HIV Testing

The most frequently used HIV tests detect the presence of antibodies to HIV, not the actual virus itself. A positive HIV antibody test indicates the presence of antibodies to the virus. A negative test result indicates either no antibodies or an undetectable level of antibodies to the virus. It is possible that these tests can miss infection in a person who was recently infected with HIV and has not yet developed enough antibodies to show a positive result.

The period of time from infection with HIV until the body has developed detectable antibody levels is called the window period. The window period is approximately three months on average. A person who is worried that he or she may have been exposed to infection should be encouraged to seek testing, and the counselor should explain that if the test comes back negative, it should be repeated after three months to confirm the result because the person could have been infected but still may be in the window period. During this period, a person may not test positive even if he or she is infected with HIV.

Rationale for Testing

HIV testing should always be done voluntarily and never mandated or coerced. If people have a desire to know whether or not they are infected, they have a right to know. It is strongly recommended that clients be counseled both before and after testing. Where testing is readily available, a person who thinks he or she might have been exposed to HIV should consider being tested for a number of reasons:

• A person who knows he or she is HIV-infected can take steps to prevent transmission to others.
• In settings where medications are available to combat opportunistic infections and keep people healthy longer, it is best for people to know they are infected as soon as possible so they can begin treatment and schedule regular checkups right away.
• Women who know they are infected can make informed decisions about family planning, pregnancy, and breastfeeding. In some settings, treatment is available for pregnant women that can greatly reduce the risk of HIV transmission from mother to child.
• Some people want to know their HIV status so that if they are infected with HIV, they can make lifestyle changes that will preserve their health to live longer or better lives.

HIV counseling and testing can be important decision-making tools for clients and service providers and can help even uninfected clients understand their risk for HIV. In addition, testing enables health care providers to offer information to infected clients about living with HIV infection and assist them in obtaining any available support services, including treatment, emotional and practical support, prevention of MTCT, and legal services.

Voluntary counseling and testing (VCT)

Voluntary counseling and testing (VCT) is a combination of two activities — counseling and testing—into a single service that can amplify the benefits of both. In its ideal form, VCT can be used as a form of prevention rather than strictly for diagnostic purposes, or to facilitate entry into HIV care services.

The “gold standard” for VCT incorporates pretest counseling and posttest counseling. Helping clients understand and perceive their own risk (and the risks that their behavior may pose to others) and reduce that risk, are integral components of VCT counseling.

VCT is an important entry point to other HIV/AIDS services, which can benefit clients with positive or negative results. When it is well implemented, VCT services offer the possibility of benefiting the community by “normalizing” the existence of HIV/AIDS, thereby reducing stigma and promoting awareness.

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VCT is an essential component of prevention of MTCT programs because such programs cannot be implemented if women do not know their HIV status. Programs, however, should not focus only on identifying HIV-positive women for MTCT intervention, but they should also focus on risk reduction and helping women who test negative to remain that way. VCT programs for pregnant women can benefit from the involvement of men. Some studies have shown that when women test positive for HIV and their male partners are not tested, the women are often blamed for introducing the infection into the couple. Such unfounded blame can lead to conflict, abandonment, and even violence.

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