The only way to get treatment for HIV and/or AIDS is to know that you have it. The first step to finding out if you have HIV is getting tested. So how does testing work?
Anyone in a high-risk group or whose circumstances could have allowed them to be exposed to HIV should get tested. There are several options for tests that work in different ways.
After understanding who should be tested and how, the next steps involve knowing what to do when you receive your results.
Who Should Get Tested for HIV/AIDS?
Anyone who has participated in activities that put them at risk for HIV should be tested for it. If you continue to engage in those activities, you should be tested on a regular basis, at least once a year.
The two most common activities that lead to HIV infection are unprotected sex and intravenous drug use. The Centers for Disease Control and Prevention (CDC) offers five questions to ask yourself to find out if you are especially at high risk for HIV:
- Have you injected drugs or steroids or shared equipment (such as needles, syringes, works) with others?
- Have you had unprotected vaginal, anal, or oral sex with men who have sex with men, multiple partners or anonymous partners?
- Have you exchanged sex for drugs or money?
- Have you been diagnosed with or treated for hepatitis, tuberculosis (TB) or a sexually transmitted disease (STD), like syphilis?
- Have you had unprotected sex with someone who could answer yes to any of the above questions?
If you answer yes to any of these questions, you should get tested.
You can get tested at local health departments, your doctor's office, hospitals and clinics. You can also use a home-based testing kit. The only home-based testing kit approved by the Food and Drug Administration (FDA) is the Home Access HIV-1 Test System, available at most drug stores.
If you use the home-based kit, you will prick your finger to put blood droplets on a card and mail it off to the laboratory. Telephone counselors are available to talk to before you take the test, while you wait for the results and after you get your results.
How Does the Test Work?
There are several different types of HIV tests, and there are two different ways they can work.
The most common way is to test your blood for antibodies to HIV. Your saliva or urine can also be tested, but this is less common than blood testing.
Antibodies are the body's disease-fighting cells, but they are specific to one disease. They will only show up for that disease if you have it, so having antibodies trying to fight HIV suggests you have HIV.
However, it takes time for the body to make antibodies after you are infected. On average, it takes 25 days for a person to build up enough antibodies that can be detected on a test, but it can take three months for many others.
If you test negative within the first three months after you might have been exposed to HIV, you should get tested again three months after the possible exposure time. In rare situations it can even take six months, but this only occurs in about 3 percent or less of the population.
Typically, it takes a few days to get test results, including if you use the home-based kit. You can also use a rapid screening test that provides results in about 20 minutes based on a finger prick or oral fluid that is not saliva.
If either of these tests is positive for HIV, you should always get a second test to confirm the diagnosis.
There is another type of test that can detect an HIV infection faster, within about a week and a half to two weeks, but it is not available everywhere. It's called an RNA test, and it looks for a protein produced by HIV that can be detected within a few days after you are infected. These tests are more expensive and less common, and they are only available in some parts of the US.
What Happens After You Get Tested
If your test results come back negative, you may want to retest if your possible exposure to HIV was less than three months earlier. If you are in a group that is at a high risk for contracting HIV, you should discuss with a healthcare provider how frequently you should get tested.
Meanwhile, be sure to protect yourself and any partners from infection through preventive behaviors, like using a condom for all forms of sexual contact and not sharing needles for intravenous drugs.
Also, just because you test negative does not mean that your partner or partners are also negative for HIV. Any person at risk for HIV should get tested, and their results apply only to their HIV status.
If you test positive for HIV, you should get a second test, usually one called a "Western blot," to confirm the results. If you have HIV, the next step is to see a healthcare provider.
Your doctor will first do some tests to find out how advanced your disease is. There are three main tests you should expect to take to find out more about the course of your disease.
In a CD4 count test, you will find out how many of your white blood cells that HIV has killed. A healthy count ranges from 500 to 1,000. A person is diagnosed with AIDS when the CD4 count drops below 200.
A test for your "viral load" measures how much of the HIV virus is in your blood. Just because you have the virus does not mean it has reproduced a great deal in your body. Patients who have lower viral loads typically do better than those who have higher viral loads.
Another important blood test will help doctors learn whether the strain of HIV in your body is typically resistant to certain types of medications used to fight HIV. Knowing which medications most likely will and will not work for you will help your doctors develop an effective treatment plan.
Meanwhile, if you smoke, drink a lot of alcohol or use illegal drugs, you should seek help to stop using these substances. They can weaken your immune system and make it harder for your body to fight HIV.
And Then What?
Finding out that you have HIV can be a very emotional experience. It is important to realize that you may go through a variety of emotions and that you may be at risk for anxiety and/or depression.
If you find out you have HIV, contact a therapist or ask your doctor for a recommendation of someone to talk to about your feelings and how you want to share the news with others. The stronger your support system is, the better your future will most likely be.
In the early stages of seeing a doctor, your provider will probably order a variety of tests to see if you have additional infections or complications that can be caused by HIV or AIDS or that can make the disease harder to treat or fight.
These tests might look for hepatitis, tuberculosis, toxoplasmosis, liver or kidney damage, a urinary tract infection or other sexually transmitted infections.
Not everyone will necessarily begin treatment right away, but there are certain people who definitely are recommended to start treatment immediately.
If you are pregnant or you have severe symptoms, you should begin treatment right away. There are medications you can take while pregnant that reduce the risk of giving your baby HIV.
Also, if you have an HIV-related kidney disease, are being treated for hepatitis B or have a CD4 count under 500, your doctor should begin your treatment immediately.
Plan to ask your doctor questions about what to expect and anything you do not understand. Side effects of HIV treatment can involve a number of difficult conditions, including nausea, vomiting, diarrhea, skin rash, weakened bones, shortness of breath and abnormal heartbeats.
The more you know about what to expect, the better prepared you will be for your treatment.
If you want specific information on HIV treatments, you can call AIDSinfo, run by the Department of Health and Human Services, at 1-800-448-0440.