1. Testing

2. First things first
The only way to know whether you are infected is to be tested for HIV. You cannot rely on symptoms alone because many people who are infected with HIV do not have symptoms for many years. Someone can look and feel healthy but can still be infected. In fact, one quarter of the HIV-infected persons in the United States do not know that they are infected.

3. Testing
Each year, approximately million persons in the United States are tested for HIV. By 2002, an estimated 38%-44% of all adults had been tested for HIV , however at the end of 2003, approximately 252, ,000 persons were unaware of their HIV infection.

4. Why Test?
Early detection of HIV can assist with various health care programs that can keep them healthy and extend their lives.
Also with early detection, a person can take effective measures to stop the risk of spreading the infection to others.

5. The Center for Disease Control (CDC) has researched and found:
Infected persons decrease behaviors that help transmit infection to sex or needle-sharing partners once they are aware of their positive HIV status
HIV-infected persons who are unaware of their infection do not reduce risk behaviors
Persons tested for HIV who do not return for test results might even increase their risk for transmitting HIV to partners
Because medical treatment that lowers HIV viral load might also reduce risk for transmission to others
Early referral to medical care could prevent HIV transmission in communities while reducing a person's risk for HIV-related illness and death.

6. For Patients in All Health-care Settings
HIV screening is recommended for patients in all health-care settings after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
Persons at high risk for HIV infection should be screened for HIV at least annually.
Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
Prevention counseling should not be required with HIV diagnostic testing or as part of HIV screening programs in health-care settings.

7. For Pregnant Women
HIV screening should be included in the routine panel of prenatal screening tests for all pregnant women.
HIV screening is recommended after the patient is notified that testing will be performed unless the patient declines (opt-out screening).
Separate written consent for HIV testing should not be required; general consent for medical care should be considered sufficient to encompass consent for HIV testing.
Repeat screening in the third trimester is recommended in certain jurisdictions with elevated rates of HIV infection among pregnant women.

8. More on HIV Testing
Once HIV enters the body, the body starts to produce antibodies—substances the immune system creates after infection. Most HIV tests look for these antibodies rather than the virus itself.
There are many different kinds of HIV tests.
including rapid tests
home test kits.
All HIV tests approved by the US government are very effective at finding HIV.

9. Window Period
Since most HIV tests require the presence of antibodies created by the immune system, it may take a period for enough antibodies to be created for an accurate test.
This time period is commonly referred to as the “Window Period”
The average widow period is 25 days.
However, in rare cases it can be from 3-6 months
To guard against false negatives it is recommended to get a second test around 3 months after initial testing.

10. Recent studies demonstrate that voluntary HIV screening is cost-effective even in health-care settings in which HIV prevalence is low.
In populations for which prevalence of undiagnosed HIV infection is >0.1%, HIV screening is as cost-effective as other established screening programs for chronic diseases (e.g., hypertension, colon cancer, and breast cancer
Because of the substantial survival advantage resulting from earlier diagnosis of HIV infection when therapy can be initiated before severe immunologic compromise occurs, screening reaches conventional benchmarks for cost-effectiveness even before including the important public health benefit from reduced transmission to sex partners

11. Linking patients who have received a diagnosis of HIV infection to prevention and care is essential. HIV screening without such linkage confers little or no benefit to the patient. Although moving patients into care incurs substantial costs, it also triggers sufficient survival benefits that justify the additional costs. Even if only a limited fraction of patients who receive HIV-positive results are linked to care, the survival benefits per dollar spent on screening represent good comparative value.

12. The benefit of providing prevention counseling in conjunction with HIV testing is less clear. HIV counseling with testing has been demonstrated to be an effective intervention for HIV-infected participants, who increased their safer behaviors and decreased their risk behaviors; HIV counseling and testing as implemented in the studies had little effect on HIV-negative participants .

13. However, randomized controlled trials have demonstrated that the nature and duration of prevention counseling might influence its effectiveness. Carefully controlled, theory-based prevention counseling in STD clinics has helped HIV-negative participants reduce their risk behaviors compared with participants who received only a didactic prevention message from health-care providers

14. A more intensive intervention among HIV-negative MSM at high risk, consisting of 10 theory-based individual counseling sessions followed by maintenance sessions every 3 months, resulted in reductions in unprotected sex with partners who were HIV infected or of unknown status, compared with MSM who received structured prevention counseling only twice yearly .

15. Finding a Testing Site Many places offer HIV testing:
health departments
doctors' offices
Hospitals sites specifically set up to provide HIV testing.
You can locate a testing site by visiting the CDC HIV testing database or by calling CDC-INFO (formerly the CDC National AIDS Hotline) at CDC-INFO ( ) 24 Hours/Day.  You do not have to give any personal information about yourself to use these services to find a testing site.

16. The following may indicate warning signs of advanced HIV infection
rapid weight loss
dry cough
recurring fever or profuse night sweats
profound and unexplained fatigue
swollen lymph glands in the armpits, groin, or neck
diarrhea that lasts for more than a week
white spots or unusual blemishes on the tongue, in the mouth, or in the throat
pneumonia
red, brown, pink, or purplish blotches on or under the skin or inside the mouth, nose, or eyelids
memory loss, depression, and other neurological disorders

17. Recommendations for Adults and Adolescents
CDC recommends that diagnostic HIV testing and opt-out HIV screening be a part of routine clinical care in all health-care settings while also preserving the patient's option to decline HIV testing and ensuring a provider-patient relationship conducive to optimal clinical and preventive care. The recommendations are intended for providers in all health-care settings, including hospital EDs, urgent-care clinics, inpatient services, STD clinics or other venues offering clinical STD services, tuberculosis (TB) clinics, substance abuse treatment clinics, other public health clinics, community clinics, correctional health-care facilities, and primary care settings.

18. The guidelines address HIV testing in health-care settings only; they do not modify existing guidelines concerning HIV counseling, testing, and referral for persons at high risk for HIV who seek or receive HIV testing in nonclinical settings (e.g., community-based organizations, outreach settings, or mobile vans.)