Objectives

Level A – Extend Knowledge Base

Foundational Objective

Students will know and use appropriate health resources to develop a factual information base about testing for HIV/AIDS .

Learning Objectives

Students will be able to:

Level B – Make an Informed Decision

Foundational Objective

Students will make health-enhancing decisions about when HIV testing may be required.

Learning Objectives

Students will be able to:

Level C – Carry Out Action Plan

Students will design an action plan for obtaining HIV testing in Saskatchewan.

Learning Objectives

Students will be able to:

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HIV/AIDS Education Appendix A

Sample Checklist for Evaluating Health-related Sources of Information

Author: ________________________________ Publisher: _____________________________________________

Title: __________________________________ Copyright Date: ________________________________________

“Yes” answers are positive indicators.

HIV/AIDS Education Appendix B

HIV Antibody Testing

The HIV antibody test, mistakenly referred to as the “AIDS Test” is not a test for AIDS. In fact, there has never been a test developed to test for AIDS. The HIV antibody test will not tell you if you will develop AIDS. Nor will it tell you that you are protected against HIV infection. This test will only indicate whether a person’s body has produced HIV antibodies. If it has, the person is considered to be infected with HIV and is therefore HIV-positive.

Your body creates antibodies when foreign particles like HIV enter your system. In most cases, antibodies actually fight off the foreigners and the body stays healthy. Sometimes however, antibodies are not able to fight disease, but only mark the presence of an intruder. This is what happens with HIV antibodies. HIV antibodies are referred to as “marker” antibodies, because they only mark the existence of the virus in your body, they do nothing to fight it off.

As in the case of other antibodies, the immune system needs time to produce antibodies once infection with a virus has occurred. In the case of HIV infection, the time required for the immune system to produce enough antibodies in order to be detected is from six to twelve weeks (3 months). Seventy-two percent of all people infected with HIV will produce enough antibodies to be detected after 6 weeks from the actual time of exposure to HIV. Ninety-six percent of all people infected with HIV will produce enough antibodies to be detected after 12 weeks from the actual time of exposure to HIV. In rare cases this time period can range from 12 weeks to a year or longer.

The period of time required to develop HIV antibodies is commonly referred to as the “window period”. When HIV antibody production reaches a level (quantity) where it can be detected, it is considered as “sero-conversion”. Sero-conversion means the time at which a person’s antibody status changes from being negative for HIV antibodies to being positive for HIV antibodies. Although there may not be any physical signs or symptoms of HIV infection, some people have reported experiencing flu like symptoms for a few days when their sero-conversion occurred.

Because of the window period, a person considering being tested should wait a minimum of six weeks from their last risky behaviour before being tested. If this test result is HIV negative, it is crucial that the person wait another 6 weeks and be re-tested. This makes the total waiting time 12 weeks from the actual date of their last risky behaviour. During all waiting periods, it is wise to either abstain from all risky behaviours for HIV infection or take the necessary precautions to reduce the risks for HIV transmission. Although you may not have produced enough HIV antibodies to be detected in the test, it is still possible to infect others.

Note: Testing for youth under the age of 14 is reported under the heading of “Pediatric HIV Antibody Testing”.

The HIV antibody test is performed by taking a blood sample. This is a specific test developed to determine whether HIV antibodies, not the actual HI virus, are present. A person must request this test, it is not done automatically (i.e., If you go for a physical, your doctor will not automatically test you for HIV antibodies). HIV antibody testing cannot and should not be done without the person’s informed consent.

The most widely available and frequently used method for detecting the presence of HIV antibodies in the blood is called the ELISA (enzyme-linked immunosorbent assay). The ELISA produces a reaction to the HIV antibodies. This test rarely fails to detect HIV antibodies when they are present. In Saskatchewan, if there is no reaction to the ELISA, the testing stops and the test results will be considered HIV negative. When there is a positive reaction to the ELISA, a second confirmatory test called the Western Blot will be performed. In over 98% of all reactions to the ELISA, the Western Blot will confirm a positive HIV antibody test. The test results will then be considered HIV-positive. This means that before a person is told he or she is HIV-positive, two separate confirmatory HIV antibody tests have been performed on his or her blood sample.

Where to be tested

Your family doctor, any medical doctor, a medical clinic, a sexually transmitted disease clinic, or an anonymous test site can draw a blood sample to be tested for HIV antibodies. In Saskatchewan, the provincial lab in Regina is the only place where
HIV antibody testing is performed. All blood samples for HIV antibody testing must be sent there. Because of this, it can take about seven to
14 days to get your results.
continued ?

Note: Although the Red Cross screens all donated blood for HIV antibodies, the screening procedure should not be used as a means of being tested for HIV antibodies.

There are three basic ways in which a person can have his or her HIV testing performed. They are: nominally, non-nominally, and anonymously. Before someone makes the choice of where he or she is going to be tested, the person should be made aware of the options available regarding how the testing will be done and how the results will be handled. When deciding where to be tested, a person should inquire if pre and post test counseling is available. In Saskatchewan, only HIV antibody test results that are positive are reported to Saskatchewan Health. This is extremely important if your test is positive.

Nominal Testing

Nominal testing is mainly done in a doctor’s office, at hospitals, or at medical clinics. The name of the person being tested is written on the testing requisition, the blood sample, and on the test results. Anyone reading these items will know the identity of the person being tested and/or the test results. Nominal testing increases the risk of disclosure. In Saskatchewan, doctors are required to report all HIV-positive test results to the medical health officer. This can be done by using only the person’s initials and date of birth. However, doctors, upon request from the medical health officer, are required by law to provide the name or names of their patients who tested HIV-positive. All positive HIV results must be reported to Saskatchewan Health. Additionally, the person’s HIV status will also be recorded in the doctor’s medical file. This may be cause for concern if the person is seeking health and/or life insurance.

Non-nominal Testing

Non-nominal testing is done by some doctors or medical clinics. The identity of the person being tested is disguised by a code on the testing requisition and the blood sample. Only the doctor and the person being tested will know whom the specific code identifies, unless the doctor or the person discloses this code to someone else. When a person is going to be tested by a doctor, he or she should request that the testing be carried out non-nominally. This will reduce the risk of unwanted disclosure. However, if a doctor is using non-nominal testing, and the test result is positive, the doctor is still obligated to follow the same procedures as outlined in nominal testing. Non-nominal testing can also be performed at sexually transmitted disease clinics. In this case, the identity of the person being tested does not have to be revealed to anyone. If the test result is positive, only your initials and date of birth are reported.

Anonymous Testing

Anonymous testing is carried out at some sexually transmitted disease clinics and at anonymous testing sites. The identity of the person being tested does not have to be revealed to the doctor, nurse, or staff member. The person’s only identifier is a code name or number assigned by the clinic staff. Anonymous testing ensures the confidentiality of the person being tested. An anonymous test site must report an HIV positive test result but does not have to give your name or initials. They give only the identifier code name or number. Additionally, all anonymous test sites and sexually transmitted disease clinics provide pre and post test counseling.

HIV Antibody Test Results

Understanding Negative Test Results

1. At the time your blood was tested HIV antibodies were not found. Either you are not infected with HIV or you were in the window period. If you believe you may be in the window period, testing should be repeated at six weeks and possibly three months after the first HIV antibody test. If you are in the window period, you can still infect others.

2. Does not mean you have a “resistance” to HIV infection.

3. Does not mean you will never gets AIDS.

If you participate in future high risk behaviours, the risk of being infected with HIV remains.

4. Does not mean you are immune to AIDS.

Understanding Positive Test Results

1. HIV antibodies were found in your blood sample.

2. You are probably carrying the HI virus.

3. You are infectious, currently for life, and are capable of transmitting the virus to other people. You should take the necessary precautions to reduce the risks of infecting others.

4. Does not mean you have AIDS.

5. Does not mean that you will develop AIDS, although it is a possibility.

6. If your test result is positive, you will be asked to make some difficult decisions. You will be asked to notify your present and past sexual or needle sharing partners of your HIV-positive status and suggest they consider being tested for HIV antibodies. If you are uncomfortable doing this, you will be asked to provide their names and addresses to your primary care provider (physician, testing clinic staff, or public health). The primary care provider will then contact your partners stating that there is reason to believe that they may have been exposed to HIV and should consider being tested. The physician, testing clinic staff, or public health person will not disclose your name to your contacts.

7. If your test result is positive you may face the tough choice of informing present and future sexual partners, or persons with whom you may share needles, about your HIV-positive status. It is against the law to knowingly infect another person with HIV, without the individual’s knowledge of your positive HIV status.

Understanding False Negative Test Results

False negative test results mean that the presence of HIV antibodies was not found, but the person being tested is infected with HIV. This can happen for two reasons.

1. The person being tested had not yet produced enough HIV antibodies to be detected; in other words, they were in the window period. Inadequate waiting periods, from the time of actual exposure to the time of testing, is the most common cause for false negative test results.

2. In very rare cases, a person infected with HIV for some unknown reason will not have produced HIV antibodies. If a person assesses his or her risk for HIV infection to be highly likely and has received a negative test result, further in-depth testing should be performed by the Laboratory Centre for Disease Control in Ottawa. A new blood sample may be required.

Understanding Indeterminate Test Results

In extremely rare cases, the ELISA test will have a positive reaction and the Western Blot will have a negative reaction. This is considered to be an indeterminate test result. If and when this happens, the blood sample will be sent to the
Laboratory Centre for Disease Control in Ottawa for further analysis and in-depth testing. The results of this testing will confirm if the blood sample is HIV-negative or HIV-positive.

In conclusion to HIV antibody testing, small traces of HIV antibodies can also be detected in saliva, urine, and feces. If HIV antibodies are detected in these fluids before the person has had a HIV antibody blood test done, it is imperative that a follow up blood test be performed to confirm the person’s HIV status.

The HIV Antibody Test

The decision on whether to be tested for HIV antibodies lies with the person considering being tested. This is a matter of individual choice. HIV testing cannot be performed without a person’s informed consent. Some reasons why people choose to be tested or not tested are listed below.

Why to be tested:

1. People want to know if they have been exposed to HIV through unprotected sexual contact or through sharing unclean needles.

2. People want to know if they are infecting others.

3. People want to know their HIV status (and that of their partners) if they are considering having a child or getting married.

4. People want the information so they can reinforce their own safe, healthy behaviours.

5. Anyone who may have received a blood transfusion or blood products prior to 1986 in Canada or received a blood transfusion or blood products in another country where the HIV screening practices of blood and blood products may not be known.

6. If someone has experienced forced unprotected vaginal or anal intercourse, especially if the perpetrator is suspected of having high-risk behaviours

7. A person has participated in a high-risk behaviour either voluntarily or by force and begins to experience unexplained or chronic infections.

8. If a youth is known to have a high risk sexual background or a history of injection drug use.

Why not to be tested:

1. If you may be at risk for HIV infection, you should only engage in safer sex or safe needle use regardless of your test result.
2. The test results may cause such anxiety that it is better not to know the results. People who test positive show increases in anxiety and depression.

Remember, for anyone 14 years of age or older, whether to be tested is an extremely personal decision. We cannot presume to make that decision for anyone. We can only advise people of the implications of a positive or negative test result in their lives. The decision is theirs to make. People who choose to be tested often experience high levels of anxiety, fear, and an emotional roller coaster while waiting to receive their test results. It is crucial for anyone considering being tested that he or she receive pre and post test counselling.

Pediatric HIV Antibody Testing

The decision on whether a child should be tested for HIV antibodies lies with the child’s parents or legal guardian. An HIV antibody test cannot and should not be performed on a child under the age of 14 without the informed consent of the parent or legal guardian. A list of possible reasons why a parent or guardian may consider having his or her child tested are:

1. The mother was HIV positive at the time she gave birth or found out she was HIV positive after she gave birth. HIV antibody testing will not be considered on newborns until they have reached 18 months of age. An exception will be made if the infant starts to exhibit symptoms of HIV infection before the age of 18 months. In this case, testing for the actual virus may be performed instead of testing for HIV antibodies to determine if the infant is HIV-positive. In rare cases, infants may be born with full blown AIDS, therefore HIV antibody testing may or may not be performed.
HIV/AIDS Education Appendix B

2. The child received a blood transfusion or blood products prior to 1986 in Canada or received a blood transfusion or blood products in another country where the screening practices of blood and blood products may not be known.

3. If the child is being considered for adoption, whose mother is known to have high risk behaviours or if the child is from areas where HIV is endemic.

4. If a child has experienced genital to genital sexual abuse, especially if the perpetrator is suspected of having high risk behaviours or the child starts to experience unexplained or chronic infections.

5. In older children if they are known to have a high risk sexual background or a history of injection drug use.

6. If a child’s parents are known to have a history of injection drug use.

Remember, whether to test a child is an extremely personal decision for parents or legal guardians. We cannot presume to make that decision for anyone. We can only advise parents or guardians of the implications of a positive or negative test result in their child’s life as well as their own lives. The decision is theirs to make.

Additionally, parents or guardians who choose to have their child tested, often experience high levels of anxiety, fear, and an emotional roller coaster while waiting to receive the test results. It is crucial for them to receive pre and post test counselling.

Note: The above outlined testing information is the only difference between pediatric and adult testing procedures.

Printed with the permission of AIDS Regina.
Scotiabank Building, 1504B Albert Street, Regina, Saskatchewan, S4P 2S4, 306-924-8420, toll free
1-877-210-7623

HIV/AIDS Education Appendix C

Sample Checklist for Evaluating Health-related Information

Author: ________________________________ Publisher: _____________________________________________

Title: __________________________________ Copyright Date: ________________________________________

“No” answers are positive indicators.

HIV/AIDS Education Appendix D

Sample Rubric for Assessing the Design Phase of an Action Plan to Arrange for HIV Testing