Should You Seek HIV Counseling and Testing?

If you have engaged in behavior that can transmit HIV, it is very important that you consider counseling and testing. The following checklist will help you assess your degree of risk.

At Risk

There is evidence that HIV, the virus that causes AIDS, has been in the U.S. at least since 1978. The following are known risk factors for HIV. If you answer yes to any of these questions, you should definitely seek counseling and testing. You may be at increased risk infection if any of the following apply to you since 1978.

• Have you shared needles or syringes to inject drugs or steroids?
• If you are a male, have you had unprotected sex with other males?
• Have you had unprotected sex with someone who you know or suspect was infected with HIV?
• Have you had a sexually transmitted disease (STD)?
• Have you received a blood transfusion or blood clotting factor between 1978 and 1985?
• Have you had unprotected sex with someone who would answer yes to any of the above questions?

If you have had sex with someone and you didn't know their risk behavior, or you have had many sex partners, then you have increased the chances that you might be HIV infected.

If you plan to become pregnant, counseling and testing is even more important. Without treatment, HIV-infected women have about a one in four chance of infecting their baby during pregnancy or delivery. Medical treatment can reduce this to about a 1 in 12 chance.

Reasons for Seeking Testing and Counseling for HIV/AIDS

People consider counseling and testing for a number of reasons, some of which may apply to you:

• Knowing whether you have HIV infection would alert you to your need to seek medical care to prevent or delay life-threatening illness. Your test result (positive or negative) would also help your doctor determine the cause and best treatment of various illnesses you may have now or in the future. For example, if you are HIV positive, tuberculosis (TB) and syphilis are treated differently than if you are HIV negative.

• If you find out you are infected, knowing your result would help you protect your sex partner(s) from infection and illness. If they are not infected, you can avoid infecting them.

• Knowing your result would help you assess the safety of having a child.

• Knowing your result, even if you are infected (positive test result) may be less stressful for some people than the anxiety of thinking you might be infected but not knowing. If your result indicates you are not infected (negative), you can take action to be sure you don't become infected in the future.

Reasons for Not Seeking Testing and Counseling for HIV/AIDS

People may not seek counseling and testing for a number of reasons. For instance, if they are certain they have never engaged in behavior that could infect them with HIV, or had a blood transfusion, they do not need to be counseled and tested. Other reasons are less clear-cut. For instance, they think the stress of a positive test result - and the issues it would raise among family members, friends, and sex partners - would be more harmful than not knowing if they are infected. Perhaps they fear that others may find out their result without their permission. They might also be concerned about discrimination; some people have been denied housing, jobs, and insurance because they have HIV infection.

Many people are troubled by these concerns. You should decide for yourself whether these concerns outweigh the benefits of testing and early medical attention. The latest medical knowledge gives added weight to the benefits of knowing if you are infected. If you have any doubts about what you should do, get counseling. Then you can decide whether to go ahead with testing. However, if you decide not to be tested you should prevent the transmission of any possible HIV in your body to sex or needle sharing partners.

Understanding the HIV Counseling and Testing Process

It is very important that you understand the confidentiality policies of the testing center. Ask your testing counselor how they will protect your test results. Most counseling and testing centers follow one of two policies:

• Confidential Testing. The confidential testing site records your name with the test result. They will keep your record secret from everybody except medical personnel or, in some states, the state health department. You should ask who will know the result and how it will be stored. If you have your HIV antibody test done confidentially, you can sign a release form to have your test result sent to your doctor.

• Anonymous Testing (not available in all states). No one asks your name. You are the only one who can tell anyone else your test result.

If you wish to be tested, ask your health department, doctor, or the CDC National AIDS Hotline (1-800-342-AIDS) about the location of facilities near you.

Deciding Where to Go for Testing and Counseling for HIV/AIDS

Depending on the area where you live, there are different counseling and testing places from which to choose. These options include publicly funded HIV testing centers, community health clinics, sexually transmitted disease (STD) clinics, family planning clinics, hospital clinics, drug treatment facilities, TB clinics, and your doctor's office. In making your choice, you may want to consider these factors:

• If you have been to a particular place for health care before for other reasons, you may feel comfortable with the staff who will counsel you and offer you testing.

• If the center can provide immune system monitoring and medical care if you are infected with HIV, it might speed up the beginning of your medical treatment.

• Some counseling and testing centers offer special features. For instance, if you use drugs, you can receive counseling, testing, and help for addiction at a drug treatment facility.

At some centers, such as doctors' offices or clinics, information about your test result may become part of your medical record and may be seen by healthcare workers, insurers, or employers. Your status may become known to your insurance company if you make a claim for health insurance benefits or apply for life insurance or disability insurance. If any health care provider proposes to test you for HIV antibodies, discuss the reasons and the potential benefits before deciding whether or not to take the test.

You can call the CDC National AIDS Hotline (1-800-342-AIDS) to get the address of places where you can get counseling and testing. Do not go to a hospital emergency room to be counseled and tested. You should go to an emergency room only if you have a health problem that demands urgent attention. Also, do not give blood at a blood donation center as a way to get tested for HIV antibodies. Blood donation centers are not HIV-antibody counseling and testing centers and should not be used as such.

The Process of Testing and Counseling for HIV/AIDS

Counseling: You should be given materials to read before you enter a group or private session with a counselor or doctor. He or she might ask why you want to be tested. Your counselor should also ask about your behavior and that of your sex partner(s). This will help your counselor and you to determine whether testing is appropriate for you. If testing is appropriate, your counselor or doctor should:

• Describe the test and how it is done.
• Explain AIDS and the way HIV infection is spread.
• Discuss ways to prevent the spread of HIV.
• Explain the confidentiality of the test results.
• Discuss the meaning of possible test results.
• Ask what impact you think the test result will have on you.
• Address the question of whom you might tell about your result.
• Discuss the importance of telling your sex and/or drug using partner(s) if the result indicates HIV infection.

If these questions are not covered, or if you have any other questions, ask them. You should come prepared with questions that have been on your mind. Also, ask your doctor or counselor how you will be told of the test result. If your test result is negative, the post-test counselor will talk to you about how to avoid behaviors that will put you at risk.

• Informed Consent. You have the right to refuse any medical procedure, to be fully informed about it, and to agree to it. You should be asked to read a statement saying that you have been informed about the HIV-antibody testing procedure, you understand it, and you consent to have it done.

• The Blood Test. A small amount of blood will be drawn from your arm, taken to a lab, and tested. The time it takes to get results back varies in different areas. It can take anywhere from a few days to a few weeks.

• The Waiting Period. This period of days or weeks can produce anxiety and tension. Some people decide during this time that they do not want to know their test result and never return to receive it. It is very important that you finish the process and find out the test result in spite of your anxiety.

  It is also important that until you return for your result and post-test counseling you act as if you were infected and could transmit the virus. In other words, don't have unprotected sex or share needles.

  When your result arrives, you will be asked to return to the counseling and testing center to receive the information in person. Everyone tested is asked to return for counseling, whether the result is positive or negative.

• Counseling after the Test. When you return, your counselor should tell you your result and, regardless of whether it is positive or negative, how to protect your health and the health of others. He or she will review methods to prevent the spread of HIV.

  If your result is negative, your counselor may discuss retesting if, during the 6 months before your test, you engaged in any behaviors that may have infected you. You may be infected but your body may not yet have produced enough antibodies for the test to detect. Since it takes time for your body to develop antibodies, you may need to be retested.

  If your test result is positive, your counselor will tell you what this means for you. Any questions you have will be answered and your counselor will refer you for follow-up health care, support services, or further counseling. Your counselor will also talk to you about telling your sex and/or drug using partner(s).

• Types of Tests. The ELISA (Enzyme-Linked Immunosorbent Assay) is a screening test that is widely used. It can be performed relatively quickly and easily. If a positive (reactive) result occurs, the test is repeated to check it.

  If an ELISA test yields two or more reactive results, a different test such as the Western Blot is used to confirm these results as positive for HIV antibodies. The Western Blot is more specific and takes longer to perform than the ELISA. Together, the two tests are more than 99.9 percent accurate. Further evaluation can be done if results of repeated ELISA and Western Blot tests are unclear. Your testing facility should do the ELISA twice on the same blood sample and a confirming test such as the Western Blot if the ELISA tests are repeatedly reactive.

Each year, Medical College of Wisconsin physicians care for more than 180,000 patients, representing nearly 500,000 patient visits. Medical College physicians practice at Children's Hospital of Wisconsin, Froedtert Memorial Lutheran Hospital, the Milwaukee VA Medical Center, and many other hospitals and clinics in Milwaukee and southeastern Wisconsin.