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Testing practices (HIV)

HIV stands for Human Immunodeficiency Virus.

Going for an HIV test can be intimidating and very scary. This is completely normal. So it is very important that you are fully prepared when you go for the test. Try this: think about the possible consequences of having both positive and negative results. Also, think about who you would tell, if anybody, if you were HIV positive – in other words, who you would be able to count on for support.

The Advantages of Testing for HIV:

  • If you test positive, you can learn more about HIV and decide how to take care of your health. Early diagnosis and treatment can help you stay healthier for a longer period of time.
  • By taking the test you are taking control of your life and your health.
  • Taking the test takes away the anxiety of not knowing. Sometimes it is worse not to know, which can cause ongoing unnecessary stress.
  • The longer HIV and STIs are left undiagnosed and untreated, the more serious health problems they can cause.
  • If you know your status, you can better protect yourself and your sexual partners.
  • Free treatment is available in the public health sector and all medical aids must now provide treatment for people living with HIV.

A few points to consider when testing for HIV:

  • If you test HIV positive, your partner might blame and reject you. If you were both negative at the beginning of your relationship, it means that one of you has had unprotected sex outside of the relationship. This may cause a great deal of distrust and anger.
  • There is still a lot of fear, shame and blame around HIV. Stigmatising attitudes can spill over into actual discrimination.
  • Sometimes internal stigma can lead to low self esteem and social withdrawal in people living with HIV.
  • Testing positive may mean disclosing to others and this can be stressful as the outcome is mostly uncertain.
  • It is not always easy to tell potential sexual partners you are HIV positive.
  • Getting good treatment is not always a simple matter.
  • Depression and anxiety can affect your quality of life.

What’s the point? I’m sure I’m HIV positive already!

Even if you have had unprotected sex previously or are currently engaging in risky casual sex, or if you are in a “monogamous” relationship where you have had unprotected sex once or several times over the last few months, it does not mean that all is lost! It is never too late to start afresh and to have an HIV test to kick-start your own determination. Remember that there is no accurate way of knowing your status unless you go for an HIV test.

Many guys think that:

  • The test is too complicated;
  • The tests are not accurate;
  • They will not cope with the result;
  • A positive result will be the end; or
  • They are already positive “so what’s the point?”

Open your mind to the possibility that you could be HIV negative and make a decision to find out what your HIV status is. If you are already in a relationship, make a plan to go for a test together. Remember that there is no way of knowing your status, as individuals or as a couple, unless you go for a test. You could both still be lucky and be negative. If you do test positive this will be hard but at least you are in a position to make some good decisions.

Testing for HIV – What to expect?

Informed consent

It is a legal and ethical requirement that all HIV testing be accompanied by informed consent. Consent has two parts to it – information and permission. With an HIV test, a person must know what the test is, why it is being done and what the result will mean before agreeing to go ahead with the test. A person may not be forced or tricked into consenting to testing or treatment.
Your right to confidentiality

Ethical and legal rules say that doctors, nurses and other health care workers must keep all patient information confidential. This means that any information about your test, any illness or treatment, or HIV status, can only be given to another person with your consent. Therefore, a health care worker cannot tell your family, employers, friends, other health care workers, or sexual partner of your HIV positive status.

There are only very few exceptions where this does not hold true, and where the health care worker is allowed to tell someone else without your permission. In such cases you will be counselled extensively beforehand. If you still did not want to disclose, you would be notified by the health care worker of their intent to disclose your status even without your permission. But the health care worker needs valid reasons for doing so. An example of this would be when you refuse to tell your regular partner you are HIV positive and there is a chance he is not yet HIV positive.

In some medical settings, such as a hospital ward, or an ARV treatment site, all people treating you will know your HIV status. This is called shared confidentiality and it ensures that you are getting the best possible treatment. This should be explained to you when you first enter that medical setting (although this does not always happen).

In South Africa, a health care worker is not required to tell the health care authorities (the government) that you have tested positive for HIV or have AIDS.

Pre- and post-test counselling

Every HIV test should be accompanied by pre-test counselling. This is where you have a discussion with a trained counsellor about the nature of the test, the reasons why it is being done and how the result, whether positive or negative, could affect you. Following this, you are asked for your informed consent, which means having all the necessary information to give permission to go ahead with the test. Pre-test counselling is a legal and ethical requirement and no one can force you to have a test against your will. Pre-test counselling should never be rushed or done in a routine way – the HIV test result can have an important impact on your future, whether you test HIV positive or HIV negative.

Once the test has been completed it is important that you also have post-test counselling. At the post-test session, the results of the test will be presented to you and the counsellor will discuss the meaning of the results and provide you with information on the way forward. Post-test counselling is required even if your test result is negative, in which case the counsellor will discuss with you how best you can stay negative. If your test result is positive, the counsellor will discuss the way forward, in terms of health and treatment issues, disclosure and support. A positive result may feel like the end of the world but in time most people make an adjustment to being HIV positive and learn to integrate this into their lifestyle.

Types of tests

There are a number of different types of tests for HIV. Most look for the presence of antibodies for HIV in the blood. Antibodies are special protein complexes that are produced by the immune system that attack and neutralise specific disease-causing organisms. The antibodies, which the body creates in response to HIV, are unfortunately powerless to protect against the long-term destructive effects of HIV on the human body.

The most common HIV test is a blood test. The following blood tests can be used to diagnose HIV:

  • Rapid test – results are available within 10 minutes after a sample is taken (this test is most commonly used in the public health sector as a screening test).
  • ELISA – looks for antibodies against HIV.
  • Western Blot – to confirm a positive ELISA test.
  • P24 Antigen test – measure the proteins of the virus.
  • PCR – detects viral genetic material.
  • Saliva test – tests saliva rather than blood (normally used as a screening test).

The ELISA test is commonly used as a screening test (especially in the private sector) but the new “rapid test”, based on the ELISA test, is the most common test in the public sector. The P24 Antigen test and PCR are not widely used in South Africa because they are more expensive than the other two. The saliva test is a non-blood test which works on the same principles as the rapid tests, i.e. it is antibody based.

A positive result for any HIV test should be confirmed with a second test. Antibody test results for HIV are accurate more than 99 percent of the time.

Test Results

Now is the time for you to think about the following:

  • Make a plan to go for regular HIV tests.
  • Think about your safer sex options and try incorporating these into your sex life.
  • Set your limits beforehand and stick to them.
  • Get an adequate supply of lube and condoms and make sure they are easy to find when you need them.
  • Talk to your partner(s) in advance so that they know your limits.
  • Never make the dangerous assumption that you can tell if a current or potential sex partner has an STI or HIV just by looking at him.
  • Don’t let alcohol or drugs cloud your judgement. Don’t kid yourself by thinking that it won’t. You should have some idea how you react when you are under the influence of drugs or alcohol. It is perhaps a good idea to put certain plans in place in case your judgement does become impaired (for example, go clubbing with a friend you trust and tell him to make sure you go home alone, or that he carries condoms and lube and gives them to you if you leave with someone else).
  • Don’t give up if you had an unsafe encounter – it’s never too late to start over.
  • What if I test HIV Positive?

It may not be the test that is daunting for you but the consequences of a positive result. Here we start to look at some of the challenging aspects that you may find difficult to think about.
Your right to disclose

You can choose who, when and how to disclose your HIV status. Think carefully about who you would tell if you tested positive and why you would tell them – this is one of the things that will be discussed with you during your pre and post-test counselling – as you will most probably only want supportive friends and family to know your results.

There are various advantages and challenges to disclosing your HIV status. The advantages of disclosing include:

  • It can help you accept your HIV positive status and reduce the stress of coping on your own.
  • You can get necessary emotional and other support – You will have supportive family and friends (those who you have chosen to tell) who will help you deal with HIV and AIDS and you won’t be on your own.
  • If you disclose to your sexual partner(s), he/they can also go to test to determine their status. You can engage in safer sex every time to ensure that the risk of infection or re-infection is minimised.

The challenges may include:

  • You may be rejected because the stigma associated with HIV is still so prevalent.
  • While your friends and family (whoever you have chosen to disclose to) may try to be supportive, they may start to change in the way they treat you. This may lead to a change in your relationship.
  • Your sexual partner(s) may reject you because of their fears and prejudices.

Your psychological reaction to a positive test result may vary.