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Braving An HIV Test

"Gee, I must really care for you, because I've never considered doing this before. Not even for myself."

Justin rolled up the sleeve of his grey sport shirt and braced for the needle as Becky looked on. As their friendship grew, Justin had opened up about his turbulent past, including drug use and promiscuity. And as the relationship turned romantic, Becky issued an ultimatum: No sex without an HIV test.

They were tested together. And they returned together for the results, trembling as the lab technician handed them plain white envelopes. They opened them in a stairwell outside the clinic. When Justin saw the results — negative for both of them — he dropped to one knee and proposed to Becky, right then and there.

"He was dead serious," Becky says. "He felt the gods were smiling on him. It was like a reprieve from his past sins."

Two years later, there are still no wedding vows. But Becky and Justin live together happily in the mountains above Asheville, N.C. The test results are pinned to a billboard in their home, a reminder of an experience that galvanized their relationship.

"It really solidified a friendship," Becky says. "And it made us realize the emotional support we could give each other."

"Justin" and "Becky" asked for their real names to be withheld to protect their privacy.

One of out of three people infected with HIV in the United States doesn't know it, according to the CDC. Many of them are unknowingly spreading the disease to people they love.

If you're sexually active and haven't been tested, there are two things you should know:

  • HIV is no longer a death sentence. Thanks to new medications, many people with HIV can live their natural lifespan without developing AIDS.
  • At many places you can get tested anonymously, so that nobody — not your parents, siblings, friends, or teachers — will find out about the test. Thanks to new tests, you won't even have to suffer a needle jab.

    This article will help you prepare for your test. It will tell you when and where to get tested, what a test is like, and what to expect when you get the results.

    When To Test

    "Basically, anyone who has had more than one sex partner should be tested," says John Flaherty, M.D., director of the HIV Center at Northwestern Memorial Hospital in Chicago. "If you're having new partners from one year to the next, you should be tested on a routine basis, even if you're using safer-sex techniques."

    Too many people come to Flaherty's clinic sick only after their HIV infection has developed into full-blown AIDS — in other words, too late to treat. They could have survived into old age if they had only been tested and treated earlier.

    Some people believe there's no point in getting tested because HIV is fatal, says Chris Hubbard, of the Whitman-Walker HIV clinic in Washington. They're not aware that medication makes living with HIV manageable.

    Others fear they won't be able to afford treatment if they test positive, Hubbard says. But even the poorest patients can get affordable medication through programs such as Medicaid, he says.

    Many younger people don't get tested because they feel healthy. But it often takes several years until people with the HIV virus develop the first signs of AIDS, says Amneris Luque, M.D., director of the HIV clinic at Strong Memorial Hospital in Rochester, N.Y.

    There is one important exception, Luque says. In about half of all cases, Luque says, a person will get an acute infection within a few days of contracting the HIV virus. The tragedy is that doctors may confuse this infection with flu or mononucleosis. The real cause may not be known for years.

    If you come down with flu-like symptoms soon after a risky sexual encounter — such as unprotected sex — or a drug-related episode such as needle sharing, that's a good time to get tested, Luque says.

  • It's also useful to know about the "window period." After a person contracts the HIV virus, it may take up to three months before he develops the HIV antibodies that the tests pick up. If you've had a risky encounter, you may want to wait three months before getting tested (unless you get signs of a viral infection). In rare cases, it may take up to six months before antibodies develop.

    Where To Get Tested

    You can get tested at many different locations, including doctors' offices, clinics, Planned Parenthood centers, hospitals and the lab test centers found at malls. At some sites you'll have to make an appointment; others allow walk-ins.

    At most of these places, they'll ask you about your sexual and drug use history, either in person or through a questionnaire. The testing procedure is similar at most places, but it can vary in some important ways:

  • Blood test or oral tests. You don't have to face a needle for an HIV test these days. Some places only require a finger prick. Others collect your saliva by putting a swab inside your mouth.
  • Slow or rapid results. At some locations, you'll be asked to wait several days for your results. At others, you may get results as quickly as 20 minutes. With rapid testing, you'll know right away if you're negative. If the test comes back positive, however, you may have to wait a few days while a second test is done to confirm the first test. At a site where you must wait several days, the second test will already have been done when you come in for the results.
  • Anonymous or confidential testing. They're not the same. Confidential test results become part of your medical record. Your health care provider and insurer may learn the results. If someone else is paying your insurance bill (for example, your parents), then they may learn at least that you've had a lab test. By contrast, anonymous test results are known only by you. In many areas, anonymous (and free) testing is available through your local public health department. Use the Yellow Pages or Internet to look up the public health department for your area.

    If you're really worried about confidentiality, you can even get tested at home. The FDA has approved one test, dubbed Home Access, which is available at most drugstores. The test kit requires you to mail in a blood sample to the Home Access Corporation's labs. The FDA warns that "rapid" home tests sold over the Internet may not provide reliable results.

    Getting The Results

    In one episode of the TV series Sex and the City, Samantha gets her first HIV test. As she waits for the results in a clinic, a doctor leads her into a private room to discuss her results. Certain that this is the signal she is positive, she collapses as she approaches the door. Actually, she was negative; the doctor just wanted to lecture her on the importance of safe sex.

    When it comes to telling you the results, different testing sites will have different customs. Some sites will notify you of negative results by phone, but require you to come in for positive results. Other sites will require you to come in either way (the Home Access kit provides pre- and post-test counseling by phone).

    It's no surprise that people who have been told they're HIV-positive are in a vulnerable state. Keep in mind that specialized HIV testing sites or clinics may provide more extensive counseling than, say, a general lab test center or a local doctor.

    If a test is positive, "I emphasize that this can be managed, it can be treated, you can have a full, long life," says Stacey Vlahakis, M.D., of the HIV center at the Mayo Clinic in Rochester, Minn.

    In fact, many HIV patients can manage well with just a single one-a-day treatment. But Vlahakis leaves out discussion of treatment options, further testing, and social support for subsequent visits. "Usually they remember nothing from that first visit," she adds.

    If a test turns up negative, "I tell them they're negative for now," Vlahakis says. "It doesn't mean they'll be negative forever. You still have to use condoms with any partner and any kind of sex, and to never share needles or blood products."

    That includes being careful of tattoo parlors, which can transmit diseases such as HIV or hepatitis C through unclean needles or machinery, Vlahakis says.

    Sources: HIV InSite educational Web site, University of California at San Francisco, "For Patients and the Public." CDC National HIV Testing Resources, "FAQs About HIV and HIV Testing." John Flaherty, M.D., Director, HIV Center, Northwestern Memorial Hospital, Chicago. Chris Hubbard, Program Manager, HIV Rapid Testing Unit, Whitman-Walker Clinic, Washington. Amneris Luque, M.D., director, HIV clinic, Strong Memorial Hospital, Rochester, N.Y. Stacey Vlahakis, M.D., Mayo Clinic, Rochester, Minn.

    By Richard Sine
    Reviewed by Charlotte E. Mathis, M.D.
    © 2006, WebMD Inc. All rights reserved