Despite continuous efforts by health organisations to increase awareness on the importance of regular HIV screening, many people are still not getting themselves tested. Approximately 15% (1 in 7) of people in the United States are presently living with HIV and unaware that they have been infected. In an update on the HIV situation in Singapore in 2020, the Ministry of Health (MOH) stated that only 14% of newly reported HIV cases in 2018 were detected by voluntary screening.

So, what are the common reasons that deter people from doing HIV testing?

I am scared of getting tested positive for HIV

Fear and anxiety are the biggest reasons why people avoid getting tested. The truth is, living in the unknown is worse and often scarier. It is far better to get the testing over and done with. If it is negative, it will bring much relief. If unfortunately the result is positive, all is not lost. Knowing your status early is the first step to getting support and receiving treatment in order to stay healthy. 

If I test positive for HIV, people will find out

Medical clinics and testing centres work to keep all patient records strictly confidential. Under the Infectious Diseases Act in Singapore, a positive test for HIV is notifiable to MOH. This is mainly for public health purposes, such as disease surveillance, monitoring the HIV infection situation, conducting contact tracing and assessing disease prevention and management measures. Healthcare professionals and MOH will not inform your employer, insurance provider and definitely not your family and loved ones.

I am not at risk of HIV

Even if you think that there is no chance that you have been exposed to HIV, as long as you are sexually active, it is recommended to do HIV testing at least once a year, or more frequently if your sexual activity is of higher risk.

I trust my partner

If two HIV-negative people are in a mutually monogamous relationship, then of course there is no risk of HIV, but if one member slips up, then both parties could be at risk of HIV, especially if engaging in unprotected sex. It is important to have open and honest communication with your partner. If you or your partner has had sex with any casual partner, or if there is any doubt about your HIV status at all, then do get tested.

I am afraid of being judged or being embarrassed 

Healthcare professionals are trained to provide professional and non-judgmental consultation. If you are reluctant to visit your regular doctor, take some time to do a search online as there are plenty of alternative options. It is important to find a sexual health clinic or testing centre that you feel comfortable with. 

What are some of the HIV tests available?

HIV viral load test 

This test looks for the actual virus in the blood. If the result is positive, the test will also show the amount of virus present in the blood. This is an expensive test and is therefore not routinely used to screen individuals unless they had a recent high-risk exposure and there are early symptoms of HIV infection. It is considered to be accurate during the early stages of infection, however it is best to get an antibody or antigen/antibody test at the same time to help in the instance of a negative result. Taking pre-exposure prophylaxis (PrEP) or post-exposure prophylaxis (PEP) may also reduce the accuracy of HIV viral load testing.

A viral load test is able to detect HIV as early as 1 to 4 weeks (7 to 28 days) after infection.

Antigen/antibody test

Also known as a fourth generation or combo test, this test looks for both HIV antibodies and antigens. Antibodies are produced by the immune system when one is exposed to bacteria or viruses. Antigens are foreign substances that cause the immune system to activate. In acute HIV infection, an antigen called p24 is produced even before antibodies develop.

The fourth generation test is able to detect HIV approximately 2 to 6 weeks (13 to 42 days) after infection, and is most accurate after a 28-day window period.

Antibody test

Also known as a third generation test, it is able to detect HIV in approximately 97% of people within 3 to 12 weeks (21 to 84 days) of infection. If a positive HIV result is obtained, a follow up test is required to confirm the result. 

What does testing involve?

All tests are performed using blood samples. Laboratory testing can be performed for all three types of HIV tests, whereby blood is drawn from a vein and collected in a tube. Rapid testing is available for only the third and fourth generation tests, whereby a few drops of blood are obtained via finger prick, and the results are ready in 20 minutes. 

The rapid antibody test can also be performed using oral fluids collected from the mouth and gums with a swab stick. This option is available in some clinics and community testing programs, such as Action for AIDS (AFA) Singapore. 

Regardless of the test you opt for, the process is simple and fuss-free, and no prior preparation is required. Pre and post-test counselling are always conducted professionally and non-judgmentally. 

Yet there are many who still feel extremely self-cautious about getting tested, for fear of stigma and discrimination. This is where anonymous HIV testing (AHT) comes in. AHT is offered as a means to encourage more high-risk individuals to come forward to do testing. There are only 10 clinics in Singapore that are licensed to offer AHT. AHT does not require you to provide your name, contact number or any form of identification. The entire testing process is kept confidential and strictly anonymous, even if the test result is positive.  

What happens after the test?

If your healthcare provider uses a fourth-generation antigen/antibody test, you should get tested again 45 days after your most recent exposure. For other tests, you should test again at least 90 days after your most recent exposure to tell for sure if you have HIV.

If your last HIV test was negative, you can only be sure you are still negative if you have not had a potential HIV exposure since then. If you are sexually active, continue to take actions to prevent HIV, like using condoms the right way every time you have sex and taking PrEP if you are at high risk.

Please get tested if you have not done so recently!