For over three years, I’ve worked as a counselor offering on the spot HIV tests in clinical and community settings. Patients that opt-in first receive a rapid test which produces a result in 10 to 20 minutes. If this first test yields a reactive (also called preliminary positive) result, another sample is collected from the patient and then sent out to the state laboratory for further analysis. This second test will determine whether the patient is diagnosed with HIV, or not. My role as counselor is to provide the patient with support but also to gather enough information about his/her risk behaviors to determine if follow-up testing will be necessary to rule out HIV infection. I briefly interview the patient to assess his/her knowledge about HIV transmission and understanding of measures that can be taken to reduce their risk of becoming infected. After a while, I realized I was hearing the same misconceptions from my patients, over and over again. I’m sharing these conversations to raise public awareness about the risks surrounding HIV transmission and to hopefully reduce its spread in our communities.
If I Test Today, I'll Be Able to Tell If I Have HIV
Scenario: At a party last weekend you did something you regret and now you're concerned that you could've gotten HIV.
Modern tests are very sensitive, but they are still unable to detect HIV in someone who is newly infected. The tests do not actually detect HIV itself, but rather the antibodies a person’s body makes after being exposed to the virus. Depending on the person, it can take anywhere from one to three months for the body to produce enough HIV antibodies to cause a test to become reactive. Any risks taken less than one month prior to the test date cannot be evaluated, your body hasn’t had enough time to react to the HIV (and produce a response that can be picked up by the test) if you were in fact exposed to the virus. You can be sure that today’s test will show if you’ve contracted HIV from any risks taken in the past three months or more. However, if you’re concerned about something that happened between one and three months ago (also referred to as the “window period”), today’s test might show if you’ve contracted HIV during that time, but it might not. You’ll need to retest in three months from your last risky act.
If I Was Going To Get It, I Would Have Been Infected By Now
Scenario: Over the years, you've had lots of partners. You don't like condoms and so you hardly ever use them. You acknowledge it's likely that you've been with people that were HIV+ but you keep testing negative. You think you're probably immune.
It’s very hard to get infected with HIV. First, you have to engage in risky behavior with someone who actually has HIV. You can have all the unprotected sex you want, but if none of those people are positive then you’re not going to get it. Second, it’s not guaranteed that you will get HIV if exposed to it. Like a gun with only one bullet in the chamber, each time you engage in a risky behavior with an HIV+ person you have a chance of getting infected. Third, certain behaviors are riskier than others. Exposure to HIV+ blood (via sharing needles or other injection drug equipment) is a very high risk behavior. So is receiving anal or vaginal sex because of the fact that the pre-ejaculate/semen carries the virus and the friction associated with these activities can cause irritation/bleeding. Irritated mucous membranes could actually have microscopic cuts which HIV can use get into the body.
If I'm Negative That Means My Partner Has to Be Negative
Scenario: You tested negative for HIV a few months after being intimate with your current partner. You're not sure if he tested, but since you tested negative, it must mean that he's negative too.
The test results are a reflection of what’s going on in your body only. It is possible that your partner is positive and has not yet infected you. Or, you could already be infected and in the window period. Remember that every time you engage in a risky behavior it presents a new opportunity for the virus to invade your body.
My HIV Viral Load Is Undetectable Which Means I Can't Transmit HIV
Scenario: You are HIV+ and your physician has just told you that your body is responding well to the HIV medications. The results of your viral load test, which measures the amount of HIV in your blood, show that the virus is undetectable.
Many people incorrectly think that if there's no virus in their blood, they don't have to worry about infecting others. The term “undetectable” is used when the amount of HIV in the blood is so low that diagnostic tests are not picking it up. The lower the viral load, the less infectious a person is (i.e. less likely to give someone else HIV). However, it’s worth noting that a person’s viral load fluctuates all the time and a temporary spike in viral load could mean that the risk of transmission is greater. Once a person is infected, they always will have HIV, they will test positive if they take a test, and they can transmit it to others.
If Infected, You Will Die of HIV
Scenario: You've heard that HIV is a horrible disease which weakens your immune system until it finally kills you.
Persons infected with the virus don’t die of HIV or even AIDS, the advanced stage of the illness. They die from complications caused any number of 45+ opportunistic infections, such as cancer, pneumonia and tuberculosis. These illnesses take advantage of the HIV+ person’s weakened immune system and progress rapidly. Often a person is suffering from multiple opportunistic infections at the time of their death.
You Can't Get HIV from Oral Sex
Scenario: You always use condoms, except when it comes to oral sex.
Mucous membranes (pink areas of the body with lots of capillaries like the insides of your mouth, vagina, penis and anus) can absorb HIV. Oral sex poses a lesser risk but a person can still become infected that way. Semen or vaginal secretions carry HIV which can be absorbed by the mucous membranes in the mouth. Conversely, if even a small amount of blood is present in the giver’s mouth, it could be absorbed by the receiver. Unlubricated condoms and dental dams are safer sex products that are designed to be used for oral sex.