On Saturday, I attended a workshop on HIV/AIDS in communities of color presented by folks from the Pittsburgh AIDS Task Force (PATF). The session was part of a day long event, the 17th Annual Summit Against Racism, and was a tremendously powerful and useful presentation. More than half of the audience in this workshop were young men of color, many of whom may be at risk for HIV. I’m hoping to get the slide show from PATF to post here on my blog as it was full of great information, but today, I want to write about one aspect of the battle against HIV– the importance of regular and consistent testing. This apples not only to persons of color but to everyone who could be at risk for HIV.

How often should you be tested?

I posed this question and received an excellent answer which I’ll share below, but as I worked on this blog post I also did some searching for an answer to this question. After so many years of the epidemic of AIDS and millions spent on research, one would think that even though a vaccine is difficult to create, basic epidemiology this would make this an easy question to answer. But surprisingly, answers aren’t so straight forward. Consider this info from aids.gov: (formatting is mine)

How often should you take an HIV test? That depends!

The CDC recommends that opt-out HIV screening be a part of routine clinical care for all patients aged 13-64. In other words, you should have an HIV test during a medical check-up—just like you have a blood test or a urine test to be sure you are healthy.

In spite of that recommendation, however, most people are tested on the basis of their risk factors for getting HIV. You should get tested for HIV every at least every year if you:

• Share needles/syringes or other equipment (“works”) for injecting drugs
• Have a history of sexually transmitted diseases (STDs)
• Have had unprotected sex (vaginal, anal, or oral) with multiple or anonymous partners. Or if you have had had unprotected sex with a partner who did not know their own HIV status.

Some healthcare providers may recommend testing every 3-6 months if you have certain risk factors, including injection drug use and/or unprotected sex with others who engage in high-risk behaviors.

So what did that just say:

The CDC thinks everyone between 13 and 64 should bone tested on a regular basis, but doesn’t specify how often. Though the implication is for a yearly test. This is for everyone.

But then says only some people need be tested every year based on three factors. And then, it says some providers (AKA doctors?) recommend testing every 3-6 months for the very same set of factors.

So, what is it: once a year or every 3-6 months? We don’t know from this site, ad this is the foundational site for basic HIV information! I’m going to bet that many people read this type of confusing information and are left still unsure so they just give up and don’t get tested.

I  say this is utter crap. If the CDC spearheaded an effort to get everyone tested in an opt-out fashion as a part of a yearly health care check up, The number of people who are unaware of their status would be cut significantly, and much of the stigma that surrounds testing would be diminished.

Why be tested every 3 months

Here is what I learned at the session, and this would apply to anyone who is a male who has any sex with other men, anyone who has sex with multiple partners, or anyone who has shared needles in IV drug use. Because of the amount of time that HIV can enter your system before a positive result may appear, is between 30 and 90 days. Here is what the San Francisco AIDs Foundation says:

A test taken at least 12 weeks (3 months) after exposure to the virus provides highly accurate results. In rare cases, a person could take up to six months to test positive using standard tests, and that is almost always a person with a severely compromised immune system due to another disease, such as leukemia.

So if you are tested every three months, you are most likely to never have a test that fails to shows an infection, and allow you to get on treatment as quickly as possible allowing you to as quickly as possible affect your viral load. The quicker and more completely you keep your viral load under control, the less likely that you will ever have AIDS.

It may be less than 30% of gay men who are tested within a year, and most are not tested because they aren’t concerned about becoming infected, although this is clearly irrational given the number of men who are already infected. In other words, guys convince themselves that they don’t need to be worried, and I’d bet a large part of that is because it takes a big toll on a person to worry all of the time. With so little clear guidance about when to be tested and what treatment opportunities exist for those who have become positive, it is just easier to pretend you don’t need to be concerned.