIDS section of the American Public Health Association. "But that's not going to do you any good."

That's because tests for HIV infection look for the antibodies your body makes to fight the virus. They don't detect HIV itself. Most people develop detectable levels of antibodies within three months of infection; the average time period, says the CDC, is 25 days. In some cases, it can take up to six months to develop the antibodies. So while many public health experts say you can get a test about three months after you think you may have been exposed to the virus, the CDC recommends waiting six months.

If your test is negative, says Fulmer, you may want to get another test within three-to-six months "just to be sure."

How often should I be tested?

If you test positive, you must have another test to confirm your results. Your health care provider should help you get the right follow-up test.

If you test negative, how often to get tested depends on your situation. If you engage in risky behavior, such as unprotected sex or sharing needles, you'll need more frequent testing. The CDC recommends annual testing for sexually active men who have sex with men. According to CDC spokeswoman Stanton, people at the highest risk for infection – for example, men who have sex with multiple, anonymous male partners or people who have sex in conjunction with using drugs – may need more frequent testing, such as every three-to-six months.

What kind of tests are available?

There are five main types of tests:

• The enzyme immunoassay, or EIA, blood test is the standard method of HIV testing in the United States. A health care provider takes a sample of your blood and sends it to a lab for testing. Usually, you get the test results within a few days to two weeks.
  
  
• EIA oral fluid tests use a sample of fluid that a health care provider collects on a swab from the inside of your mouth, which makes this test attractive if you are reluctant to give a blood sample. The sample is tested at a lab, and results usually are available within a few days to two weeks.
  
  
• Rapid tests are newer than conventional HIV tests. They use samples either of blood or oral fluids, and provide results in as little as 20 minutes. As with all other tests, if you test positive for HIV you must have a follow-up test to confirm your results. Since the tests are relatively new, they may not be as readily available as the conventional tests. If you'd prefer to have a rapid test, call your health care provider and ask if the test is available.
  
  
• EIA urine tests use urine instead of blood or oral fluids. The sample is sent to a lab for testing. As with the other tests, you usually get results within a few days to  two weeks.
  
  
• Home tests require you to prick your finger, put blood on a specially treated card and mail the card to a lab for testing. You don't test your blood yourself. In about three days, you telephone for your test results, and get the chance to talk to a counselor. Keep in mind that while you may see other tests advertised, only one home test has been approved by the Food and Drug Administration: the HomeAccess test. As Kurth says, using other "home tests" is "not a good idea at all."

HIV tests can be either confidential or anonymous. With a confidential test, your name is listed along with your test results and may be available to your state health department and to medical staff. All states offer confidential testing, which is what you're likely to get if you go to a private doctor. Anonymous tests don't connect your name to your test results. Most states offer both anonymous and confidential testing, but a few offer only confidential.

Where can I get a test?

You have several choices, including:

• local health departments
• private doctors' offices
• hospitals and clinics
• clinics that provide tests for HIV

To find a testing site near you, see the National HIV Testing Resources (http://www.hivtest.org) Web site, which lists sites by zip code.