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 “The Top Ten Questions About HIV Tests.” My name is [PRESENTER NAME]. I’m [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 “antibodies” 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 test’s result is “HIV positive,” then you will be tested with a second test called a “Western Blot.” Only after both tests return a result of “HIV positive” 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 “HIV negative” 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 “HIV Negative” test results?

The two tests we talked about already will only return an “HIV positive” 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 “window period,” during which the first test, the second test, or both tests may return an incorrect result of “HIV negative” even though the person has actually been infected with HIV. This is why even if you get an “HIV negative” 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. It’s called the viral load test. It’s 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 hasn’t 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 “Did I Just Contract HIV? Signs of Primary HIV Infection” to learn more about how to tell if you have early HIV infection. 

If you think you may have come in contact with HIV, it’s important to get tested. If you think you have signs of early HIV infection, it’s extremely important that you be tested for HIV right away. The viral load test, if available, can be used to see if you’re 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 “HIV positive”?

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 “HIV positive.” According to the U.S. Centers for Disease Control and Prevention:2
•	On average, it takes 25 days after infection for a person’s body to respond so the first test will give a result of “HIV positive.”
•	For most people, the first test will give a result of “HIV positive” within two to eight weeks.
•	For 97 out of every 100 people who become infected with HIV, the first test will give a result of “HIV positive” within three months of being infected.
•	In very rare cases, it can take up to six months after infection for the first test to give a result of “HIV positive.”

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 “HIV positive” 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 “HIV positive” 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 “HIV positive,” but it is later shown that they are not infected with HIV, we say that the first test result was an incorrect “HIV positive” result, also known as a “false positive.” Incorrect “HIV positive” test results on the first test do happen. Pregnancy, recent flu vaccination, and diseases like lupus are some possible causes of incorrect “HIV positive” results on the first test. 

5) What's the risk of an incorrect “HIV positive” 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 “HIV positive” 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 “HIV positive” 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 “HIV positive” results on both the first and second test, only one person’s 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.  Don’t let the fact that you don’t have health insurance or can’t 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 don’t want to give your name, there are several ways you can do this. Let’s 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 “Confidential, Name-Based Testing.” If you don’t want to give your real name, you don’t have to. Don’t 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 don’t 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 don’t 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 “HIV positive” 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 “HIV Positive,” Does That Mean I’m 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 doctor’s 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, don’t 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:
•	“Window Period” 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 “HIV positive.” Please try to find out if there is a specific term used in your own language to describe the “Window Period.” If there is not, or if you cannot find out what that term is, you could translate this as “waiting period” or something similar.
•	“ELISA” and “Western Blot” 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 “first HIV test” and “second HIV test,” or similar, understandable equivalents.
•	 ““false negative” result” is another technical term. If it is too confusing in your language, you could translate this as “incorrect HIV negative result” or something similar. 
o	Likewise, if “false positive result” is too confusing, you could translate it as “incorrect HIV positive result” or something similar.
•	In this script, in all cases, the phrase “positive result” means “HIV positive test result,” not “certain result” or “definite result.”
•	“viral load test:” This test is also known as a “PCR test” / “Polymerase Chain Reaction test,” 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 “viral load test.” 
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, “Acute HIV-1 Infection,” HIV Medicine, 14th Ed., 2006.

[2] Centers for Disease Control and Prevention, “How long after a possible exposure should I wait to get tested for HIV?,” 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:

“ELISA,” 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

“Western blot,” accessed 27 June 2008, http://en.wikipedia.org/wiki/Western_Blot