The Top Ten Questions About HIV Tests
Are you thinking about being tested for HIV? Are you wondering what types of tests there are, whether you can be tested for free, and whether you have to give your real name? Or have you received a test result and are now wondering if it is correct? Welcome to ÒThe Top Ten Questions About HIV Tests.Ó My name is [PRESENTER NAME]. IÕm [PRESENTER ROLE]. In this video, we will explain the different kinds of HIV tests that are commonly used today, how likely they are to be correct, and how you can be tested quickly, easily, and at no charge.
1) How do HIV tests work?
HIV tests try to find out if you have been infected with HIV, the cause of AIDS. The most widely used tests look to see if your body has responded to HIV infection by creating something called ÒantibodiesÓ to fight HIV. Antibodies are like tiny balls in the body that fight infections. To keep the risk of an incorrect test result as low as possible, in developed countries, you will normally be tested twice. Initially, you will be tested with a first HIV test called an ELISA. If the first testÕs result is ÒHIV positive,Ó then you will be tested with a second test called a ÒWestern Blot.Ó Only after both tests return a result of ÒHIV positiveÓ will you be told you are HIV positive. In developing countries, it may not be possible to do that second test, and your doctor may use the result of the first test alone.
To be certain that you are not infected with HIV, you will have to get an ÒHIV negativeÓ test result at least six months after the last time you may have come into contact with HIV, such as the last time you had sex or shared needles.
2) What are the Window Period and incorrect ÒHIV NegativeÓ test results?
The two tests we talked about already will only return an ÒHIV positiveÓ result after your body has responded to HIV infection. That takes a while—as long as six months in some people. This is called the Òwindow period,Ó during which the first test, the second test, or both tests may return an incorrect result of ÒHIV negativeÓ even though the person has actually been infected with HIV. This is why even if you get an ÒHIV negativeÓ test result, your doctor may tell you to come back in a few weeks or months to be tested again.
Viral Load Test: for detection of HIV infection during the Window Period
There is another test that can be used during this window period. ItÕs called the viral load test. ItÕs a very sensitive test that counts the amount of HIV in your blood. The viral load test is usually used when someone is already known to be HIV positive and not typically used to check if someone is newly infected with HIV.
However, if the viral load test is available in your area, it can be useful for telling if you have an early HIV infection. When people are initially infected with HIV, the amount of HIV in the body increases very rapidly because the body hasnÕt had time to build up a strong response and fight back yet. During this time, a person will have extremely high amounts of HIV in their blood, and they are by far the most capable of spreading HIV. In fact, many HIV transmissions may occur during the period of early HIV infection. During this time, some people infected with HIV have signs of early HIV infection such as fever, sore throat, tiredness, rash, and body aches.1 Watch our video ÒDid I Just Contract HIV? Signs of Primary HIV InfectionÓ to learn more about how to tell if you have early HIV infection.
If you think you may have come in contact with HIV, itÕs important to get tested. If you think you have signs of early HIV infection, itÕs extremely important that you be tested for HIV right away. The viral load test, if available, can be used to see if youÕre infected with HIV even before your body responds to the infection. Go to the doctor. Tell them the reasons that you think you might have early HIV infection. Ask whether the viral load test would be right for you. You may also ask to see an HIV doctor who will know about the use of the viral load test.
3) How long after coming in contact with HIV does it take for a person to get a test result of ÒHIV positiveÓ?
Different people will take different lengths of time after they are infected with HIV for the body to respond so the first test will give a result of ÒHIV positive.Ó According to the U.S. Centers for Disease Control and Prevention:2
á On average, it takes 25 days after infection for a personÕs body to respond so the first test will give a result of ÒHIV positive.Ó
á For most people, the first test will give a result of ÒHIV positiveÓ within two to eight weeks.
á For 97 out of every 100 people who become infected with HIV, the first test will give a result of ÒHIV positiveÓ within three months of being infected.
á In very rare cases, it can take up to six months after infection for the first test to give a result of ÒHIV positive.Ó
Using a viral load test, HIV infection can be seen within nine to eleven days after being infected with HIV.
4) What's the risk of an incorrect ÒHIV positiveÓ result on the first test?
The first test is quick, easy, inexpensive, and fairly accurate, although not perfect. A scientific study we list in the references at the end of this video3 showed that an incorrect ÒHIV positiveÓ test is very rare. For every 1000 people who receive a first test result of "HIV positive," in 985 cases the test result is correct and the second test will confirm that the person is in fact "HIV positive."
What about the other 15 times out of a thousand? If a person got a first test result of ÒHIV positive,Ó but it is later shown that they are not infected with HIV, we say that the first test result was an incorrect ÒHIV positiveÓ result, also known as a Òfalse positive.Ó Incorrect ÒHIV positiveÓ test results on the first test do happen. Pregnancy, recent flu vaccination, and diseases like lupus are some possible causes of incorrect ÒHIV positiveÓ results on the first test.
5) What's the risk of an incorrect ÒHIV positiveÓ diagnosis after the second test?
If a person gets a result of "HIV positive" on the first test, the doctor will perform a different second test called a Western Blot test to make sure that the first test result was correct. If the second test also returns a result of "HIV positive," the person is told they are "HIV positive."
It is POSSIBLE for an ÒHIV positiveÓ result on the second test to be incorrect. However, this is EXTREMELY rare. The same scientific study we talked about earlier showed that if a person gets a result of ÒHIV positiveÓ on both the first test and the second test, there's only one chance in 250,000 that the person's "HIV positive" result is incorrect.4 That means that out of every 250,000 people who got ÒHIV positiveÓ results on both the first and second test, only one personÕs test result would be incorrect.
HIV denialists are people who claim that HIV isn't the cause of AIDS. Videos and web sites on the Internet by HIV denialists often talk about incorrect "HIV positive" test results and exaggerate how often they occur. HIV denialists are usually talking about incorrect "HIV positive" results on the first test, which could be as many as 15 out of every 1000 "HIV positive" results on the first test. But in the developed world, a person is not told they are "HIV positive" until they've received an "HIV positive" test result on BOTH the first test and the second test. If you have taken both the first test and the second test and your doctor tells you that you are HIV positive, believe them. The odds are extremely high at that point that you are in fact HIV positive. If you have any doubts about whether your HIV test results are correct, talk to your doctor.
6) Can I be tested for free?
Yes. Just about anywhere in the world, if you can get to a public health clinic or Sexually Transmitted Disease testing center, you can be tested for HIV for free. DonÕt let the fact that you donÕt have health insurance or canÕt pay stop you from getting tested for HIV.
7) Can I be tested without giving my name?
Yes. If you want to be tested for HIV but donÕt want to give your name, there are several ways you can do this. LetÕs talk about each one.
Anonymous Testing
In some places, you can go to a public health clinic and tell them that you want to be tested for HIV anonymously. That means they will test you for HIV without writing down your name.
Confidential, Name-Based Testing
Not all places have this kind of anonymous testing program. In some places, you must give a name when you are tested. They keep the name secret and do not make it public. This is called ÒConfidential, Name-Based Testing.Ó If you donÕt want to give your real name, you donÕt have to. DonÕt let the need to give a name stop you from getting tested for HIV.
Home-Based Testing for HIV-1
There are two major types of HIV: HIV-1 and HIV-2. HIV-1 is the type of HIV found most widely outside of Africa. Another way to be tested for HIV-1 is to use a home-based HIV-1 test kit that you can buy at a pharmacy. You donÕt need a prescription to get the kit. You just go to the store, buy it, and take it home with you. At home, you follow its instructions to get a sample of fluid from your gums. You mail in your sample and then call a phone number to find out your result later. No one knows your name because you get your results using a number from your test kit.
This way is not free; you do have to pay for the test kit. But you donÕt have to give your name and you can do it right in your own home.
8) Do I Have to be Stuck With a Needle?
In many places today, you do not need to be stuck with a needle for the first test. It can be done with either a simple oral swab or a small needle stick in the finger. If get a result of ÒHIV positiveÓ on the first test, you will need to give blood for the second test. But you only have to give a little bit of blood.
9) If I Get a Result of ÒHIV Positive,Ó Does That Mean IÕm Going to Develop AIDS and Die?
It doesn't have to. People who are HIV positive can make wise choices that will improve their chances of living a long, healthy life. If a person gets tested for HIV, learns they are HIV positive, and follows their doctorÕs instructions, including the use of AIDS medications where appropriate, they may be able to avoid developing AIDS for years, decades, or possibly for the rest of their life.
10) Why Should I Get Tested?
It's quick, easy, free, and your private life is protected. If you're HIV negative, it will keep you from worrying needlessly. If you're HIV positive, it can save your life and the life of your sexual partners or unborn child. Health experts tell us to get tested. So, donÕt wait. Do your part in the global fight against HIV. Get tested. This is [PRESENTER NAME].
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WORD COUNT: 2010
Information for translators:
á ÒWindow PeriodÓ is a special term used in English to describe the waiting period between when a person is first infected with HIV and when their body generates enough antibodies that an ELISA test will return a result of ÒHIV positive.Ó Please try to find out if there is a specific term used in your own language to describe the ÒWindow Period.Ó If there is not, or if you cannot find out what that term is, you could translate this as Òwaiting periodÓ or something similar.
á ÒELISAÓ and ÒWestern BlotÓ are technical terms. If there are standard names in your language for these kinds of tests that doctors use when discussing the tests with patients, use those standard names. If there are no standard names and/or these terms would just create confusion, you may translate this as Òfirst HIV testÓ and Òsecond HIV test,Ó or similar, understandable equivalents.
á ÒÒfalse negativeÓ resultÓ is another technical term. If it is too confusing in your language, you could translate this as Òincorrect HIV negative resultÓ or something similar.
o Likewise, if Òfalse positive resultÓ is too confusing, you could translate it as Òincorrect HIV positive resultÓ or something similar.
á In this script, in all cases, the phrase Òpositive resultÓ means ÒHIV positive test result,Ó not Òcertain resultÓ or Òdefinite result.Ó
á Òviral load test:Ó This test is also known as a ÒPCR testÓ / ÒPolymerase Chain Reaction test,Ó in case this helps you to identify the right translation in your language for this term. PCR is a highly technical term, and we would like to avoid using it in this script, which is why we are using the phrase Òviral load test.Ó
Script by Eric Krock and Becky Kuhn, M.D.
This script was reviewed for accuracy and approved by Becky Kuhn, M.D. on June 28, 2008.
Works Cited:
[1] http://www.hivmedicine.com/textbook/acuteinf.htm
Marcus Altfeld and Bruce D. Walker, ÒAcute HIV-1 Infection,Ó HIV Medicine, 14th Ed., 2006.
[2] Centers for Disease Control and Prevention, ÒHow long after a possible exposure should I wait to get tested for HIV?,Ó accessed 27 June 2008.
http://www.cdc.gov/hiv/topics/testing/resources/qa/be_tested.htm#wait
[3] Chou et al, Annals of
Internal Medicine, 5 July 05, vol 143, #1, p 55-73.
[4] Chou, 2005.
Other References:
ÒELISA,Ó accessed 28 June 2008, http://en.wikipedia.org/wiki/ELISA_test
Gallant, Joel E., MD, MPH. "The HIV-Positive Patient: The Initial Encounter." 7 May 2002. MedScape Today. Accessed 28 June 2008.
"HIV test," http://en.wikipedia.org/wiki/Hiv_test
"Sensitivity and specificity," http://en.wikipedia.org/wiki/Sensitivity_(tests)
"Type I and type II errors," http://en.wikipedia.org/wiki/Type_I_and_type_II_errors
ÒWestern blot,Ó accessed 27 June 2008, http://en.wikipedia.org/wiki/Western_Blot