HIV testing

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The benefits of knowing you are HIV-negative
The benefits of knowing you are HIV-positive
Symptoms of HIV infection
Frequency of testing
Different HIV tests available
Where to test
Which sexual partners should I inform if I've been diagnosed with HIV

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.

"When my boyfriend found out that he had HIV, I thought I was bound to have it too. I'd used condoms with other guys but not with him. When my test came back negative it was a huge relief. It felt really good to know I was negative. Because of my boyfriend's result, I felt guilty for feeling so good at first. But his positive diagnosis brought home to me what I'd nearly lost. And it does feel good to be negative. I hadn't given my boyfriend HIV, or vice versa. This really helped us focus on his health, and meant I could give him the support he needed."

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.

"I always have safer sex so I didn't bother to have regular HIV tests. I hadn't been for a test for about five years. Like a lot of my friends, I don't prefer using condoms; I do it because I want to stay negative. Then this doubt started to creep into my head. Since my last HIV test I could remember a few occasions where the condom broke, a night where I'd taken enough chems not to know exactly what happened, fucking a guy without a condom and telling myself it was OK 'cos I was fucking him. I started to question why I was using condoms because I thought I was probably HIV-positive. By the time I went for the test, I was convinced I was positive. I just went to confirm that I already had HIV. Getting a negative test result gave me the kick up the backside that I needed to keep using condoms. It made me realise I could stay negative, that I was able to keep myself HIV-free."

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.

"Using condoms isn't a problem for me, but then I fell in love. So my partner and I talked about fucking without condoms, discussed what the rules were going to be and then got tested. From the first discussion to finally getting the test results took us nearly a month, but knowing that neither of us would infect the other was worth the wait."

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.

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.

Symptoms of primary infection include:

Fever (high temperature)
Rash
Oral ulcers
Joint pain
Sore throat
Loss of appetite
Weight loss
Muscle pain
Feeling overly tired
Feeling sick

Over 60% of people who get HIV will have at least one of these symptoms two to six weeks after becoming infected.5 These symptoms of infection are called seroconversion illness. Some people experience severe symptoms and some people experience very mild symptoms.

These symptoms can be linked to many other illnesses too (like the flu), but if you think it could be HIV it's worth getting it checked out. You should be concerned that these symptoms are possibly HIV-related rather than flu if you had sex which put you at risk of HIV infection in the last six weeks. If you haven't, then your symptoms probably are flu or some other medical condition rather than HIV infection, in which case you should still make an appointment with a GP.

After the first stages of HIV infection, it can be many years before you experience any other symptoms or ill health. However, some people do develop medical conditions as HIV wears down the immune system.

Some people notice signs of the effects of HIV infection on their immune system including swollen lymph nodes (small lumps) in the neck, armpit or groin, or fever/night sweats.

HIV can also have a profound effect on the digestive system, so in some cases people experience stomach upsets and diarrhoea more than they used to.

Symptoms associated with breathing (shortness of breath or coughs) usually occur later in the course of the HIV disease and can be a sign of bacterial pneumonia, which is common in untreated HIV infection.

Because your immune system is weakened, you may also be more prone to other viruses, fungi or bacteria which can cause rashes on the skin and sores in the mouth.

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 only have one partner who you know is HIV-negative, then testing regularly may be less important to you. If you might have been at risk of getting HIV, 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.

Even if you've tested negative in the past, you need to test regularly because a negative HIV test doesn't mean you can never get HIV; it just means that you've avoided HIV infection up until that point. Not every unprotected fuck automatically gives you HIV so if you have sex with a guy who has HIV without using condoms, you could still test negative. However, that's no guarantee that you won't get infected if you do the same thing again. Some people get infected with HIV the first time they fuck without condoms and some people get HIV only after having lots of unprotected fucks.

A negative HIV test result can mean:

that you have not put yourself at risk of HIV infection, or
that you have put yourself at risk but have avoided HIV infection up to that point.

A negative HIV test result doesn't mean:

that you will never be infected with HIV
that you are immune to HIV
that the sex you are having is always safe enough
that the people you've had sex with are HIV-negative
that none of the people you've had sex with is HIV-positive

Different HIV tests available

Taking an HIV test is the only way to know your HIV status for sure. But if you think you've been at risk of getting HIV, you will have to wait a while before taking a test to make sure the result is accurate. The length of time you should wait after an HIV risk will depend on the type of test you take.

If you took an HIV test in the UK before 2008, it's likely that it was an HIV antibody test. This test may still be used in some clinics, but it doesn't always give an accurate result if you've been at risk in the last three months (known as the 'window period'). The British Association of Sexual Health and HIV (BASHH) now recommends that clinics use a 'fourth generation' test, which tests for both p24 antigen and HIV antibodies, and usually gives an accurate result a month after exposure to HIV.7 This means that most people only need to wait a month from when they were at risk before testing.

When you go for a sexual health check-up, most clinics now include an HIV test on an 'opt out' basis – they tell you they're doing an HIV test and you have an opportunity to decline the test. If the clinic does not ask you to test for HIV, ask for the test specifically rather than assume that they are testing you for HIV.

Some clinics have more than one type of HIV test available so you may be able to have a particular type of test to suit you.

To make sure you get the right HIV test, it helps to know when you last put yourself at risk of getting HIV (the last time you took a sexual risk, such as fucking without condoms). If it's been a month or more since you took a risk, you should be able to get an accurate test. If it's less than 72 hours since you were at risk, taking PEP may prevent you from becoming infected.

You can make a few more choices too:

Don't like giving blood? See rapid tests for information on finger prick tests, swabs from the mouth and tests on samples of piss.
Want results the same day as the test? Also see rapid tests
Want to take the test at home? See home sampling.

Combined p24 antigen/antibody test

This is the standard test offered by many clinics. It detects p24 antigen, a protein found in HIV, about two to four weeks after someone is infected, as well as HIV antibodies, which can take up to three months to be produced. This means that HIV can be diagnosed earlier than if antibody testing is used alone. This is important because if someone has HIV, they can be highly infectious before they develop antibodies to the virus.

Many clinics offer combined p24 antigen/antibody tests (also known as fourth generation tests) which are accurate after one month of any risk of HIV infection.

Antibody test

Rather than testing for HIV itself, this tests for antibodies to HIV – your body's natural response to the virus. While these antibodies can often be detectable within two to eight weeks, it can take longer. Therefore, this test can be less accurate if you've taken a risk in the last three months. If you get tested before the three months have elapsed, you could get an incorrect test result as antibodies may not have developed. Some clinics may still use this test if you have had no HIV risks in the three-month window period.

Some clinics recommend testing again at six months, but this is rare. However, if you have just taken PEP, it's recommended you return after six months for another HIV test in case PEP has made the first test result inaccurate.

Antigen test

During the first few weeks after someone becomes infected with HIV, p24 antigen is produced in excess and can be detected in the blood. It usually takes about two to four weeks after someone is infected with HIV before there is enough of the antigen to be detectable, but it can take longer.

Some clinics may offer a p24 antigen test three to four weeks after any risk of HIV infection, but you may also have to get an antibody test after three months to be absolutely certain that it is accurate. It is more common for this test to be combined with an antibody test.

Tests for HIV's genetic material

There are also tests available which can detect HIV's genetic material (the building blocks that make up the virus) around nine to twelve days after being infected. These tests are not routinely used because they can be expensive and samples have to be sent away to a lab before you can get the results. However, they can be used to confirm a positive result from an antibody or antigen test.

Rapid tests

The length of time it takes to get your results depends on the type of test you have. Some antibody tests can take a few days or weeks to get results. However, rapid tests are available that can give you results in under an hour. The advantage of a rapid test is that you do not have to return to the clinic to get your result – they are usually available in less than 30 minutes.

Rapid tests that detect HIV antibodies use saliva swabs or small samples of blood, either taken with a syringe or a finger-prick test. You can't get HIV from saliva but it contains antibodies, which means rapid HIV saliva tests are possible. These can be useful if you don't like needles.

Rapid tests which detect both antibodies and the p24 antigen are available at some clinics, but these need a sample of blood.

Home sampling

It is generally recommended that HIV tests are done with medical supervision. However, home sampling kits are available. You take a sample (usually from inside your mouth with a swab) at home which you send to a laboratory for analysis. Your results are then given to you by a doctor.

There are tests which you can take and get the results at home – similar to a pregnancy test – but these are currently unregulated in the UK and illegal to sell. Because of this, you have no guarantee of the quality of the apparatus in these tests, and a substandard kit may not give you an accurate result.

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

HIV organisations used to recommend that you wait three months after unprotected sex before you got tested. Now you do not need to wait that long.

HIV can now be detected after one month of you becoming infected.

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

If there is a particular test you want, it's best to do some research and find somewhere that offers it. Not all clinics offer all the types of 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 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.

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.