HIV Testing: Everything you need to know

HIV testing is a great way to look after your health. It is also a great way to look after the health of your sex partners and the people you use drugs with.

Whether or not you have an HIV test is completely your decision. The decision cannot be made for you by a healthcare provider, family member or partner.

Each time you get an HIV test from a healthcare provider or community worker, you need to give informed consent.

Being informed about HIV testing means that you know:

  • what HIV is and how it is passed
  • the ways to prevent HIV
  • the benefits of getting tested
  • the kinds of tests that are available
  • what will happen if the test result is negative
  • what will happen if the test result is positive

Giving consent means that you agree to get an HIV test.

This resource will walk you through the main things to think about before having an HIV test. This information can help you decide if, when and how often you will get a test.

What is HIV?

HIV stands for human immunodeficiency virus.

HIV is a virus that can weaken your immune system, your body’s built-in defence against disease and illness. Some people have flu-like symptoms such as fatigue, fever, sore throat, swollen lymph nodes, headache, loss of appetite or a skin rash when they first get HIV. It can take between two and four weeks for these symptoms to show up. However, people can have HIV for a long time without any obvious symptoms.

People can have HIV for many years without knowing it, but if a person is not receiving HIV treatment, they will get very sick over time. Without HIV treatment, a person’s immune system can become too weak to fight off serious illnesses, and the person can eventually become sick with life-threatening infections and cancers. This is called AIDS (acquired immunodeficiency syndrome).

Thanks to effective HIV treatment, these days most people with HIV never get AIDS. With proper treatment and care, people with HIV can live long and healthy lives and avoid passing HIV to others. The earlier someone with HIV starts treatment and care, the better it is for their health.

There is no vaccine to prevent HIV but there are lots of things you can do to avoid passing or getting HIV.

How is HIV passed from person to person?

A note on language: In this booklet we use medical terms for genitals (e.g., vagina and penis). We also include gender-neutral alternatives in brackets the first time we use a term. Everyone has a right to choose the words that they want to use to talk about their bodies and genitals.

HIV can only be passed by these five body fluids:

  • blood
  • semen, including pre-cum
  • rectal fluid
  • vaginal (frontal) fluid
  • breast milk (chest milk)

HIV can be passed when enough virus in one of these fluids gets into the bloodstream of another person. It can pass through broken skin or the wet linings of the body, such as the vagina (front hole); foreskin of a penis (strapless), rectum; or the urethra/pee hole.

HIV is most easily passed in the following ways:

Through anal sex

HIV can be passed through anal sex if the person with HIV is not on successful treatment. The chance of HIV transmission is highest when the person with HIV is the insertive partner (the person inserting the penis, or the “top”). This is because HIV can more easily get into a person’s body through the rectal lining than through the urethra or foreskin of a penis. HIV can also be passed if the person with HIV is the receptive partner (the bottom), but the chance is lower.

Through vaginal sex

HIV can be passed through vaginal sex if the person with HIV is not on successful treatment. The chance of transmission is highest when the person with HIV is the insertive partner (the person inserting the penis). This is because HIV can more easily get into a person’s body through the vagina than through the urethra or foreskin of a penis. HIV can also be passed if the person with HIV is the receptive partner (the person with the vagina), but the chance is lower.

The chance of HIV passing during anal and vaginal sex is heightened if one or both people have another sexually transmitted infection (STI). If a person with HIV is on successful treatment, there is no chance of passing HIV through sex, even if they have an STI. It is a good idea to get tested for other STIs and hepatitis regularly.

When sharing equipment for injecting drugs

HIV can be passed when sharing injection drug use equipment. This is because needles, syringes and other injection equipment that have been used by others may have blood containing HIV in them. This blood can then get into another person’s body when they are injecting.

To a baby during pregnancy, delivery or breastfeeding

If a person with HIV is not taking effective HIV treatment throughout pregnancy, there is a chance of passing HIV to a baby during pregnancy, delivery or breastfeeding.

Some rare ways that HIV can be passed include:

Oral sex. There is little to no chance of HIV being passed during oral sex.

Tattooing or piercing. HIV can be passed if needles or ink are reused. However, most tattooing or piercing in Canada is done using proper infection control procedures, which ensures that all equipment is new or properly sterilized between use.

HIV cannot be passed through coughs or sneezes, shaking hands or sharing eating utensils. HIV also cannot be passed through kissing, hugging or mutual masturbation.

What are some ways to prevent HIV?

Knowing your HIV status is an important first step to help you decide what prevention methods to use.

Whatever your HIV status is, there are many ways to prevent passing or getting HIV.

It is also helpful to talk to your sex partners and the people you use drugs with about whether they know their HIV status. Remember that someone might have HIV and not know it. So, if a sex partner or someone you use drugs with hasn’t had an HIV test recently or is unsure of their status you can encourage them to get tested.

Condoms are a great way to help prevent passing HIV and other sexually transmitted infections (STIs) through sex.

If you use drugs, using new equipment each time prevents passing HIV and other infections like hepatitis C. In many communities, there are places where you can get free needles and other equipment for using drugs.

If you are HIV positive, taking HIV treatment is one of the best ways to stay healthy and can help prevent passing HIV to others. If you take your HIV treatment as prescribed, the amount of HIV in your blood can become so low that tests can’t detect it. This is called having an undetectable viral load. If you are on treatment and maintaining an undetectable viral load, you will not pass HIV through sex. Successful HIV treatment also lowers the chance of passing HIV from sharing equipment for using drugs, but we don’t know exactly how much so it’s best to use new equipment every time you inject drugs.

If you are HIV negative, you can take medications to prevent HIV. One highly effective method is pre-exposure prophylaxis (PrEP), which you would take on an ongoing basis starting before and continuing after you might come into contact with HIV. For most people this means taking a pill every day. Another method to help prevent HIV after a single accidental exposure is post-exposure prophylaxis (PEP). You need to start PEP within 72 hours after you may have been exposed to HIV, to help prevent getting HIV. It needs to be taken every day for 28 days.

For more information on all of these prevention methods, speak to someone at your local HIV organization or talk with a healthcare worker.

Why should you get tested for HIV?

The only way to know for sure if you have HIV is to get tested.

Whatever the result of your test, knowing your HIV status is important for your health. It also gives you the information you need to help you decide what HIV prevention methods you may want to use.

If you have HIV, it is better for your health if you are diagnosed and start treatment as early as possible.

If you test negative for HIV, knowing your status can give you peace of mind. You can then also think about what you can do to prevent getting HIV, such as taking PrEP.

What should you think about when you’re deciding where to get an HIV test?

Getting an HIV test can be stressful for some people. Before you get tested, think about where you would feel most comfortable getting a test and finding out your result. Many people get an HIV test from their family doctor, but there are alternatives you can consider, such as going to a sexual health clinic or taking a self-test. If you decide to get a test from a healthcare provider or community worker, try to find somewhere to do the test where you feel comfortable talking openly. If you decide to do a self-test, think about if you want to have someone else present when you take the test. Whatever type of test you get, it is a good idea to think about who you will talk to if the test result is positive.

What kinds of HIV tests are available in Canada?

The two main kinds of HIV tests available in Canada are the standard HIV test and the rapid HIV test.

Most people get what is known as a standard HIV test. Blood is taken from a vein in your arm and sent to a laboratory for analysis. It can take up to two weeks to get your result. Talk to the person who does your test about how you will get your test result. There are many places to get a standard HIV test, including family doctors’ offices, walk-in clinics and sexual health clinics.

Rapid testing is another option. With a rapid test, you get an initial result within a few minutes of doing the test. Rapid tests are screening tests. This means that if the test shows a positive result, you will need to get a standard test to confirm the result. You might be able to get a rapid test from a healthcare provider or community worker, but this option isn’t available in every part of Canada. In regions where rapid tests are available, they are often provided at certain specialty clinics, such as sexual health clinics, or through HIV organizations. However, anyone in Canada can get a rapid self-test, which you perform on yourself at home. Self-tests can be ordered online and may be available for free from community organizations or for purchase in some stores.

HIV cannot be detected by tests immediately after someone gets HIV. The time between when you may have been exposed to HIV and when a test can tell that you have HIV is called the window period. The window period can vary between two weeks and three months, depending on the person and the type of test used. If you test negative within three months of your last potential exposure you may be in the window period and therefore you may need to test again at a later date to be sure you don’t have HIV. If you are not sure when to test again, talk to a healthcare provider or community worker.

How is your privacy protected when you get an HIV test?

As with all medical procedures, your discussions with the person giving you an HIV test are confidential.

Normally when you get an HIV test from a healthcare provider, your name will be recorded and the test result will be noted in your medical records.

If you take a self-test, you are the only person who will know your result unless you choose to tell someone else. However, if your test indicates that you are HIV positive, you’ll need to go to a healthcare provider to get a standard HIV test to confirm the result.

In some parts of Canada, it is possible to get a test anonymously. If you are interested in getting an anonymous test, ask a healthcare provider or a worker at an HIV organization whether this is an option where you live.

If you test positive for HIV, your local public health department will be notified of this result. Also, if you test positive your past sex partners and people you have shared drug use equipment with will be told that they may have been exposed to HIV. You can tell these people yourself, or if you prefer public health officials can contact them. Public health will not use your name when talking to these people.

What happens if you test positive?

If you test positive on a rapid test, you will need to get a standard test with a blood draw to confirm the result. If you receive a positive result after taking a standard test, it means that you have HIV.

It’s important to know that people with HIV who are diagnosed early and get the right care, treatment and support can live long, healthy and full lives. HIV treatment involves seeing a doctor regularly and taking HIV medication (for most people, one pill once per day).

The person who gives you your result will talk to you about next steps, including linking you to HIV care and other supports. Your past sex partners and people you have shared drug use equipment with will be told that they may have been exposed to HIV. You can tell these people yourself, or if you prefer public health officials can contact them. Public health will not use your name when talking to these people. You may also be connected to public health workers in your community to help you with care, treatment and other support. If you are not referred to a healthcare provider, an HIV organization may be able to help you find one. HIV organizations can also provide information and counselling and may be able to connect you with other health and social services in your area.

After you are diagnosed with HIV, you can think about how you will prevent passing HIV to others.

Once you know that you have HIV, Canadian law requires that you tell your sex partners that you have HIV in certain circumstances. For the most up-to-date information on when people living with HIV have a legal duty to disclose their HIV status, contact the HIV Legal Network (www. hivlegalnetwork.ca).

What happens if you test negative?

If you test HIV negative, it means that the test did not detect HIV in your body. If you have had a potential exposure to HIV in the past three months, you may have to repeat the test at a later date to be sure that you don’t have HIV. Ask a healthcare provider or community worker about how often you should test in the future.

After a test, you can think about how you will prevent getting HIV. You can consider taking PrEP, using condoms for sex, or using new equipment each time you inject drugs.

Connecting to supports in your community

After you get tested for HIV, it can be an opportunity to learn about resources available in your community that can support your health and well-being. Some challenges in people’s lives can make it difficult to stay healthy. If you test positive, think about whether you might have difficulty consistently taking HIV treatment and taking steps to prevent passing HIV. For example, it can be hard to look after your health if you are dealing with mental health issues, challenges with drugs or alcohol, unstable housing or domestic violence. If you test negative, think about if there is anything in your life that might make it difficult for you to take steps to prevent getting HIV. If you are dealing with challenges like these, talk to a healthcare provider or community worker. They may be able to help you or refer you to someone else in your community who can help you. Getting help with these things can improve your well-being and can make it easier to take steps to prevent getting or passing HIV, and to take treatment if you are living with HIV.