terre thaemlitz writings

- Terre Thaemlitz

1993 (comatonse.com). Most of this information was written in committee with others, and Terre is not the sole author. Please note that this information was compiled during the late '80s and early '90s, and some of it may be out of date (statistics, etc.). However, most information is general enough that it is still relevant. In particular, the "HIV/AIDS Lexicon" remains as important as ever. The old "HIV/AIDS Resources" section has been deleted since HIV and AIDS related organizations and referral agencies are easily located through current internet search engines.

introduction | transmission | prevention | testing | lexicon


About the HIV Antibody Test

To know whether one is infected with HIV or not, one has to take the HIV antibody test. The antibody test is not a test for AIDS [Acquired Immune Deficiency Syndrome], but a test for the presence of HIV antibodies. It does not tell if a person has AIDS because AIDS refers to a syndrome of effects one can experience as a result of a low immunity tolerance, which is caused by HIV. The presence of antibodies indicates HIV infection.

In most people, antibodies to HIV develop within three weeks to three months after infection, although some individuals may take much longer to seroconvert (develop antibodies). Health care professionals usually recommend that risk behavior within the past six months should be taken into account when testing, because transmissions during that time period may not be reflected in the results of an antibody test.

How Is The Test Done?

A small amount of blood is drawn from a person's arm, taken to a lab, and tested. The time it takes to get results back varies in different areas. It can take anywhere from a few days to a few weeks.

Two different antibody tests are being used by the NYC Department of Health [DOH] Laboratory:

  • The Enzyme Linked Immunosorbent Assay (ELIZA): it is a highly sensitive test for HIV antibodies, but it may also pick up other antibodies that are similar.
  • The Western Blot: this test is used for the detection of HIV antibodies only.

A blood specimen is first tested twice using ELIZA. If both of the test results are non-reactive, a Western Blot is generally not performed, and the result is negative. If both ELIZAs are reactive and the Western Blot is reactive, the result is positive.

Why Should Someone Take the Test?

Early Intervention
Knowing a person's HIV status alerts one to seek medical care to prevent or delay life-threatening illness. The test result (positive or negative) can also help health care professionals determine the cause and best treatment for various Opportunistic Infections and other illnesses one may have now or in the future.

Health Care Issues Are Important, Knowing One's Health Status Can Be Empowering
For some individuals, knowing their results in an antibody test can help them feel better about themselves, even though the test result is positive. The concept of being aware of one's own health status is important and empowering because she/he is the one making important decisions regarding her/his health, and not letting unexpected surprises take place. She/he can also change her/his personal habits which could be considered risky in order to protect her/his sexual partner(s) from infection and illnesses. If the test result is negative, one can take actions to reduce the risk of infection in the future.

Deciding Whether To Take The Test Or Not

The primary reason for taking the HIV antibody test is to start early intervention. Current medical research has shown that early detection and intervention of HIV infection can delay the onset of HIV illnesses, but there are some issues to be taken into consideration before believing in such findings.

  1. Not all people have equal access to medical care. Testing antibody positive might mean other medical tests and interventions that can be expensive and may be required for a lifetime.
  2. Not all people who take the test can do it voluntarily. For example, current U.S. laws enforce mandatory testing for the following populations:
    • Applicants to and members of the Armed Forces.
    • Applicants to and members of the Job Corps, and Peace Corps.
    • Overseas State Department positions.
    • Federal prisoners.
    • Applicants seeking legal residency status (green card) in the United States.

  3. No guarantee of confidentiality is absolute, and consequences for the individual can be severe if one's HIV status is know by others.
    • Applicants seeking legal residency status can be deported by the U.S. Government if the test result is positive.
    • Individuals may no longer be able to get health insurance.
    • One may loose her/his job, housing, or community support.
    • One may be disowned by her/his parents, sisters, brothers, or other relatives.

If Decided to Take the Test, What Are the Issues?

Pre- And Post-Test Counseling
All testing should be performed with extensive, face-to-face pre- and post-test counseling by a trained counselor.

The pre-test counseling process should encourage self-assessment of risk and attempt to determine whether the individual really needs to be tested to accomplish prevention or medical goals.

Effective counseling must be done in non-judgmental, respectful, culturally sensitive, and language specific manners.

All information regarding eligibility for public and private health benefits and eligibility for social services and public entitlement programs must be made available to the individual taking the test during the post-test counseling.

Informed Consent
Testing should be performed after full informed consent is obtained during the pre-test counseling process. The informed consent should ensure the following:

  • An understanding of the interpretation of test results, including delays in developing antibodies after infection.
  • An understanding of high-risk behaviors associated with HIV transmission in both an individual's own behavior and the behavior of their sex and/or needle sharing partners.
  • Discussion of the potential psychological ramifications of learning antibody status, and an assessment of the individual's ability to cope with that information.
  • Recognition of the social and legal consequences that often accompany testing:
    • The possibility that test results with identifiers (not anonymous) may be reportable to state health departments.
    • Contact tracing or partner notification programs may be in effect for persons who test positive.
    • The very act of taking the test can lead to discrimination.
    • Persons who have tested positive have lost their jobs, homes, custody of their children, etc.
    • Persons who test positive may face disownment by their family members because of widely shared cultural beliefs which define people with HIV as people who have "done the wrong things," and as sources of shame.
    • Individuals who test positive may risk losing their ability to obtain health or life insurance in the future.
    • An understanding of the availability or lack of availability in the individual's own community of:
      • Drug treatment options.
      • Diagnostic measures and other medical intervention.
      • Clinical Trials.
    • An understanding that culturally sensitive and language specific support services and groups for those who test positive may be difficult to locate. In particular, support services for Asian and Pacific Islander communities are extremely rare at this time.

Please be sure that you feel that you have taken into account all of these issues when considering testing. It is commonly suggested that a person take an anonymous test which is free (you will receive a number to identify test results; therefore, you do not have to give your name, address, or phone number).

Confidential testing, which requires disclosure of a tester's personal information to the testing facility, is commonly provided by medical practitioners' offices and usually costs around $50.00. Confidential testing is typically not recommended because a client's HIV status can easily be leaked out to government agencies, as well as health insurance companies.