The purpose of HIV tests is to determine the presence of an HIV infection typically using blood, oral fluid, or also urine samples. HIV tests may be used as a routine screening test, as a diagnostic test after possible exposure to HIV, or in patients with symptoms of an HIV infection.
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HIV tests detect the presence of the HIV virus genetic material, antigens, and/or antibodies. If these substances are detected, the test returns a positive result for HIV. Tests are performed on blood, urine, or oral fluid samples.
Since HIV is primarily a sexually transmitted disease (STD), testing is very important for those who are sexually active &#; particularly those who have multiple partners. HIV tests are recommended for:
It is important to note that not everyone who is infected with HIV will develop early symptoms. However, two to four weeks after HIV exposure, you may experience the following symptoms:
These symptoms are not specific to HIV and the presentation (or not) is not enough to predict your HIV status &#; only an HIV test can confirm a positive case. It is important to consult a health care professional if you think you may have been exposed to HIV.
HIV tests use results from blood, urine, or oral fluid samples. Some tests are taken at-home while others are administered in a health care setting. There are three types of HIV tests available:
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OraQuick In-Home HIV Test
Price: $45
Type: Self-collection
Sample: Oral fluid
Tests for: HIV (I and II)
Results timeline: 20 minutes
If you&#;re looking for an HIV test that you can take at home, the OraQuick In-Home HIV Test from OraSure is a user-friendly kit that offers quick results using a simple mouth swab. The test is ideal for people seeking discreet and convenient testing options.
The test works by detecting HIV (I and II) antibodies in oral fluid swabbed from your gums. Results are easy to read and will appear on the test&#;s display window in 20 minutes. If you receive a positive result, follow up with additional testing at a healthcare facility. OraSure recommends you refrain from eating or drinking for 30 minutes before taking the test. You should also remove dental products that may cover any part of your gums, such as dentures.
Since it can take weeks for the body to produce antibodies after infection, this test may yield inaccurate results if used less than three months post-infection. The test should not be used to diagnose HIV immediately after an exposure.
The OraQuick In-Home HIV Test is non-refundable.
HIV tests are conducted at doctor&#;s offices, medical clinics, and many community-based organizations. Taking an HIV test does not typically require a doctor&#;s orders, although HIV tests may be ordered by a doctor as part of a routine health screening.
At-home HIV tests are a convenient way to take an HIV test in a private location. Testing for HIV at home is a form of screening that requires additional follow-up if preliminary results are positive. At-home HIV tests can be obtained online, at a pharmacy, or at health departments and community-based organizations.
The cost of an HIV test is usually covered by insurance without a copay, although specific costs depend on a person&#;s insurance coverage and where the test is performed. Check with your health plan and health care provider for specific cost details.
At-home HIV tests cost below $50. Health departments and community-based organizations may provide HIV self-test kits for free or at a reduced cost.
HIV testing involves an initial test and, if the preliminary result is positive, additional follow-up testing to confirm these results. Laboratory testing uses blood samples to look for evidence of HIV. Rapid testing provides faster results from oral fluid, a finger-stick, or urine and can be administered on-site in a variety of health care and community settings.
For an HIV test administered in a medical facility or lab, there is no preparation needed before the test. The type of HIV test administered depends on a person&#;s reason for getting tested, so it&#;s important to talk to a health care professional if you believe you&#;ve been exposed to HIV or have experienced symptoms of an HIV infection.
At-home HIV test kits offer detailed instructions for collecting a sample and administering the HIV test. Although test kits are designed to make the process straightforward, it&#;s important to read all instructions to reduce errors and contamination.
When an HIV test is administered in a medical facility or lab, a health care professional will instruct you on how the blood, oral fluid, or urine sample will be taken.
Laboratory-based HIV tests will take a blood sample through a vein in your arm. This process takes less than five minutes and some people feel minor discomfort, such as pain or stinging where the needle is inserted into the arm. There is no pain when the sample is taken from an oral swab or urine.
At-home HIV tests use a sample of oral fluid to check for HIV. During this test, a device is used to swab the gums and inserted into a vial of testing solution. After 20-40 minutes, results can be read.
If blood was drawn from a vein, pressure is placed on the puncture site with a clean gauze or cotton ball. You may be instructed to keep the gauze in place to reduce bruising. Although there are slight risks from a blood draw, including infection and lightheadedness, there are no restrictions on activity after the blood draw is complete.
Rapid HIV tests that use blood from a finger-stick, oral fluid, or urine require no precautions or post-test restrictions. Some at-home HIV tests require samples to be mailed to a certified laboratory according to the instructions contained in the test kit.
How long it takes to get results from an HIV test depends on the type of test administered:
For HIV tests conducted at a medical facility or community organization, a trained staff member will report your results and be available to answer any questions. Health care providers can also discuss your risk factors for HIV and advise you on the next steps if the results of the HIV test are positive.
After rapid testing, you wait for the results in the facility. For laboratory testing that can take up to several days to receive results, you may be asked to schedule a follow-up visit or consent to receiving results by .
For at-home HIV testing, results can be read according to instructions contained in the test kit. These test kits may also contain an information booklet designed to instruct you on what to do once you have obtained your test results.
HIV test results are reported as positive, negative, or indeterminate. The results of HIV tests should be interpreted with caution. Follow-up testing is often necessary. Patients must take into account the test&#;s window period, the time between when a person gets infected with HIV, and when a test can detect the infection.
No test can detect HIV immediately after infection and all HIV tests have a window period. The length of the window period varies from test to test, ranging from about two to 12 weeks. At-home tests have a window period of about three months.
A negative HIV test result means that HIV antibodies or antigens weren&#;t detected in the test sample. If a person has had no potential exposure to HIV within the test&#;s window period, they are considered negative for HIV infection. If a person has had potential exposure within the test&#;s window period, HIV testing must be repeated after they are past the window period.
Positive results on an HIV test need to be confirmed through follow-up testing. Laboratory tests conduct the second test on the same blood sample as the first test. If you receive a positive result on a rapid test, the health care professional will schedule a second confirmatory test. At-home HIV-positive test results must be confirmed in a laboratory or health care setting. If the follow-up test result is also positive, a person is considered HIV-positive.
Indeterminate results on an HIV test occur when an initial screening test is positive, then a follow-up test is negative. In this situation, doctors may order a more detailed HIV viral load test for additional confirmation.
You may want to ask your doctor follow-up questions, such as:
This article is part of Health Divide: HIV, a destination in our Health Divide series.
An HIV test is used to determine if someone has been infected with human immunodeficiency virus (HIV). The test is commonly performed on a blood or saliva sample, but a urine-based test was approved for use in the United States in .
Both point-of-care tests used in hospitals and clinics and at-home tests used at home are extremely accurate if used correctly. However, they can deliver an incorrect result if the test is performed too soon after an exposure.
Verywell / Emily Roberts
This article details what tests are available, how accurate the tests are, how the tests are performed, and what to expect if you test positive for HIV. It also looks at gaps in testing among people living with HIV. Gaps in testing among Black and Latinx people, men who have sex with men (MSM), transgender women, and the broader transgender community are discussed in this article.
Purpose of Test
There are an estimated 1.2 million people living with HIV in the United States, 13% of whom remain undiagnosed. In response, the U.S. Preventive Services Task Force issued updated guidance recommending that everyone between the ages of 15 and 65 undergo HIV testing as part of a routine doctor's visit.
Testing every three to six months is advised for people who belong to groups more likely to be diagnosed with HIV, including:
Verywell / Julie Bang
Testing Types
There are both indirect and direct methods of HIV testing. Indirect methods do not detect the virus but rather proteins, called antibodies, that are produced by the immune system in response to the virus. Direct testing methods detect either proteins on the surface of the virus, called antigens, or the genetic material of HIV in the form of RNA (ribonucleic acid, which is important in regulating gene expression).
There are a few testing options, which vary in their speed, accuracy, and ease of use and include:
Any positive result&#;called the preliminary positive&#;would require a second confirmatory test to ensure the diagnosis is correct. The only exception is the NAT, which does require confirmation.
Stigma plays a large part in why 15% of Black people with HIV remain undiagnosed in the United States. Chief among the concerns is the fear of being labeled "promiscuous" or being judged or shamed by community or faith-based leaders.
Test Accuracy
HIV tests are highly accurate if used correctly. However, some testing methods are more reliable than others. Improper use or storage can also undermine the accuracy of a test.
By and large, point-of-care tests are more accurate than home-based tests due in part to user error. Similarly, blood tests tend to be more accurate than saliva or urine tests because there are higher concentrations of HIV in blood.
Clinics in the United States report a 98.5% accuracy rate when using an antibody test and a 99.9% accuracy rate when an antibody test is combined with a confirmatory test. This translates to one false-positive result for every 250,000 tests.
Certain conditions can also trigger a false-positive test result, meaning that the test shows positive for HIV while the person is not actually HIV-positive. Conditions that can trigger a false positive include syphilis, lupus, and Lyme disease. Confirmatory testing will almost always weed out these incorrect findings.
According to the Food and Drug Administration (FDA), at-home rapid HIV tests have an 8% false-negative rate. This means that 1 of every 12 negative results is incorrect and the person tested actually has the virus. This is not only due to user error but also to the fact that the saliva-based test is less sensitive.
Risks and Contraindications
There are no contraindications for HIV testing, meaning there is nothing that makes getting tested inadvisable. Also, there are few risks. If a blood draw is required, you may experience soreness, swelling, and bruising at the injection site. Light-headedness and testing HIV positive are also possible.
If you are afraid of needles or are squeamish about blood, let the nurse or phlebotomist (healthcare professional who draws blood) know in advance. Other testing options may be available. Additionally, if you have hemophilia (a blood disorder that interferes with blood clotting) or if you are taking blood thinners, a child-sized butterfly needle may be used to reduce the risk of bleeding.
Before the Test
The HIV test requires no preparation other than your readiness to take the test. That said, HIV remains highly stigmatized, and people often avoid HIV testing out of fear of disclosure.
If you are concerned about your privacy, find a clinic that offers either confidential testing (in which your name is shared only with your healthcare provider, your insurance company, and a government reporting agency) or anonymous testing (in which your name is shared with no one).
Concerns about confidentiality discourage many people from getting tested for HIV. Among stigmatized groups such as MSM and trans people&#;especially Black trans women&#;those fears are compounded by the fact they may be forced to come out about their sexuality and/or gender identity. For some, these "secondary disclosures" are more distressing than the fact they have HIV.
Timing
Timing is an important part of HIV testing. If you have been exposed to HIV, there will be a period of time, called the window period, when the test cannot deliver an accurate result.
Because HIV tests generally detect antibodies and/or antigens, you need to wait until your body has produced enough of these to get an accurate result. If you test too early, you will get a false-negative reading. Even with the nucleic acid test, you need to wait until the virus has replicated to detectable levels.
Because detectable levels can vary by individual, most clinics will advise you to wait to be tested for HIV after possible exposure, according to the following timetable:
The procedure itself involves three steps: pre-test counseling, the HIV test, and post-test counseling. Depending on the test being performed, the process can take 30&#;45 minutes. Walk-in centers may take far longer.
Location
HIV tests are available at many medical and public health facilities. These include hospitals, clinics, retail pharmacies, community-based HIV organizations, antenatal and family planning clinics, youth drop-in centers, mobile testing sites, and drug and alcohol treatment centers.
To find a testing site near you, use the online locator offered by the Department of Health and Human Services (HHS). Many of the sites offer walk-in testing. Others require an appointment.
Black people in the United States often have limited options for healthcare. Many within the community will avoid getting tested because it forces them to go to a local clinic where others may see them. Even buying an at-home HIV test at a local drugstore poses risks.
Food and Drink
There are no food or drink restrictions for an HIV test. However, if you are using an at-home oral test, avoid brushing your teeth or using mouthwash 30 minutes beforehand as this may affect the results.
What to Bring
Even if you are undergoing anonymous testing, the facility may require government-issued ID to confirm your residency. Call in advance for details. You should also check to see if the site accepts your insurance, if you have a plan. If so, bring your insurance card.
You may also want to consider bringing someone with you if you are unsure how you might react to a positive HIV diagnosis. Having support can be very important.
Cost and Health Insurance
Most insurance plans, including Medicare and Medicaid, will cover the cost in full as part of the Affordable Care Act&#;s essential health benefits.
It is important to note that, while point-of-care tests are typically covered by insurance, at-home test kits may not be. Check with your insurance provider to better understand your benefits in this regard.
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If you are uninsured, you can find low- to no-cost testing sites through the GetTested locator offered by the Centers for Disease Control and Prevention (CDC).
Despite increased access to healthcare under the Affordable Care Act, 1 of every 9 Black people is without insurance. Black trans people, especially Black trans women, often experience hostility in health settings. Black transmasculine people are often excluded from HIV discourse despite testing positive at higher rates in comparison to the general population.
Poor community access to health insurance, provider hostility, and lack of provider knowledge about trans communities may increase a person's likelihood of testing HIV-positive. Among Black MSM, the lack of insurance increases the risk of HIV by 2.5 times compared to those who have insurance.
HIV Disclosure Laws
Despite whether your HIV test is anonymous or confidential, any positive test result will be reported to your local health department who will, in turn, disclose the information&#;without your name&#;to the CDC in Atlanta. The information is not shared with any other government agency.
A positive result may also be shared with your insurance company and the doctor who referred you for testing. It cannot be shared with any other doctor or agency without your expressed written consent under the Health Insurance Portability Accountability Act (HIPAA) of .
Many states and some cities have partner-notification laws, meaning that your healthcare provider may be legally obligated to tell your sex partner or needle-sharing partner if someone they have been with has tested positive for HIV. Your name or personal information is not shared in the disclosure.
If you are married and test positive for HIV, be aware that health departments funded by the federal government's Ryan White HIV/AIDS Program are required to show good-faith efforts in notifying married partners of the result. Implementation of this requirement varies significantly.
High rates of distrust of public health services have seeded doubts about medical confidentiality in many Black communities. This, in turn, has led to lower HIV testing rates, particularly among Black men.
Other Considerations
It is a mistake to think that there is nothing you can do if you&#;ve been recently exposed to HIV. If you have had sex without a condom, have shared needles, or have some other form of exposure, you may be able to avert the infection by starting HIV postexposure prophylaxis (PEP) within 72 hours.
PEP involves a 28-day course of two or three antiretroviral drugs depending on the severity of your exposure. Used by healthcare workers and in cases of rape, the strategy may reduce your risk of transmission by as much as 79%.
During the Test
On the day of the test, after registering and confirming your insurance information, you will be asked to sign a consent form acknowledging that your test results may be shared with the relevant agencies and individuals as directed by HIPAA. Speak with the office staff if you do not understand any part of the consent form.
Many sites will also ask you to fill out a questionnaire to get some background information on you, including your ethnicity, sexual orientation, sexual activity, and substance use, and whether you have had an HIV test before. Some of the information will be used for confidential reporting purposes; some to assist with counseling.
Pre-Test
Pre-test counseling is performed in a private room with a qualified health professional. During the counseling, you may be asked about your recent exposure, if any, as well as your sexual or recreational drug practices. The questions are not meant to judge or embarrass you. Rather, they help the counselor gain a better understanding of your personal risk of transmission.
The counselor will then explain what HIV and AIDS are, how the test is performed, what a window period is, and what a positive and negative result means. If it is determined that you are testing too soon, the counselor may request that you come back when the test is more likely to be accurate.
Feel free to ask any questions you need. There is no such thing as a bad question.
Throughout the Test
The testing procedure in a clinic can vary based on whether you are taking a rapid HIV blood or oral test, or an HIV antibody blood or saliva test. (The urine test, while approved, is rarely used in a clinical setting. This is, in part, because it is less accurate than any of the other tests.)
A rapid HIV blood test is performed as follows:
A rapid HIV oral test is performed as follows:
Note that if you used a home kit, the toll-free support helpline listed on the test's instructions will advise your further.
An HIV antibody blood test is performed as follows:
An HIV ELISA saliva test is performed as follows:
After the Test
Some people will tell you that the hardest part of an HIV test is not taking the test but waiting for the results. This is especially true if you have a preliminary positive result and have to wait several days or more for the final results.
The wait can often be agonizing; so much so, in fact, that as many as 1 in 15 people will not return for their results, according to a study published in the International Journal of STDs and AIDS.
There are several measures you can take to remain composed during the wait, including:
If you are unable to cope and don't have someone to talk to, call the 24-hour, toll-free HIV hotline in your state for a referral to a qualified counselor in your area.
Black men are 24% less likely to return for HIV test results than other groups. The fear of stigmatization paired with an underlying conspiracy belief (such as HIV being created in a government lab) account, in part, for this disparity.
Interpreting the Results
The time it takes to get your results can vary. Many states mandate that the test results be delivered only in person. While some states will allow doctors to deliver negative results over the , the practice is frowned upon by most healthcare professionals.
This is because a call doesn't allow for adequate post-test counseling, and it poses the potential of a breach of confidentiality that you've been tested (something you may not want shared). HIV test results are not sent by mail.
Test results are interpreted as follows:
Post-test counseling is always performed, no matter your test results. The aim of counseling is twofold: to help you understand what the results mean and to provide you with information on next steps to stay safe and healthy.
A positive HIV test result may be shared with the CDC, your insurance company, or your doctor, or certain individuals in accordance with the rules you agreed to before your test. If your confidentiality is breached, you can file a complaint with HHS and seek legal damages as laid out in the laws of your state.
Follow-Up
Upon receiving an HIV-positive diagnosis, you will be advised that there are treatment options and support systems to link you to medical care. You may also be referred to a care navigator, who can assist you with referrals and any financial, emotional, family, legal, or drug treatment services you need.
If you feel overwhelmed, you can request to discuss your options on another day or use the time to ask as many questions as you need. Coming to terms with an HIV diagnosis is a process. Don&#;t feel rushed.
Get our printable guide for your next doctor's appointment to help you ask the right questions.
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AddressHowever, if you are ready to proceed and the test was performed in a clinic or hospital, you may be asked to undergo additional tests called a CD4 count and HIV viral load. The CD4 count measures the number of immune cells (called CD4 T-cells) in your blood and helps establish how strong your immune system is. The viral load uses a similar technology to the NAT and counts how many viruses there are in a microliter (µL) of blood.
Both of these tests help establish your baseline status before treatment and will be routinely repeated to assess your response to therapy.
HIV treatment should ideally be started at the time of diagnosis. Genetic tests may be used to identify which drugs work best for you. The drug therapy itself typically involves a once-daily dose and, if taken as prescribed, can ensure a normal quality of life and a near-normal life expectancy.
You will have ongoing medical evaluations to monitor your condition for the rest of your life. A testing schedule will be determined by your doctor.
A positive HIV diagnosis does not mean the same thing that it used to. Advances in HIV therapy are such that you can now live a long and healthy life and may never be faced with the prospect of a serious HIV-related illness or AIDS.
According to the CDC, only 63% of Black people in the United States receive some medical care after an HIV diagnosis, while only 48% remain in care. Many of the factors that discourage people from getting tested discourage them from staying with their treatment.
A Word From Verywell
Receiving an HIV diagnosis can be a life-altering event, and there is often no way to know how you will react to the news. Whatever your response, accept that it is normal. Some people might even feel a sense of relief from no longer having to wonder about their status. By knowing your HIV status, you can make an informed choice on how to protect yourself from testing positive for other strains of HIV and others.
This is not to suggest that living with HIV is without its challenges. If you are having trouble coping, consider joining a support group or seeking one-on-one counseling from a qualified therapist.
On the other hand, if you are experiencing extreme depression or anxiety, ask for a referral to a psychiatrist who may be able to offer medications and therapy to help you better cope.
What can cause a false-positive result on an HIV test?
While it's unusual to get a false-positive result on an HIV test, it can sometimes happen if you've participated in an HIV vaccine study or have certain medical conditions, such as an autoimmune disease. It can also happen for technical reasons in the lab, such as improper handling or misinterpreting a result. A follow-up test can help verify if your first test result was accurate.
Can you have HIV antibodies but not have HIV?
Yes, an infant born to an HIV-positive birthing parent can have HIV antibodies but not HIV. For these babies, the birthing parent's HIV antibodies are transferred across the placenta and stay in their system for 18 months. To get an accurate result, children up to 18 months need viral diagnostic testing. After that age, an antibody test should be accurate for detecting HIV.
Where can you get an HIV test?
You can get an HIV test in a healthcare setting (doctor's office or lab), a community-based organization, a mobile testing van, or at home. Some of these involve different methods of testing for HIV. For example, a rapid home test kit can use saliva or blood to deliver results quickly but may be less accurate than a rapid point-of-care test done in a doctor's office. In the rapid point-of-care test, HIV can be tested using a drop of blood, urine sample, or oral swab for more accurate results.
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