TESTING HIV NEGATIVE: THE MESSY TRUTH

In our current world of HIV treatment and prevention, there has been a lot of talk about PrEP and #uequalsu, so much so that almost no one is talking about being HIV negative.

Maybe the issue is because the expected default for humans is to not be living with an incurable virus. But it could also be that some who are negative have made it into a point of pride; rather than the dumb luck it probably was. This grows into a sense of entitlement that fuels the stigma that so many of us fight every day. Remember, everyone who is living with HIV today, at one point, was HIV negative. (Yes, except for those born with HIV)

As always, our articles are not meant to scare or traumatize you, rather to educate and inform you. So, let’s talk about what being HIV negative really means.

Warning, some of you are not going to like what you find out.

WHAT IS AN HIV TEST?

This is actually where the problem of understanding begins. The average person has never had an actual HIV test, if we take each word literally. The test most receive is an HIV ANTI-Bodies test, which tests for your body’s reaction to a possible infection.

There are three types of tests used to diagnose HIV infection. How soon each test can detect HIV infection differs, because each test has a different window period. This is the time between when a person may have been exposed to HIV and when a test can accurately detect HIV infection.

Antibody tests check for HIV antibodies in blood or oral fluid. HIV antibodies are disease-fighting proteins that the body produces in response to HIV infection. Most rapid tests and home use tests are antibody tests.
Antigen/antibody tests can detect both HIV antibodies and HIV antigens (a part of the virus) in blood.
NATs look for HIV in the blood.

A person’s initial HIV test will usually be either an antibody test or an antigen/antibody test. NATs are very expensive and not routinely used for HIV screening unless the person had a high-risk exposure.

Those who receive a NAT test are usually already known, or highly suspected, to be HIV positive.

WINDOW PERIOD

Now things get a bit tricky. The time period from exposure to HIV infection, to when the body produces enough HIV antibodies to be detected by standard HIV tests is the “window period” or sometimes called the “look back period”. The length of the window period varies depending on the test used. During the window period, a person can have a negative result on an HIV test despite having HIV.

Example:

Joe is tested for HIV antibodies on the 1st of January. His results return as negative. But this doesn’t mean Joe REALLY is HIV free, it means that the test could not detect any anti-bodies within his blood at that time. For the two (2) most common tests, the window period is between three (3) to even six (6) months, depending on the person.

For Joe, his test in January, really means that he was HIV free in OCTOBER, three months earlier. If we use the shorter 3 month time frame.

If Joe wants to know if he was HIV free in January, he would need to wait another 3 months, then get tested again. During this time he would also need to refrain from any types of sex that could possibly infect him.

THE MESSY PARTS

There are so many guys on the internet, posting their latest HIV results, not understanding what they do and don’t really mean. This also means that many of you reading this, had no idea either.

Let’s take a look back at Joe again. Let’s say you met him on-line, he says that he is HIV negative and has the form to prove it. You see the January date and think all is well and proceed to have condomless sex with him.

For all either of you know, Joe could actually be HIV positive but didn’t have a reaction to the test. Also, we don’t know what he did AFTER he had his HIV test. Did he run out and put himself at risk for exposure the same day? Maybe the next day? We don’t know, and Joe probably won’t tell you.

If Joe wants to be truly sure of his negative status, he would need to abstain from, or refrain from risky sex, for another 3 months, then get tested again. This will give him the greatest information about his health.

WHY THIS MATTERS

Approximately 1.1 million people in the U.S. are living with HIV today. About 15 percent of them (1 in 7) are unaware they are infected.

Gay and bisexual men are the population most affected by HIV. In 2017:

Gay and bisexual men accounted for 66% (25,748) of all HIV diagnoses and 82% of HIV diagnoses among males.
Black/African American gay and bisexual men accounted for the largest number of HIV diagnoses (9,807), followed by Hispanic/Latinos (7,436) and whites (6,982).

Among all gay and bisexual men, HIV diagnoses remained stable from 2012 to 2016, but trends varied by race/ethnicity:

HIV diagnoses among white gay and bisexual men decreased 14%.
HIV diagnoses among African American gay and bisexual men remained stable.
HIV diagnoses among Hispanics/Latino gay and bisexual men increased 12%.

Half of the Americans recently diagnosed with HIV had been living with the virus for at least three years without realizing it. These people were missing out on opportunities for early treatment, and in some cases spreading it to others within knowledge.

What’s more, of the 39,720 Americans newly diagnosed with HIV in 2015, one-quarter had been infected for seven years or more without knowing they were ill.

This means there are too many people walking around believing that they are HIV negative, but aren’t!

WHY YOU SHOULD CARE

Persons unaware of their human immunodeficiency virus (HIV) infection account for approximately 40% of ongoing transmissions in the United States. People who know they are living with HIV and are on proper treatment to become undetectable are not infecting others. There is no need to fear them.

• Eighty-four percent of sexual transmission from men who have sex with men (MSM) and heterosexuals is estimated to occur from MSM.

• Among persons with HIV infection diagnosed in 2015, the estimated median interval from infection to diagnosis was 3 years.

• Prior year testing increased over time among groups at high risk for HIV infection. However, 29% of MSM, 42% of persons who inject drugs, and 59% of heterosexual persons at increased risk did not report testing in the past 12 months.

• In each risk group, at least two thirds of persons who did not have an HIV test had seen a health care provider in the past year.

• Continued efforts to ensure routine and targeted testing can help reduce the number of persons who are unaware of their infection, diagnosis delays, missed opportunities for care and treatment, and HIV transmission.

GAY MEN AND TESTING

Not just in the United States, but all around the Western World, members of our community are not getting tested for HIV anti-bodies as often as they should, or as often as they say they are.

A recent study exploring HIV testing frequency among MSM in the UK identified variation in testing practices among young men (aged ?25 years) with 38.6% reporting testing once or less in the past 2 years, and 27.5% reporting at least four HIV tests in the same period.

Furthermore, research exploring HIV testing histories among MSM in England found that when compared with those in their 20s, as a group, men under the age of 20 were more likely to have never tested for HIV. This supports research from the Australian context which provides evidence that the proportion of those who report never testing is highest among young gay men, something the authors suggest is indicative of a lack of engagement with sexual health services among this group.

A sexual health needs assessment of MSM in central Scotland, concluded that younger men are highly sexually active, often have a high number of partners, and engage in high-risk sexual behaviour; factors which place them at greater risk of HIV. Many young men were less aware of HIV risk, and thus less equipped to employ strategies to reduce risk, including HIV testing.

SOLUTIONS

HIV testing was an initial way to separate the sick from the healthy so that the former could be treated, but along the way it morphed into camps of “the clean and unclean”. This not only increased the level of stigma within our community, but also decreased the amount of testing; because who wants to live with the high level of HIV stigma he helped create?

The first thing you can do to stop the needless spread of HIV, is make sure that you are getting tested at least very 3 months and practicing safer sex. Beyond that, there are other simple things we all can do that can help our community rebound from the AGE of AIDS.

Stop living based on these tests, because they don’t say and mean what you think they do.
Stop posting them as proof of your status because you might be one of the guys responsible for spreading HIV.
Create a safe space for your friends to talk about getting tested.
Trust the facts and science behind #uequalsu because those living with HIV but undetectable cannot transmit the virus.
Stop letting someone’s HIV status totally inform and dictate who your sexual partners are.
Start taking PrEP!

We told you this article was going to be a rough read. But hopefully, you now have a better understanding of how those HIV anti-bodies tesst work and what they really mean.

Only an HIV Viral Load test can accurately tell if you are living with the virus, at that time. Anything else, is going to have a window period that must be factored in.

If you still have concerns or fears about taking an HIV anti-bodies test, maybe this article will help.