The standard test used is the ELISA test, which does not test for the virus itself.† Instead, it tests for the antibodies your body creates to the virus, which must be produced in large enough quantity before the test can detect them, hence the ďwindow period.Ē† If that test comes back positive, they confirm it with another ELISA test and a Western Blot or IFA test.† If the first test is negative, they usually stop.† Provided you are beyond the window period, these tests are almost 100% accurate.†
There is a second type of antibody testing out there called the rapid test.† This test is as reliable as the standard ELISA test and the results come back very quickly (usually within a half an hour).† This test has the same window period as the standard ELISA test.† The drawback of this test is if the test does come back positive, it still needs to be confirmed with the other tests, which makes it take as long as the standard test would anyway.
The dreaded window period.† With current tests, about 50% of those who will test positive do so by 21 days after infection, 95% to 99% (depending on who you ask) will test positive by three months after exposure.† Some rare people may take up to six months to test positive, and almost no one ever takes longer, but you can feel pretty secure with the three month test.† Most people will test positive within 21 to 45 days of exposure, although I donít have percentages for those dates.† There are other tests available, which can test earlier, but they are not as reliable, more expensive, and your doctor should only order them if he or she feels there is good reason to test that way, which does not include easing the anxiety of a person without symptoms waiting out the window period.†
Apart from some speculation, I could find very little that indicates why some people have longer window periods than others, except that people just react differently to the disease.† There has been some evidence though that occupational exposures (i.e. healthcare workers who get accidental needle-sticks) take longer to test positive than people who acquire it via sex.
If you truly fear you may have been infected, test first at four to six weeks after exposure, then provided that is negative, test again at three months.† You may also test immediately after exposure, as a baseline, but remember that will only tell you your status prior to the exposure, and will not indicate anything about the exposure itself.† If youíre a hypochondriac and feel you are one of the rare ones that will take longer than three months, test again at six months.† If you test negative after six months and have had no additional risks, STOP TESTING, you donít have it!† Youíd just be wasting your time, money and sanity on unnecessary tests.† If youíre showing weird symptoms, look for another cause; itís probably stress.
You can get tested by your private doctor, health departments or obtain a Home Access HIV test kit.† Confidentiality will vary depending on where you get tested, and many states require governmental notification if you test positive.† With the exception of giving blood, you will not generally be tested unless you request a test.†
The Home Access kit is the only one available to use at home that is approved by the FDA, and is as reliable as the tests doctors and hospitals use.† You prick your finger, send in the blood, and they test it, then you get your results over the phone.† This test is completely anonymous and rather convenient, but there are drawbacks.† For one, itís more expensive than going to the doctor or health department.† Also, they do provide counseling, but that counseling is not as good as what you would get from a doctor or health department.† Plus, anyone that gets a hold of your number can retrieve your results.† It may also be difficult for you to prick your own finger, and human error can play a part in screwing up the test.† Depending on what package you buy, you can get your results in three days or a week.† If your test is negative, you may never speak to a human being throughout the entire process, but the option is available if you want to talk to someone.† From my understanding, if your result is positive or indeterminate and on random negative tests, a live person will give you your results, but otherwise, everything is automated.
If you are tested at a health department or your doctor, you will most likely be expected to go in to get your results, regardless of what those results may be.† This test includes a lab technician drawing a small vial of blood from you, which then gets tested.† There are also saliva tests out there, which are just as accurate.† Saliva doesnít really pose a risk of infection, but it will contain enough antibodies to test.† It usually takes three days to two weeks to get results, depending on where you get tested.† The reason for this length of time is whether or not they ďbatchĒ the tests.† Batching the tests means the lab will wait until they have a certain number of tests and do them all at once, thus it may take longer to get the results.
Confidentiality will vary when it comes to going to your doctor or health department.† The test will either be ďanonymousĒ or ďconfidential.Ē† With an anonymous test, you never give them your name, so it is completely confidential.† With a confidential test, you give them your name, but they will only release your name with your results if required to do so by law or court order.† Many health departments will do anonymous testing, but most doctors will not.† If you do test positive, no matter what kind of confidentiality there is, they are required to report that a new case of HIV has been diagnosed to the CDC, although they arenít required to release the identity of the person who tested positive.† Many states now require that someone who tests positive must have their name and status reported to the state, so you may want to be aware of the laws in your state before getting tested.† If you live in one of those states that require that, and donít want that information relayed to the government, I would recommend using the Home Access test since they are exempt from those state laws.
I have been tested through a health department, my doctor and Home Access, and I canít really say one way is significantly better or worse than another.† Since I donít drive, I found the Home Access test to be the most convenient, but there are the drawbacks I mentioned earlier.† Health departments tend to not have a very personable attitude towards people; however, they are usually free or very low cost and the staff is generally very knowledgeable about HIV.† When I was tested by my doctor, I happened to be going to a doctor who did not appear to have a great deal of experience with HIV or HIV testing, so I got some incorrect information from him regarding the testing procedure (he told me they would give me the results over the phoneÖthey didnít) and HIV in general (he said it could be transmitted by saliva), but the cost was covered by my health plan, and even if it hadnít been, it would have still been cheaper than Home Access.† Also keep in mind, when getting tested at a health department or your doctor, you may have to sit through a lecture on safer sex.
Speaking of health plans, most health plans will cover HIV testing, but many doctors and health departments will not bill your insurance company directly for the test.† You must submit the bill to the insurance company yourself for it to be covered.† Also, most health plans will not cover the Home Access test.
Your results to the antibody test will be reactive (positive), non-reactive (negative) or indeterminate (who knows).† An indeterminate result is usually due to seroconversion (the time right before you would test positive), presence of another disease that confuses the test, recent vaccination, or you may just happen to be one of those people that confuses the test.† If you get an indeterminate result, get retested in four weeks.† If that result remains indeterminate, you are negative.
It is possible, but unlikely, that you will get a false negative or false positive result.† False negative results are almost always due to testing during the window period, and not a failure on the part of the test.† When these tests were first developed, false positive and false negative results were a lot more common; however, with advancement in testing technology, those are very rare now.† The most common reason for false positive results these days is clerical error.
Also, keep in mind, if you get a positive or indeterminate ELISA, but the confirmatory tests are negative, you are negative.† The ELISA is very accurate, but there are several factors that can cause that test to be positive, only one of which is HIV infection.† That is the reason they do the confirmatory tests.
Giving blood is not a reliable method of getting tested.† While they do test all blood donated, they will only notify you if they find a problem, and thatís only if they can find you.† Also, I donít believe they confirm positive results (they just throw the blood away), so the likelihood of a false positive is much greater.
The test used for HIV in the U.S. is usually only for HIV-1.† There is another, less common, strain called HIV-2.† Since this strain is extremely uncommon in the U.S. (less than 100 confirmed cases in the entire country), you will most likely not be tested for it, although the standard test for HIV-1 will pick up HIV-2 about 70% of the time.† If you fear you may have been infected in another country (especially western African countries), you may want to talk to your doctor about being tested for HIV-2.
There are a variety of tests out there, but the antibody test remains the most reliable and cheapest of them all.† Other tests include viral load testing, which counts the number of viruses per milliliter of blood.† Viral load tests may give false negatives.† The reason for false negatives in viral load testing is that the test can only detect the virus if the viral load is high enough.† People may have an undetectable viral load and still be positive.† This is especially true immediately following seroconversion, which is when your body has gotten as close as it ever will to defeating the virus itself.† One benefit to this test is that the window period is only a few days following infection; however, this test is expensive and is difficult for labs to do, so itís not recommended for screening purposes.
Another test is the p24 antigen test.† This is a test that tests for the virus itself, but has an error rate of about 10%.† It is also only useful shortly following infection or at the end stages of the disease.† During the lengthy asymptomatic stage of the disease, this test will be negative, despite the person having the virus.† Basically, if you test positive on an antibody test, you will probably test negative with this test.† Like the viral load test, this test is expensive and difficult for a lab to perform, so it shouldnít be used for general screening purposes.
Doctors will typically only order the viral load test or antigen test under certain circumstances.† These include someone who is showing symptoms that may be ARS following a high risk exposure, someone who has had a definite exposure or someone who has another immunodeficiency disease that could cause them to be unable to produce antibodies to HIV.† They may also use these tests on newborns of an HIV infected mother.† The viral load test will also be frequently used on someone who has been diagnosed with HIV as a way to monitor disease progression.
Also on the market are a variety of at-home tests in addition to the Home Access test.† These are rapid tests that work in a way similar to a home pregnancy test.† These tests, however, have not been proven to be reliable (in many cases, they have been proven to be unreliable), are not approved by the FDA and shouldnít be used.
How often to get tested is really up to you. †Only you know what you have and havenít done and if there is a need to test.† Having said that, there are some general rules of thumb you could follow.† If you frequently engage in high risk activities, getting tested every three to six months is recommended.† If you frequently engage in low risk activities, getting tested once a year should be more than adequate.† You may also decide not to test at all or only test following a high risk activity.† Keep in mind if you only test after a high risk activity, you are going to have to wait out the window period, which can cause a great deal of anxiety.
Why To Get Tested
Testing is not fun, and not a particularly easy process to go through.† Your best bet would be not to put yourself in a situation where testing is necessary, but if you do happen to put yourself at risk, do yourself the favor of getting tested.† There are reasons to find out if you are positive.† For one, you will know that you are a danger to others, and will be more aware to take the steps to avoid transmission.† Second, there are treatments available that may help, and could lead you to have a long and happy life.† Also, wouldnít it be better to be prepared for the possible sicknesses that could occur?† Instead of suddenly getting terribly sick one day unexpectedly, at least you would know that it could happen to you, and it wonít be as much of a surprise.† And if you find out youíre negative, wouldnít that be a relief instead of worrying about all the what ifs in life?† Remember, just because you have tested negative doesnít mean youíre immune and will never get the disease.† It only means as of the time of that test, you were negative; itís not a license to go out and do risky behaviors, nor is it even remotely like a cure.
The worst part of HIV testing is the waiting.† Testing after a risky episode means you have to wait out the window period, then after that has elapsed, you will have to wait to get your results.† This is stressful, no doubt about it.† If you are waiting out the window period to get tested, there are some ways you can go about getting your mind off of it in order to get through, or at least try to deal with the anxiety.† Here are some tips I found seem to work fairly well:
∑ Donít spend a whole lot of time reading about HIV.† If you fear you could be infected and want to do some research to find out what your risks really are, thatís fine, but donít spend hours upon hours looking into it.† Once you have gotten a fairly good idea of what your risks really are, stop.† Continuously reading about it will only increase your anxiety.† Despite the fact that there is a lot we know about the disease, there is still a lot we donít know.† You will eventually run into a roadblock with your research.† There are a lot of maybes and ifs involved here, and the chances of you getting an answer which is 100% to your satisfaction is slim.† Not to toot my own horn too much here, but reading this site alone will probably give you all the information you will actually need in order to determine your risk.† The only way youíre going to find out if your risk actually led to transmission is going to be testing.
∑ Donít watch HIV/AIDS movies or television shows.† These are pretty much universally depressing.† They are heart wrenching even if you know youíre not infected, but trying to watch them while you think you might be just makes things worse because you start thinking, ďhey, that could be me.Ē† Hollywood likes to portray AIDS sufferers as noble and all, but usually at the end of the movie, they die.
∑ Take a trip.† If you have the wherewithal to do so, take a trip out of town.† Getting out of your current environment for a little while is a great way to get your mind off of things.† If you canít afford a trip out of town or hate to travel, take a drive around.† Take a walk.† Anything to get you out of a place where you are going to sit there and mull over the possibilities.
∑ Have sex.† Sex is the great stress reliever and is very healthy for the mind.† Of course, you want to practice safer sex; otherwise, the waiting starts all over again.
∑ Get drunk.† No doctor in his or her right mind would ever suggest this, but since Iím not a doctor, I will suggest it.† Obviously, if you have a problem with alcohol or get depressed when you drink, this is not a good option for you, nor am I suggesting anyone spend three months drinking.† However, for those who have a healthy relationship with alcohol (or other drugs for that matter), getting drunk is a good way to escape from it all for a little while.† Do so responsibly, of course; donít drive while drinking, etc.
∑ Do things you enjoy.† If you have a hobby, do it.† If you like watching movies, watch some comedies or other things that will make you feel good.† Read a lighthearted book.
∑ Write it out.† If you keep a journal or diary, write out your feelings in it.† Something to get whatís in your head out of it.
∑ Talk to people.† If you have a confidant, use them.† Tell someone what you are feeling, what your fears are and how itís affecting your life.
∑ If you meditate, do so.† Meditation is a great way to relieve stress and this is a perfect opportunity to utilize that.
∑ If youíre religious, turn to your religion.† Religion provides comfort for a lot of people, which is pretty much why itís there.†
Basically, do what you can to not think about it too much.† Thereís nothing you can do until you get tested, so stressing out over it will just make you feel worse.† My suggestions here may be somewhat unorthodox, but, hey, they work.