HIV Testing

Submitted on Dec 9, 2022

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A blue neon sign that reads "Free HIV testing".

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Table of Contents

What Is an HIV Test?

An HIV test can tell you if you have HIV, the virus that can cause AIDS. For some, getting tested for HIV can be scary. However, it can also be a very important way to say "yes" to your life and your health.

The only way to know if you are living with HIV (to know your 'status') is to get tested. If you are worried because you think you may have been exposed to HIV, get tested. Then, if you learn that you are negative (not living with HIV), you can stop worrying. There are many ways to remain HIV-negative. For more information, see our fact sheet on how HIV is spread and how to avoid transmission.

The bottom line – it is important to know your HIV status and to get regular HIV tests. There are several types of HIV tests, which are described below.

Why and Whom to Test for HIV

It is a good idea to get tested for HIV before beginning a new sexual relationship, regardless of your age.

Do you know your HIV status - or your partner's HIV status? If not, it is important for you to get tested for HIV. Did you just have unprotected sex, use someone else's needle, have a condom break, or learn that a previous sexual partner is living with HIV? Are you pregnant or planning to become pregnant? These are all important reasons to get tested for HIV.

Recent research has shown that someone living with HIV who is on effective treatment and whose viral load is below the limits detected with standard tests cannot pass the virus on to his or her sexual partner (U=U). Despite this exciting development, you should still get tested for HIV, if your partner lives with HIV.

Getting tested for HIV is part of routine, regular health care in many countries. The Public Health Agency of Canada, for example, recommends that HIV testing be discussed as part of routine medical care. The US Centers for Disease Control and Prevention (CDC) now recommends testing all people ages 13 to 64. It also recommends that people are tested every year, if they have had a new partner, shared needles with anyone, have had condomless anal sex or have engaged in other behaviors that carry a risk of HIV transmission. It is also a good idea to get tested for HIV before beginning a new sexual relationship, regardless of your age. This is just as important for teens as it is for older adults.

The World Health Organization (WHO) makes different suggestions based on where you live. Where HIV is widespread, it recommends that HIV testing be offered to anyone who goes to a healthcare facility. Where HIV is less common, it suggests that HIV tests be offered to people who may be at higher risk of having been exposed to HIV.

Certain groups of people are considered at higher risk of HIV exposure and therefore should be tested for HIV at least once a year:

  • People who have had more than one sexual partner since their last test or who have had sex with someone who has more than one sexual partner
  • Sexual partners of people living with HIV
  • People who inject drugs and their sexual partners
  • People who exchange money or goods for sex, or exchange sex for drugs

It is also important to get tested for HIV when:

Where to Get Tested

There are many different types of places where you can get an HIV test. These include health clinics, private health care providers' offices, HIV testing centers, and health departments. There are also HIV tests you can order online or buy over the counter at stores that have pharmacies (such as CVS, Walgreens, Walmart in the US). These tests allow you to collect a sample or complete a full rapid test (20 minutes) in the privacy of your home.

In the US, you can go to the National HIV and STD Testing Resources website or the HIV.gov website to find a testing site near you. You can also call the CDC's information line at 800-CDC-INFO (1-800-232-4636) or call your state's HIV/AIDS hotline.

Which Test to Take and When to Take It

The type of test that is best for you depends on when you might have been exposed to HIV. Most tests, including rapid tests done at testing centers or at home, detect antibodies to HIV. Antibodies are proteins that your body makes to mark HIV for destruction by your immune system. The body takes one to three months to develop antibodies to HIV. This time between acquiring HIV and the production of antibodies is called the "window period." Therefore, the results of tests that detect antibodies are only reliable three months or more after your exposure to HIV.

If your HIV test is negative during the window period, you could still be living with HIV. If you want to get tested before the body has had a chance to produce antibodies (i.e., before the window period has passed), there are tests that look for pieces of the virus itself. These pieces of the virus or viral particles are called antigens. If an HIV antigen is in your blood, some tests can identify seroconversion as soon as two weeks after exposure to the virus.

HIV Tests

There are a few tests to identify HIV. You will first have a screening test. If that test is positive, a confirmatory test is done.

Screening Tests

Screening tests are used first.

  • If an antibody screening test is negative for HIV and you are outside the window period (3 months after your exposure), you are not living with HIV.
  • If an antigen screening test is negative for HIV two weeks or more after your exposure, you are not living with HIV.
  • If your screening test comes back positive, you will need a second test to confirm (make sure) that you are living with HIV.

Antibody tests

Antibody tests are the most common tests to screen for HIV. They look for antibodies to the HIV virus in your blood, oral fluid (not your saliva), or urine. Antibodies are proteins that your body makes to mark a germ – in this case the human immunodeficiency virus – for destruction by your immune system. If you have been exposed to HIV, your body will produce antibodies to that virus after one to three months. The period between exposure to HIV and your body's production of antibodies is called the "window period." Having a negative HIV antibody test after the window period means you have not acquired HIV.

There are several types of antibody tests for screening:

  • Rapid HIV antibody test: uses blood or oral fluid; results are available in 20 minutes. The OraQuick in-home oral HIV test is now available online or over the counter for at-home use. Rapid HIV tests are also available in clinics and HIV testing centers.
  • Home testing kit: is not so much a testing kit as a collection kit for use at home. It tells users how to put a drop of blood on a card that they then mail to a licensed laboratory. Some kits use an oral swab, which customers must swipe along their upper and lower gums to collect a sample. Customers get an identification number to use when calling the laboratory for results. The 'Home Access HIV-1 Test System' is one such test; it takes about a week to get results.

It is important to know that at-home tests like the OraQuick and Home Access HIV-1 Test System do not provide in-person counseling or link customers to appropriate care and treatment if they test positive for HIV.

  • Original blood tests: also called 'third generation' tests or enzyme immunoassay (EIA) tests, they look for antibodies. It can take up to two weeks to get the results of an EIA. These tests are no longer used where combined antibody-antigen tests are available.

Combined Antibody-Antigen Tests

Combined antibody-antigen tests (or 'fourth generation tests') combine antibody tests and antigen tests to screen for HIV. They are better at showing if you have acquired HIV around three weeks ago while still preventing results that show a person has acquired HIV when they have not (false positive). Combined antibody-antigen tests use either blood or saliva and are the recommended first-line test in many countries.

Follow-up or Confirmatory Tests

Any positive antibody or antibody-antigen test needs to be confirmed with a second test – either another HIV antibody test or a test called the Western Blot.

  • HIV-1/HIV-2 antibody differentiation immunoassay: this test looks for antibodies in the blood; there are two versions that give results in an hour or less. The test can tell if you have strain one (HIV-1) or strain two (HIV-2) of HIV, which can be important information for your provider to know when deciding what treatment is best for you. It is now being used as the recommended second, or confirmatory, test in the US.
  • Western Blot: this test looks for several different antibodies to different parts of the virus in the blood.

Viral nucleic acid tests

These tests look for HIV's genetic material in the blood and can identify an HIV infection within two to three weeks of exposure. They are generally used in special circumstances, such as:

  • Babies born to mothers living with HIV: since babies carry their mother's antibodies in their blood for up to 18 months, traditional antibody tests would produce results that are not specific to the baby
  • Testing someone with a known recent exposure, before HIV antibodies can be identified in the blood
  • Testing people who have participated in an HIV vaccine trial: these people will already have HIV antibodies in their blood
  • Testing people for whom test results have not been clear: for example, people who had a positive first test, and a negative second test (possibly because they acquired HIV very recently)

Today's HIV drugs let many people with HIV have long, healthy lives. If you test positive for HIV, it is important for you to get proper care and treatment as soon as possible.

Getting Your Test and Its Results

If you have just been told you acquired HIV, it can feel like the worst news in the world. As upsetting as this can be, you are better off knowing. Once you know you are living with HIV, you can take charge of your health and have the best chance to slow or prevent HIV disease from getting worse.

If you have acquired HIV, there are many things you can do to stay healthy. One important thing is to find a good health care provider. In the US, you may be able to get care or health insurance, even if you do not have health insurance now. For more information, see our fact sheets on Public Benefits and HIV in the US and The Affordable Care Act and Women in the US.

It is also important to begin taking HIV drugs, which will help keep your immune system healthy. The longer you live with HIV and do not receive treatment, the more likely you are to have a weakened immune system, and the harder the HIV drugs may have to work once you start taking them. Learning about HIV and its treatment will help you make the best of your situation. Some people find it helpful to join or set up a support group or to find others who share their experience (see our community of women living with HIV at A Girl Like Me). For more information, see our Did You Just Test HIV+? fact sheet.

If you have acquired HIV, there are many things you can do to stay healthy. One important thing is to find a good health care provider.

A person living with HIV who knows her status can also do things to protect the health of others. She can tell previous sexual partners that they might be at risk of having acquired HIV, practice safer sex to prevent transmitting the virus, and take HIV treatment to prevent transmitting  HIV ("treatment as prevention"). Recent studies have shown that people living with HIV who are taking HIV treatment and have an undetectable viral load cannot pass HIV on to their sexual partners. For more information, see our fact sheet on this exciting discovery, known as Undetectable Equals Untransmittable.

In addition, if a woman living with HIV is pregnant or wants to become pregnant, she can take steps to prevent her child from acquiring HIV. For more information, see our fact sheets on Pregnancy and HIV and Getting Pregnant and HIV.

Will People Find Out if I Test HIV+?

Laws about HIV confidentiality vary depending on where you live. In the US, states require that health care providers and testing clinics report the names of people living with HIV to that state's department of health. The state health department is required to keep that information confidential (not tell anyone). State registries are intended to help public health officials keep better track of the epidemic. Testing sites do not share your results with anyone else, including your primary care provider or insurance company.

The federal HIPAA law (Health Insurance Portability and Accountability Act of 1996) also protects the confidentiality of your HIV status in the US. It prevents health care or social service providers from sharing your HIV test results without your written consent (you have to sign a paper allowing them to share your results).

Testing sites do not share your results with anyone else [other than the state HIV registry], including your primary care provider or insurance company.

If you are living with HIV, many US state laws say that you have to tell sexual partners about your status. This is called disclosure. However, you do not have to disclose your HIV status to friends, family, coworkers, or your employer. For more information, see our fact sheets on Disclosure and HIVUnderstanding Your Rights and Responsibilities in the Workplace, and HIV Criminalization and Women.

Taking Care of Yourself

Getting tested for HIV is one of the best things you can do for your health. If you test negative, you can stop worrying and have a wonderful opportunity to learn how to stay HIV-negative. If you just became aware that you acquired HIV, it is common to feel angry, scared, confused, shocked, or depressed. These feelings are normal. Please get the help and support you deserve and know that there are many things you can do to stay healthy, including taking HIV drugs.

If you need help, check out this website to find an organization near you, whether it is a support group, a health clinic, an HIV provider, or an AIDS service organization. You can also call the CDC hotline at 1-800-CDC-INFO (1-800-232-4636; TTY: 1-888-232-6348), or the HIVinfo hotline at 1-800-HIV-0440 (1-800-448-0440; TTY: 1-888-480-3739; from outside the US: US+301-315-2816).

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