The only way to know whether or not you are HIV positive is by being tested. There are benefits to being tested if you are at risk of being infected. However, you should make sure that the testing centre offers proper counselling before and after the test, says Mariette Correa

Tests for HIV involve taking a small amount of blood, usually from a person's arm. If you are pregnant when you have the test you will probably not need to have extra blood taken, as it should be possible for the test to be done at the same time as other blood tests.

The HIV test is the only way to know for sure if you have the virus. The tests commonly used to detect HIV infection actually look for the presence of antibodies produced by your body to fight HIV. While most people develop detectable antibodies within three months after infection, in some case it can take up to six months. The time from infection to the development of detectable antibodies is called the “window period”. Therefore, for those who believe they have had some risky exposure and would like to do the test, it is advisable to do one six months after the exposure to be certain of one’s HIV status.

HIV antibody tests popularly called ‘HIV tests’ or ‘AIDS tests’ alone cannot tell you if you have AIDS. The HIV test can only tell you if you have the virus. For a person to have AIDS, they have to be HIV-positive, have certain illnesses, and have a certain CD4 count.

The HIV test that is most commonly used in government hospitals as well as the private sector is the ELISA (Enzyme Linked Immuno Sorbent Assay), which takes one or two weeks for a result. Rapid tests give a result in just 15-20 minutes. The Western Blot test is a more complicated test than the ELISA, and is done to confirm the results of two positive ELISA tests. There is also a test available, though in very few places in the country and highly expensive, which can detect the presence of the virus (rather than the antibodies) even in someone recently infected. This is called the Polymerase Chain Reaction (PCR) and can also be used for testing infants whose mothers are HIV-positive.

If your test result is ‘positive’, it means you have HIV infection and could benefit from special medical care. Additional tests can tell you how strong your immune system is and whether drug therapy is indicated. Some people stay healthy for a long time with HIV infection, while others develop serious illness, and AIDS, more rapidly. Scientists do not know why people respond in different ways to HIV infection.

If your test is ‘negative’, and you have not had any possible risk for HIV for six months prior to taking the test, it means you do not have HIV infection.

Less than 2% of all people who test for HIV get an ‘inconclusive result’. This means this test cannot determine whether or not they have the virus and they would need to do the test again.

Benefits of testing

If you feel you are at risk for HIV you could consider taking the test. With recent advances in medical care and the options available for people with HIV, finding out that you are positive could help you take better care of yourself and prolong your life.

If you test positive for HIV, the sooner you take steps to protect your health, the better. Prompt medical care may delay the onset of AIDS and prevent some life-threatening conditions. Smoking, drinking too much alcohol, or using illegal drugs (such as cocaine) can weaken your immune system. There is much you can do to stay healthy. Testing can also help you to make informed choices about sexual practices, marriage, pregnancy and other decisions. If you are a woman who is planning on getting pregnant, or are currently pregnant, you may want to consider getting tested as there are various ways to help reduce the transmission of HIV from mother to child.

To find out if you are at risk for HIV, ask yourself the following questions:

• Have you had unprotected vaginal, oral or anal sex in a high risk situation (eg with a casual partner of unknown HIV status, or a sex worker)?
• Have you shared needles, syringes or other drug injecting equipment with another injecting drug user?
• Have you had a blood transfusion from an unlicensed blood bank or other facility?
• Have you had any procedure which pierced your skin (during medical care, tattooing or body piercing) where the instruments used were of questionable sterility?

Testing facilities

One of the places you can get yourself tested is a Voluntary Confidential Counselling and Testing Centre (VCCTC) or what is now called Integrated Counselling and Testing Centre (ICTC). VCCTCs have been established by NACO (National Aids Control Organisation) in most medical college hospitals across the country and in most of the district hospitals in states where there is high prevalence of HIV. In the next few years, NACO plans to cover most district hospitals across the country. Apart from these, several NGOs and private institutions run VCCTCs.
To look for a VCCTC in your area, go to: http://www.nacoonline.org/directory_vct.htm

Counselling with HIV testing

These centres are meant to provide counselling before the test to assess risky behaviour, prepare you for a possible positive result, and inform you of ways you can protect yourself and others in the future. In addition, they should help you understand the meaning of HIV and AIDS, give you the test results and inform you about locally available AIDS-related resources. The aim of the VCCTC is to reduce psycho-social stress and provide you (the client) with information and support necessary to make decisions.

Within the context of VCCTC, the principle of voluntary and informed consent remains paramount. In principle it is agreed that the right of a person to decide if and when they will be tested for HIV must be protected. It is for this reason that written consent is obtained if the person agrees to take the test. In case of unconscious patients or minors, the consent of the near relatives or guardians has to be taken.

Counselling in practise

According to NACO, ‘Pre-test counselling presents the counsellor with the challenge of balancing the provision of information, assessing risk and responding to the client’s emotional needs…It enables a person to confidentially explore and understand his or her risk of HIV infection’.

In practise, pre-test counselling is most often limited to cursory queries or deep probing into the sexual history (real or imagined) of the client and attribution of sexual risk to clients based often on moral judgments about sexuality rather than actual risks. To prevent “the further spread of HIV infection” people are told to have safe sex or to abstain, and not to donate blood, and for young married women to avoid having children.

Due to the often unwarranted assumption of sexual risks, compounded by inadequate attention to other transmission risks, these centres may be reinforcing sexual blame, guilt, and stigma, and thereby exacerbating psychological and social pressures on people found infected with HIV. Further, people who know they do not take sexual risks are not informed and aware of risks from medical injections, tattoos, or other possible blood exposures.

The majority of people who visit VCCTCs are referred by doctors. Many of them, who had no prior self-perceived risk, may be told they have an unexpected life-long infection, which is attributed to their sexual behaviour. Prevention and care messages in the VCCTC further reinforce attribution of HIV acquisition to sexual and drug injecting risk behaviour.

Testing pregnant women

If you are pregnant and visit a government pre-natal care centre, you may be tested for HIV. This is done as part of the Prevention of Parent to Child Transmission Programme and if you test positive and you decide to continue your pregnancy, you will be given a drug to reduce the chances of transmitting the virus to your child. You may also be entitled to enter the hospital’s programme for antiretroviral therapy. Remember that you should be counselled before being tested and you have the right to refuse to be tested.

(Mariette Correa is an independent consultant who has been involved in HIV/AIDS programming for NGOs in Goa and South Asia)

InfoChange News & Features, February 2008