Know Your Status - Keeping The Promise

HIV Antibody Tests

As the body fights viruses, it creates antibodies to that virus. HIV antibody tests measure the presence of antibodies to HIV. They do not measure or detect the virus itself. There are three commonly used antibody tests. Advances in HIV testing in the Caribbean, have resulted in a faster turn-around between taking the test and obtaining your result.

Knowledge is your power - the following are the advantages to knowing your status:

• Anyone who worries about possible past risks of exposure to HIV can relieve her/his mind
• Some people avoid testing because of fear that the test might be positive. Many are immensely relieved to discover that they are not infected
• Those who do test positive usually find it's better to know: there are now a variety of early treatment options that postpone the onset of illness
• Knowing one's test results means not only being able to protect oneself and future partners from infection but also to avoid passing the virus to one's children. Pregnant women who seek treatment for HIV infection significantly reduce the risk that a child will be born infected with HIV
• Many people seek tests for HIV and other sexually transmissible infections (STIs) before starting a new sexually active relationship. Since all these infections are often present without apparent symptoms, negative tests can be very reassuring

Window Period

The "window period" is the time it takes for a person who has been infected with HIV to seroconvert (test positive) for HIV antibodies. The Centers for Disease Control (CDC) says about the window period:

• Antibodies generally appear within three months after infection with HIV, but may take up to six months in some persons
• This CDC definition of a three to six month window period has been commonly used for a number of years and is most often used

What does this mean for you?

• The three month window period is normal for most of the population. Many people will have detectable antibodies in three or four weeks. Very, very rarely (i.e., only a few cases ever), a person could take six months to produce antibodies
• You may be anxious to be tested soon after an encounter which you perceive to be risky (and in many cases, the encounter actually isn't risky). You want to know: can I be antibody tested without waiting three months? How accurate is the test after, say, six weeks?  - Unfortunately, we don't know
• Think about this: if you got a negative test at six weeks, would you believe it? Would it make you less anxious? If so, go for it. But to be certain, you will need to be tested again at three months

You may have "heard" that AIDS/HIV can take years to be detectable. Here's the clarification: AIDS, or the clinical symptoms that define it, takes many years to develop after exposure. HIV -- the virus that causes AIDS -- is usually detectable within three months after exposure, and does not cause symptoms in most people.

Interpretation of Test Results

A positive result means:

• You are HIV-positive (carrying the virus that causes AIDS)
• You can infect others and should try to take precautions to prevent doing so

A positive result does NOT mean:

• You have AIDS
• You will necessarily get AIDS
• You are immune to AIDS, even though you have antibodies

A negative result means:

• No HIV antibodies were found in your blood at this time

A negative result does NOT mean:

• You are not infected with HIV (you may still be in the "window period").
• You are immune to AIDS
• You have a "resistance" to infection
• You will never get AIDS. You may wish to consider avoiding unsafe activities to protect yourself

An indeterminate result (which is rare) means:

• The Western Blot (WB) result is unclear. The entire HIV test must be repeated with a new blood sample, usually several weeks after the first blood test
• Indeterminate results usually occur if the test is performed just as the person begins to seroconvert

The Three Kinds of HIV Antibody Tests - Blood Draw

ELISA
The ELISA is almost always the first screening tool; it is inexpensive and very sensitive. In most cases, a blood sample is tested, but other types of ELISAs that use saliva and urine have also been developed. The actual ELISA takes 3.5 to 4 hours, but most test sites send samples to outside labs, where they are tested in batches, so you may have to wait one to two weeks for results.

Western Blot (WB) assay
The WB is a confirmatory test: it is only performed if the ELISA is positive. The WB can be positive, negative, or indeterminate. Indeterminate tests are neither positive nor negative. An indeterminate result usually means that a person has just begun to seroconvert at the time of their test. In the rare cases in which this occurs, the person will need to be retested, usually about one month later. False positive results are extremely rare with the WB, so it confirms (proves) that HIV antibodies are present.

Indirect Immunofluorescence assay (IFA)
The IFA can be used instead of the WB to confirm ELISA results. Like the WB, it uses a blood sample. Because it is faster than a WB, some labs that use it can get results to the client more quickly.

Private Testing

Private testing is the most private and confidential way of being HIV tested. There are doctor and labs costs for these services, but many persons prefer this option for the following reasons:

• You can make an appointment with your choice of doctor at your convenience
• You can and should insist that the doctor provide pre and post test counselling
• You can insist to be confidentially tested. For example using a code other than your name and contact
• Many doctors offices will send your blood to the testing labs and have your results sent back to them. This way you may have less of a run around, but does take a longer time to obtain your test result
• Some institutions in the Caribbean are being developed to provide Private Testing at subsidised costs and all-in-one facilities to include Pre and Post Testing Counselling, blood draw and collection of your test result

Though there are developments in the Caribbean to insure that testing labs provide pre and post test counselling, in fact many of them rarely do. This leads to additional forms of anxiety, uncertainty and questions concerning the accuracy of the test and its results

Private Testing Guidelines

• You will need a Doctor’s appointment to obtain a Doctor’s letter of referral or have your blood sent to the testing lab. Make sure and be as honest about your lifestyle and sexual activities to the Doctor you choose. Remember all Doctors are authorised to provide you with Pre and Post Test Counselling. This is known as VCT – Voluntary Counselling and Testing
• You also can insist that you be confidentiality tested to protect your privacy. This is usually done by providing your doctor with your Initials and Date of Birth e.g. John Brown will be coded as BJ1984
• Your Doctor is responsible to contact you to collect your results and also to provide what is called Post Test Counselling. You should insist that Post Test Counselling is conducted, no matter what the result is
• Post Test Counselling is essential to effective HIV Testing. It allows you to ask any additional questions now that you know your result, provide you with guidelines as how to continue to protect yourself and your partner and reinforce your concerns regarding the accuracy of the test
• You can choose to go directly to the testing lab to speed- up the testing period. Discuss these options with your doctor and choose what is best for you. Dependant on your situation, some doctors may recommend that you return to the testing lab to collect your results. Though this may save on your time and run-around, it is advised that you return to your doctor for post counselling

MSMNPA Research. Source - San Francisco AIDS Foundation - http://www.sfaf.org/aids101/hiv_testing.html 

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