HIV Testing: Where & How to Get Tested for HIV?

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HIV or Human Immunodeficiency Virus is a virus that attacks the body’s immune system – crippling the defenses of the body against infections and opportunistic diseases when left untreated. There is no outright cure for the disease itself, but with the latest developments in the field of medical science, it can now be managed enough for it to become untraceable after months of rigorous therapies and medications. It can easily be transmitted through anal or vaginal sex, needle and syringe sharing, or even through some activities (with certain exceptions) involving an exchange of bodily fluids. With the risk of developing AIDS or Acquired Immunodeficiency Syndrome – the most severe phase of infection – when left untreated, it is imperative that regular testing should be performed especially if you are a member of the at-risk population.

HIV/AIDS Testing

HIV is an immune system’s disease that can lead to AIDS – the most severe form – when left untreated. As such, opting for testing whenever you are at risk is critical to ensure that your condition, if ever there is one, is managed well and you are provided with the right therapy before the disease progresses into its more severe manifestation. As per the Centers for Disease Control and Prevention’s (CDC) recommendation, everyone from 13 to 64 years old should get tested regularly through their routine health check-ups while those who are at risk should be tested more often and more intensively than the rest. If you are sexually active with someone who is HIV-positive or has a vague status, extremely sexually active with multiple partners, partaking in intravenous drug use, or sharing penetrative equipment such as syringes and needles, it might be wise to get tested to ensure that you are well-informed about your current status. Pregnant women are likewise advised to get tested to allow sufficient time for treatment when treatment is necessary.

HIV Tests are performed to determine whether the virus is traceable in the person’s body, but not necessarily how long they have had it or if it is currently progressing to AIDS. The test, especially ones performed in a lab, would require blood or an oral fluid sample from you to determine whether there is a detectable presence of the virus within your system. When your results come back negative, and if you were not exposed to any factors within the period allotted for that test, then you can be assured that you are safe. On the other hand, if your results come back positive, then follow-up testing and immediate treatment should be performed to minimize the viral load and ensure that you could no longer transmit the virus.

Below are some of the most common questions with regards to testing and diagnosis of HIV-1 type.

Why exactly should you get tested?

Your HIV status is essentially an indicator of how your life should and will progress for the duration that you are still found to be positive. HIV, as previously mentioned, is easily transmitted and could progress to its severe manifestation when left untreated. While it might be efficient to simply claim that you are not at risk for the disease, knowing your HIV status could potentially help you from its unpleasant complications and others from contracting the condition unknowingly. CDC recommends that people ages 13 to 64 should be tested routinely, especially when they are sexually active or part of the at-risk population. Even if you are currently in a monogamous relationship, ensuring that you and your partner are safe is a way of protecting both of you from any unforeseen consequences. All pregnant women should likewise be encouraged to get tested as the fetal transmission is ever so possible if the mother is infected. Although preventive treatment, treatment after the baby is born, or even treatment during labor is still beneficial for the baby’s health, having the mother treated early is the most effective way of reducing the possibility of transmission to less than 1%.

When should you get tested for HIV?

Risk factors are great indications of when exactly you should get tested for HIV. Risk factors provide a greater possibility of contracting the condition – making it logical to have at-risk individuals be tested more regularly and intensively to ensure that they did not contract the disease from their partners or through their other activities. If your answer to at least one of these CDC questions is yes, then it is recommended that you should be tested annually for HIV:

  • Are you a man having sex with another man?
  • Have you had penetrative (anal or vaginal) sex with an HIV-positive individual?
  • Have you had multiple partners since your last HIV test?
  • Have you partaken in any needle sharing or drug-injecting activity recently?
  • Have you exchanged sex or drugs for money?
  • Have you been diagnosed or have been previously treated for sexually transmitted diseases?
  • Have you ever had hepatitis or tuberculosis?
  • Have you ever had intercourse with someone who fulfills the previous criteria or has an unknown sexual history?

It is also recommended for sexually active gay or bisexual men to get tested every 3 to 6 months as the observed risk is more relevant and testing would therefore be more beneficial for this population. In addition to that, pregnant women should likewise coordinate with their physicians to ensure that they are HIV-negative throughout their pregnancy – preventing transmission to their baby and protecting them from being immunocompromised.

To know more about the different tests, follow through the questions below.

What to expect for your test?

For your HIV test, the most involved portion for any one of them will simply be sample collection – either a blood sample, an oral fluid sample, or the use of a finger stick. After submitting your sample to the lab technician (if you have opted for the laboratory test), then the only thing left to do is to wait for the results to come back. For rapid tests, you could usually wait for the results, but for laboratory tests, you may have to wait for several days or until your laboratory of choice contacts you about the outcome.

How is each test different from the other?

There are three different tests that you could opt for and each one is performed relatively differently apart from being distinctive with the technical aspect underneath each. To provide a little more context, the tested molecule is the substance being detected from the sample, the sample required is the type of fluid that you have to provide, the waiting time is the time needed to obtain the results, and the window period is the time gap between exposure and testing that is necessary to ensure that your test could determine the virus accurately.

Note: Rotate your device for best viewing experience.

Nucleic Acid Test

Antigen/Antibody Test

Antibody Screening

Tested Molecule

Tests for the virus itself. Can determine the presence of the virus as well as its viral load within the individual.

HIV antibodies and antigen that are foreign substances coming from the virus or substances produced by your body in response to the antigens, respectively.

Determines the presence of antibodies.

Sample Required

Blood Sample

Blood Sample

Lab Test: Vein

Rapid Test: Finger Prick

Blood Sample

Oral Fluid Sample

Waiting Time

Several days

Rapid Test: 30 minutes or less

Rapid Test: 30 minutes or less

Oral Fluid Self-Test: 20 minutes

Window Period

10 to 33 days after an exposure

Sample from vein: 18 to 45 days after an exposure

Finger prick sample: 18 to 90 days after an exposure

23 to 90 days. Vein samples could produce results sooner.

In most cases, the Nucleic Acid Test is preferred over all other procedures as this is the test that could tell not only whether a person is positive or negative, but also the individual’s viral load – indicating the progression of the disease at the time of testing. In addition to that, it is also able to detect the presence of the virus earlier than other tests, making it the preferred option when urgent test results are necessary for an immediate course of treatment. However, due to the intricate procedure involved with this test, it is also very expensive to perform routinely – making it an option that is only used when a person is highly at risk or if the physician needs a confirmatory result regarding the patient’s HIV status.

Various HIV Testing Options

Where to Get Tested?

HIV Testing Centers are now present all over the United States. Despite the different tests that each lab offers, do ensure that your chosen laboratory is certified to perform these tests to likewise ensure your safety and the accuracy of the results that you will be receiving.

For starters, you can get tested in any one of the following places that offer a testing program:

  • Your health care provider’s office or clinic
  • Health clinics or community health centers
  • STD clinics
  • Your Local Government Unit’s Health Department
  • Family Planning Clinics
  • Medical Centers
  • Treatment Programs
  • Independent Laboratories and Clinics
  • The nearest hospital to your location

You could also check the recommended website by the CDC that offers a testing center locator for various states – ensuring that all of these clinics will be able to provide you with quality and accurate results. You may visit https://gettested.cdc.gov, input your State or Zip Code, and you would then be provided with various STD Testing Clinics including free or low-cost ones, conventional HIV Blood Tests, Rapid Blood HIV Tests, Conventional Oral HIV Tests, and Rapid Oral HIV Tests. You may also check out https://easystd.com/get-tested for further details about various testing options and clinic recommendations that perform such diagnostic tests.

Service Variations

1. Online/Walk-In Testing

With the stigma surrounding the concept of HIV, it is difficult to be open about such a condition and even more about getting tested with such a condition. As such, opting for online/walk-in testing has increasingly become a crowd favorite with its accuracy, quality, and most importantly, discretion when it comes to availing such tests.

The way that it is performed is by first booking or rather, ordering a testing kit online through the website of an online/walk-in testing clinic of your choice. You would have to select the necessary details and confirm your testing kit through their system. Without requiring a specific appointment, you could then visit the testing center that is nearest to you, then submit the necessary samples for testing to the assigned laboratory technician. No paperwork, no divulged information, no anything other than the profile or account that you have created through their website. Following your sample submission, you could then leave premises then wait for a couple of days for your test results to be delivered online through the same portal that you have used to order your testing kit. Do take note, however, that different testing sites may have different specific processes, but the general gist will be similar to the process illustrated above.

Pertinent Details:

Pricing – Online STD Testing can be relatively cheaper than other options, but do remember that this would be paid through out-of-pocket money. Nevertheless, it is still a relatively cheaper option on top of the confidentiality level that this type of testing offers.

Confidentiality – Extreme confidentiality, no divulged information, no unnecessary paperwork.

Speed – Quick and consistent. No need to wait for a few days to receive your results.

Quality and Accuracy – Sample contamination is less likely due to collection being performed at home. As to the accuracy of the test itself, it will depend on the test center that you have selected and the qualifications that they do have to perform the test itself.

2. At-Home STD Testing

Similar to the issue that the Online/Walk-in Testing is trying to resolve, At-Home STD Testing Kits are also designed to protect the confidentiality of the users and to eliminate any sort of interaction with the laboratory technician or other individuals in public. By eliminating direct interaction with the technician, you are essentially performing the test at home, albeit with the help of a guided testing kit to still help you achieve accurate results. To start, you would have to order a testing kit online which will then be delivered to your mail after a few days, depending on the speed of shipping and transport. Once it arrives, it will come with a set of instructions and protocols that you have to follow to a point to ensure that you will be performing the test correctly and accurately. After collecting your sample, you could then send your samples back to the company for analysis – waiting for a few more days for the laboratory to complete their analysis of your submitted samples. Once done, you will then receive your results through your preferred mode of delivery.

Do note, however, that tests performed through community testing programs or through at-home testing/self-testing kits should be supported with a follow up analysis if and when the results come back positive. This procedure is mostly done for all types of tests to confirm that the virus is indeed present within your system, but in the case of laboratory-based tests, the laboratory usually automatically conducts a follow-up test with the same blood sample as the previous one to confirm the presence of the virus or its antigens. Tests that have returned positive and were performed at-home should be supported with a laboratory-based HIV Nucleic Acid test that could further provide conclusive proof about your condition and its progression. While this is not exactly as private as the at-home testing kit that you have previously used, this follow-up procedure is necessary to rule out any false positive or negative effects and provide your physician with a conclusive and more accurate proof that you are indeed infected. After all, HIV Nucleic Acid Tests are considered to be the gold standard in many healthcare settings due to its accuracy – requiring one on top of various intermediary tests such as at-home kits to effectively conclude the observations that were made.

Pertinent Details:

Pricing – Due to the inclusion of a DIY STD Test, the pricing is relatively higher than Walk-In tests but is still lower as compared to the price of tests in hospitals or other renowned laboratories.

Confidentiality – Extreme confidentiality, no divulged information, no unnecessary paperwork.

Speed – Delays are possible due to shipping. Takes quite a while due to transport.

Quality and Accuracy – Sample contamination is possible as the entire procedure is guided only by written instructions. The analysis is relatively accurate depending on the qualifications and certifications of the testing company that you have ordered from.

3. Free Clinics and Health Centers

With the increasing awareness when it comes to STDs and HIV specifically, many people are now opting to get tested to ensure that they and their loved ones are kept safe from any potential condition that they might have. As such, free clinics are now available in most, if not all states to provide those who could not afford expensive testing kits with an avenue to get tested and be reassured of their current status. It is certainly not provided just to anyone as each clinic has a specific acceptance criteria, but if you fit their qualifications, you could certainly apply for one and get tested, potentially, for free.

What you would have to do is proceed to the nearest public testing clinic and apply for a free STD testing kit. They would then assess your information and qualifications to decide whether you are qualified or not for discounted/free testing. Once accepted, you could then submit your samples (collection performed in the clinic as well), then you would simply have to wait for your results for a couple of days.

Pertinent Details:

Pricing – Possibly free, depending on your qualification and depending on their acceptance criteria.

Confidentiality – Not necessarily discreet.

Speed – Waiting time could be extended depending on the number of people availing for the test. Completely variable.

Quality and Accuracy – Quality is not compromised at all. It is also a bonus that you could get to consult with a doctor as they are also available in the clinic for any questions that you might have regarding various STDs.

Insurance Coverage

According to the Affordable Care Act, HIV Screening is now covered and paid for by most health insurance programs without any co-pay. Based on the Act, any Grade A or Grade B preventive services should be covered by insurance programs without requiring cost-sharing. With the promotion performed by the United States Preventive Services Task Force or USPSTF of HIV Screening to an A rating for all adolescents and adults of ages 15 to 65, the current insurance coverage is now as follows:

  • Private Insurance Plans: Most plans now cover HIV screening without co-pay.
  • Medicaid: Medically necessary HIV testing and routine screening are now covered.
  • Medicare: Now covers screening for ages 15-65 regardless of risk, and ages outside this range with increased risk, all without co-pay.
  • Uninsured: Community-based clinics now offer free or discounted screening programs depending on financial status.

Testing Cost and Prices

With the improvement of facilities dedicated to HIV testing, as well as the continuously improving understanding of the virus’ behavior itself, HIV Testing facilities are now able to offer more affordable testing services that could now cater to a wider array of population instead of being restricted to those who could afford to pay the cost of such tests.

According to a 2015 study performed by the World Health Organization in high-income countries like the United States and Denmark, the average cost of testing for each type of testing service varies depending on the risk factors and the type of test that the individual is trying to avail.

Note: Rotate your device for best viewing experience.

General Population

Key Population

Other At-Risk Population

Facility

Average: $56

Range: $20-$115

Average: $177

Range: $930-$209

Average: $109

Range: $93-$209

Other Methods

No Data Available

Average: $67

Range: $34-$160

Average: $803

Range: $52-$1642

Average Cost

Average: $56

Range: $20-$115

Average: $123

Range: $34-$709

Average: $803

Range: $52-$1642

Reference: WHO. (2015). Systematic Review of HIV Testing Costs in High and Low Income Settings. Retrieved May 2021

The table below, on the other hand, shows the prices of common test variations and their popular examples in the United States:

Usual Price

Example(s)

Insurance Policy Acceptance

Walk-In or Online Testing

$258 for a 10 Test STD Panel along with an HIV RNA Test

STDCheck.com

Sometimes

  • Mostly no due to the “private” aspect that these options are trying to uphold

At-Home Testing

$79 for an HIV Testing Kit

myLAB Box

Sometimes

  • myLAB Box does not accept insurance policies but certain other options sometimes do. However, this would mean that your insurance provider will be informed about the transaction.

Public Options

Mostly Free (depends on your financial status and qualification)

Planned Parenthood

Local Clinics

AIDS Healthcare Foundation

Universities

LGBTQ+ Clinics

No

  • Public and “free” options are inherently designed for those who do not have insurance and could not afford to pay for the test.

While this information may be relevant to obtain a glimpse of HIV Testing costs in the United States, do take note that insurance coverage and the coverage of your premiums could still affect the total price that you would have to pay per testing. In addition to that, this also does not consider free testing clinics that allow those who are running on a tight budget to avail of a free testing kit in their nearest local health clinic.

Human Immunodeficiency Virus: Understanding its Manifestations

HIV or the Human Immunodeficiency Virus is a viral agent that causes an immunocompromising manifestation – a condition where your immune system is attacked and is left bare and weakened to provide sufficient protection against various diseases and opportunistic infections. It initially came from a type of chimpanzee in Central Africa, and it was reported to have been passed down to humans when humans used to hunt down chimpanzees for meat, coming into contact with the infected bodily fluids of the animal. Over years of development, the disease was able to migrate to various parts of Africa, and later to the other areas of the world, only getting recognized in the United States in the late 1800s despite being present since the 1800s.

Common Signs and Symptoms

The only way to get diagnosed with HIV is to get tested in an accredited center where your sample is going to be examined for the presence of certain molecules such as antibodies, antigens, or even the presence of the virus itself. However, there are also a few key symptoms that patients usually experience around 2 to 4 weeks after exposure, lasting for several days to weeks depending on the progression of the disease. These symptoms include:

  • Fever
  • Chills
  • Rash
  • Night Sweats
  • Muscle Pain
  • Sore Throat
  • Fatigue
  • Swollen Lymph Nodes
  • Mouth Ulcers

Despite having such key symptoms, it is still insufficient to fully conclude an HIV infection through a symptomatic analysis alone because other diseases can cause the same set of symptoms as well. To be ensured of your current status, you may check out https://easystd.com/get-tested to obtain more information about testing processes and other testing sites that you could check out.

HIV Stages and Progression

An HIV infection typically progresses through 3 stages, but this is usually halted depending on the level of treatment or the urgency of the treatment regimen that was provided to you. When left untreated, the disease would progress steadily and would then ultimately result to in Acquired Immunodeficiency Syndrome or AIDS, the severe form of an HIV infection.

Stage 1: Acute HIV Infection

This is usually characterized by an immense viral load in your blood – causing HIV-positive individuals to be extremely contagious upon transmission of their bodily fluids. People would usually show flu-like symptoms, but this is the body’s natural response to any infection, requiring specific tests to ensure that the flu is indeed caused by HIV. Only Antigen/Antibody Tests or Nucleic Acid Tests could diagnose the disease at this point.

Stage 2: Chronic HIV Infection

This is the stage where the virus becomes latent or dormant inside the body – commonly known as clinical latency. HIV is still present inside the body but its reproduction rate is now reduced to minimal levels. Although people are still contagious at this stage, they may not develop symptoms at all. However, treatment is still imperative as it may suddenly speed up, causing CD4 cell levels to drop and viral load to increase – ultimately transitioning to the final stage of an HIV infection. Upon treatment, infected individuals would usually stop at this stage and would no longer progress to stage 3.

Stage 3: Acquired Immunodeficiency Syndrome (AIDS)

This is the most severe form of an HIV infection, and by this point, the body’s immune system is now severely damaged, resulting in an increasing number of opportunistic illnesses. Without treatment, individuals with AIDS are provided with a survival rate of only 3 years.

HIV Transmission

Ways by which HIV can be transmitted

  • Anal Sex – the receptive partner has a greater risk of procuring the virus due to the rectum’s lining that could easily allow the virus to enter the systemic circulation of the individual.
  • Vaginal Sex – higher risk if no protection is used
  • Mother-to-Child Transmission – taking HIV medicine throughout pregnancy and providing treatment for the baby 4 to 6 weeks after birth, the risk of transmission is reduced to less than 1%.
  • Injections – sharing injections or any penetrative tool could easily introduce the virus to your system

Rare Ways to Transmit HIV

  • Oral Sex – sores and other ulcerations within the mouth could be potential sources of inoculation
  • Workplace – specific to healthcare workers
  • Medical Care – although blood donation is sterile and safe, blood transfusions could put you at risk of contracting the virus. However, this is extremely rare due to the safety measures being performed by medical establishments.
  • Biting – contact with broken skin
  • Deep, Open Mouth Kissing – while HIV could not be transmitted through saliva, blood exchange could occur when both partners have open bleeding sores in their mouths.
  • Female to Female Intercourse – while rare, vaginal fluids and menstrual blood could carry the virus and transmit it through the mucous membrane of the genitalia
  • Body Modifications – sanitary issues

HIV is not Transmitted Through

  • Mosquitoes, ticks, or other insects
  • Saliva, tears, and sweat
  • Hugging, shaking hands, sharing utensils, closed mouth kissing
  • Droplets or through the air

HIV Treatment

If you tested positive in your HIV test, you would have to take therapeutic steps along with your physician to ensure that your disease will no longer progress to its severe form. This is also performed to ensure that you would not be able to infect other people despite having intercourse once your viral load is already undetectable by pertinent tests.

You will be indicated with an Antiretroviral Therapy program – these are medications that are specifically designed to combat retroviruses including HIV. This therapeutic program is mainly composed of a combination of antiretroviral drugs that all work together to eliminate or at least minimize the viral count within your body and ensure that it will no longer progress and be contagious. Antiretroviral therapies are normally recommended for everyone, and this is usually provided as soon as the positive result comes in. Once started, the viral load of the patient will be continuously monitored until it becomes undetectable. Being undetectable, while it does not mean that the person is cured, means that it is now too low to be detected, too low to transmit, too low to progress, and too low to cause any significant complications.

Frequently Asked Questions

How soon can HIV be detected by blood tests?

Blood tests perform faster than rapid tests or even oral fluid sample tests. As such, laboratory-based blood tests such as Nucleic Acid Tests could detect the presence of the virus as early as 10 days after exposure. However, its window period is still relatively broad at 10 to 33 days so do remember to take a second test to make sure.

What is the best screening test for HIV?

There is no one best screening test for HIV as all of the types have their merit when it comes to their features. It ultimately depends on what type of results are you trying to get and how long are you willing to wait for the results to come back. In addition to that, budget is also an issue as these tests could run at vastly different price points.

What is the accuracy of home testing kits?

Home-testing kits are not necessarily tested at home. They are kits designed for you to collect your sample and send it back to the laboratory for analysis and testing. Although the analysis part is undoubtedly accurate on its own (except, of course, if the lab is not certified), the sample collection part could be subject to human error – compromising the quality of the specimen and producing inaccurate results. To ensure that your results are 100% accurate, follow the instructions within the guide closely.

Does it mean that I am safe if I am reported as HIV negative?

False-positive and false-negative results are evident in any testing method. In addition to that, there is also the additional concern of having a window period for each type of test that could then affect the amount of viral molecule that the test could recognize. To ensure that you are indeed HIV-negative, consult your physician or opt for another test several days after receiving the result for your first one.

Are false-positive and negative results still a concern in tests?

Unfortunately, yes, but it is very minimal and rare. In the US, false-negative rates are only about 0.003% while false-positive rates are between 0.0004 and 0.0007 percent.

How long does it take for HIV symptoms to manifest?

The acute stage of the infection is the symptomatic part of HIV based on data sourced from 40 to 90% of infected people who produced evident symptoms. This would usually start around 2 to 4 weeks after exposure, and it usually manifests like flu.

Are HIV symptoms similar for men and women?

Not necessarily. Although women do have an increased risk of contracting complications such as bacterial and fungal infections, pelvic inflammatory disease, and irregular periods, the difference in symptoms is usually based on each individual’s health status instead of their sex.

When should I start HIV treatment?

Immediately. The sooner you start your medication, the sooner you could halt the progression of the disease.

Additional Resources

NameWebsiteSummary
Centers for Disease Control and Preventionhttps://www.cdc.gov/hiv/basics/whatishiv.htmlLearn more about various preventive measures, testing tips, symptomatic manifestations, complications, and more about HIV through the CDC’s comprehensive HIV information page. Populations at risk and other risk factors are likewise included.
World Health Organizationhttps://www.who.int/news-room/fact-sheets/detail/hiv-aidsDiscover WHO’s HIV Fact Sheet containing various information regarding HIV. This also includes recent news regarding HIV treatment and diagnosis developments all over the globe, including epidemiological and statistical information regarding its progression.
HIV.govhttps://www.hiv.gov/hiv-basics/hiv-testing/learn-about-hiv-testing/where-to-get-testedHIV.gov’s HIV Information page contains a comprehensive set of data from HIV testing to HIV incidences. Federal responses regarding national HIV relief efforts are likewise indicated through their information page.
National Institute of Healthhttps://hivinfo.nih.gov/understanding-hiv/fact-sheets/hiv-testingLearn more about HIV and all of its related aspects through the fact sheet provided by NIH containing everything from the disease’s basics to the various opportunistic infections that develop along with the disease.

References

Mark Riegel, MD
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