HIV testing

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Taking an HIV test can be emotionally difficult. So much so that many of us put our own HIV status to the back of our minds, or convince ourselves that the effort or stress of taking a test outweighs the benefits of knowing our HIV status for sure. We only tend to think of HIV tests as something that we do to find out that we are HIV-positive. So if you don't believe you have HIV, why would you test?

Whether or not you think about your own HIV status, or know your own HIV status, you still have an HIV status. You are either HIV-negative or HIV-positive. Taking an HIV test won't change your HIV status but it will inform you what your HIV status is. Not taking a test doesn't mean that you are HIV-negative, it simply means that you don't know what your HIV status is.

You may have already heard that around a quarter of gay men with HIV don't know they have it,1 but did you also know that around 90% of gay men who say that they are unsure of their HIV status are actually HIV-negative?2 That's 90% of the people who may be concerned about their HIV status worrying for no reason. Knowing your HIV status – whether it's positive or negative – is empowering. It enables you to make informed decisions about your future, your relationships and the sex you have. The phrase 'knowledge equals power' is certainly true when it comes to your own HIV status.

The benefits of knowing you are HIV-negative

The biggest benefit of knowing you are HIV-negative is knowing that you don't have the virus. Sounds obvious, right? But have you ever really thought about what this could mean for you?

If you have friends or a partner with HIV, then you'll know that being HIV-positive isn't easy. But neither is sitting around worrying about what might be. Worrying about the difficulties that HIV could bring isn't even necessary for 90% of the men who don't know their HIV status, because they turn out to be HIV-negative. And you won't have to worry about these difficulties at all if you know you are negative for sure and stay HIV-negative. Knowing for certain that you don't have HIV can be a weight off your mind.

Knowing that you are HIV-negative can also help you stay HIV-negative. Keeping yourself safe every time you have sex isn't easy for everyone. It becomes a lot harder to keep the motivation to always use condoms if you aren't sure whether or not you have HIV. Being certain that you are HIV-negative can, for some men, help them commit to keeping themselves HIV-negative.

For some men, the greatest benefit of knowing that they don't have HIV is having sex without condoms with their partner and being absolutely certain that they will not infect their partner. Intimacy and sex go hand in hand for most people, and for some men, using a condom for sex feels like a barrier to intimacy. Taking an HIV test with your partner shows a level of commitment and care towards each other. Some studies have indicated that roughly a third of gay men recently infected with HIV thought that it happened while having sex with a regular partner.3 This is often due to couples abandoning condoms without being certain that both partners are HIV-negative.

The benefits of knowing you are HIV-positive

Some people feel they would rather not know that they have HIV because they wouldn't be able to cope. In truth, most people who don't believe they could cope with an HIV diagnosis, do cope.

Not knowing that you have HIV isn't really an option in the long term. If you do not get your HIV diagnosed, you will not be accessing medication. Eventually your health will deteriorate and, without medical help, you will probably die of AIDS or other HIV-related complications. How long this takes will vary. It could be a couple of years or it could be over a decade, but very few people survive HIV without medical care. HIV was a death sentence before the introduction of HIV medication and if you don't get tested and access the care you need, you could still be risking your life.

If you delay testing, it's likely that at some point your health will become so poor that your GP will probably insist on you taking an HIV test. So if you have HIV, it isn't a question of whether or not you get it diagnosed, it really is more of a question of when you get it diagnosed.

With recent advances in the medical treatments available for people living with HIV, there are fewer reasons for not getting tested at the earliest opportunity if you believe that you may be HIV-positive. People who are diagnosed early enough will have their disease progression monitored so that treatment can start whilst their immune system is still relatively strong and they are not vulnerable to opportunistic infections. This not only reduces your likelihood of developing AIDS-related problems, but also cuts your risk of some cancers and heart disease.

If you are tested and treated you will also be less likely to pass on your HIV infection to your partners. Some studies now suggest that up to 82% of HIV infections come from men who have HIV but have not had their HIV diagnosed. This is because men with diagnosed HIV will often be on medication and have a lower viral load (and therefore be less likely to pass on their infection) than men with undiagnosed HIV infection.

About one in five gay men who find out they have HIV only get their HIV diagnosed after they've had the virus for many years.1 By then it has already caused serious damage to their health and decreased their life expectancy. Research suggests that for people with HIV in the UK, average life expectancy is decreased by 13 years.4 This is an average figure, however, and does not mean all people with HIV will live 13 years less than expected. Many people are diagnosed with HIV late – at a point after they should have started treatment and after HIV has had time to do more serious damage to their immune systems. This causes them to have a shorter life expectancy and shows that the earlier you are diagnosed, the longer you can expect to live.

For example, HIV-negative men aged 20 in the UK can expect to live, on average, to the age of 78. A 20-year-old man who has HIV but was diagnosed soon after becoming infected can expect to live almost as long. However, overall, men with HIV aged 20 can expect to live on average to just 60.4 The reason this figure is much lower than 78 is because it includes men who are diagnosed late, who have shorter life expectancies.

There's more information about getting support in our Positive Gay Guide.

Symptoms of HIV infection

Taking an HIV test is recommended if you experience any symptoms linked to the early stage of HIV infection, which is often called primary infection or acute infection.

During primary HIV infection you may have a variety of different symptoms. Some doctors believe that rash and fevers are the most common symptoms linked to primary HIV infection, especially when occurring together, and with other symptoms.

Frequency of testing

It is recommended that you take an HIV test at least once a year.6 This may vary depending on the type of sex you have. If you have fucked without a condom or had a condom break, you may want to test more frequently. If you have symptoms of HIV infection within a six-week period of having unprotected sex, it is recommended that you test immediately.

If you haven’t knowingly taken any risks it can be easy to believe that the effort of having an HIV test isn’t worth it. Men who believe they know the HIV status of their partner, men in monogamous relationships and men who only fuck with condoms often think like this. However there are good reasons why these men should take an HIV test at least once a year.

It’s thought that between 2 - 3% of HIV infections occur through sucking cock. The risk isn’t high but if you are one of the people who becomes infected with HIV despite using condoms consistently, and you don’t test for HIV because you believe you haven’t put yourself at risk, you may become seriously ill and it will have a negative impact on how long you live. See the benefits of knowing you are positive.

Men who believe they know the HIV status of their partner can only know for sure if their partner has tested for HIV and continues to do so on a regular basis. If you have stopped using condoms because you and your partner have tested negative, it is important that you both test annually to keep each other safe and get treated if one of you needs to.

Many gay couples have successful monogamous relationships. However, in one survey of over 300 gay men, 15% of men who said they were in a monogamous relationship had got an STI since being in the monogamous relationship. So for some people there may be a risk of HIV infection even if they believe their relationship is monogamous. Taking an annual HIV test when you are in a monogamous relationship isn’t about a lack of trust, it’s about looking after the person you love.

If you find going to a GUM clinic every year takes up a lot of your time but you want to be sure of your HIV status, you can order a free HIV home sampling kit from GMFA. The kit will arrive the next day and you will usually get your result two days after you’ve posted you sample back to us.

Remembering to test on an annual basis isn’t as easy as it sounds. To help remind you to test at least once a year GMFA have set up a service whereby we send you an email once a year. All you have to do is give us your contact details and tell us the month you would like a reminder and we send you an email on that month. The email contains a link to GUM clinics and a short message. You can unsubscribe from the service at any time. To be sent an annual reminder to test for HIV click here.

If you are confused about which test to take or when to take it, there are two easy things to remember:

HIV organisations used to recommend that you wait three months after unprotected sex before you got tested. Now we recommend that you don’t wait to test for HIV then test again after the window period.
Different tests have different window periods (the time between when someone is infected and when it will show up in a test) and some are as short as one month. If you inform your doctor when the last time you put yourself at risk was, it will enable him/her to advise you which HIV test is the most appropriate for you.

Where to test

You can access free, confidential HIV testing at most GUM clinics. Some clinics offer a same day testing service. Our clinic guide has details of the testing services available across London.

You can also order a free HIV home sampling kit from GMFA.

You can ask your GP for an HIV test, but if you do you are not guaranteed confidentiality, which may make it harder for you to get a mortgage or other financial services. Private clinics also offer HIV testing, but this can be expensive.

Which sexual partners should I inform if I've been diagnosed with HIV

In theory, you should tell anyone you've taken a sexual risk with (such as fucking without condoms) since you became HIV-positive. Therefore, it will depend on when you contracted HIV and what risks you may have taken since. Find out more about how HIV is transmitted.

Informing sexual partners if you've been diagnosed with HIV

Most gay men would want to know if they had been exposed to HIV. As the medical treatment of HIV improves, people are likely to live longer and healthier lives if they are diagnosed early so there is considerable benefit for anyone who has the virus, or who may have been exposed to the virus, if they know. If you have been diagnosed with HIV, you should tell anyone you've taken a sexual risk with (such as fucking without condoms) since your last HIV negative test. Find out more about how HIV is transmitted.

Many men who have been diagnosed with HIV would want to tell their sexual partners but would not necessarily wish to disclose their own HIV status. GMFA runs an online partner notification system with selected GU services in England. This free and confidential service allows men who have been diagnosed with an STI, such as HIV, to contact sexual partners via text, email or a message on a gay dating website. Messages can be anonymous and you don’t have to say what it is you’ve been diagnosed with. The messages sent do not imply either that you exposed your sexual partner to the virus, or that he exposed you to it. If you are diagnosed with HIV at a GU clinic in England, ask for information about GMFA’s Sexual Health Messaging Service.

References:

1 Health Protection Agency (HPA). HIV in the United Kingdom: 2010 report. Health Protection Agency, November 2010.

2 Williamson LM, Dodds JP, Mercey DE, Hart GJ, Johnson AM. Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK. AIDS, 2008;22(9):1063-1070.

3 Jin F, Prestage GP, Ellard J, Kippax SC, Kaldor JM, Grulich AE. How homosexual men believe they became infected with HIV: the role of risk-reduction behaviors. Journal of Acquired Immune Deficiency Syndromes, 2007;46(2):245-247.

4 May MT, Gompels M, Sabin CA. Impact on life expectancy of late diagnosis and treatment of HIV-1 infected individuals: UK CHIC. Journal of the International AIDS Society, 2010;13(Suppl 4):O27.

5 Medical Foundation for AIDS and Sexual Health (MedFASH). HIV in primary care: an essential guide for GPs, practice nurses and other members of the primary healthcare team. Medical Foundation for AIDS and Sexual Health, 2004 (revised April 2005).

6 British HIV Association (BHIVA), British Association for Sexual Health and HIV (BASHH) and British Infection Society (BIS). UK national guidelines for HIV testing 2008. British HIV Association, September 2008.

7 British Association for Sexual Health and HIV (BASHH). BASHH statement on HIV window period. British Association for Sexual Health and HIV, 15 March 2010.