Our Bodies, Ourselves (67 page)

Confidential test results will become part of your medical record. Testing laboratories are not required to share test results with insurance plans, but you should check your state laws and individual insurance plan. If you file a treatment claim for HIV or AIDS, your insurance company will know you are infected with HIV.

•
Conventional HIV antibody test.
This is the most common test and involves drawing blood for the standard serological enzyme-linked immunoassay (EIA) test. These test results typically take about a week. Confirmation of a positive result (Western blot) is always done on the same sample, and a positive test is not reported until the results of the Western blot are known.

Negative test results are considered accurate and definitive, unless a person is in the window period—the four to six weeks between when a person is infected with HIV and when the body has made enough antibodies to be detected by a laboratory test—in which case the test should be repeated three months after known exposure. Commercial tests are available for use with blood or saliva.

•
Rapid tests.
Rapid tests detect HIV antibodies and results can be available in under thirty minutes. They are especially helpful in settings where immediate results are important, such as in jails (where inmates come and go rapidly), in childbirth (to prevent mother-to-child HIV transmission), during outreach, or where it is unlikely that a person will return to get the results, including emergency rooms and STI clinics. Unless you're still in the window period, a negative result is over 99 percent accurate. A rapid test positive result is only preliminary; additional confirmatory testing is required to make the diagnosis of HIV. Emergency rooms across the country are increasingly making rapid testing available, especially when it can be linked with appropriate follow-up for people who do have positive results.

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Home testing.
Available online and in most pharmacies, home test kits make it possible to collect a blood sample in private. You prick your finger, place a smear of blood on the piece of filter paper provided, and send it to a specified lab. The smear is identifiable only by an identification number. Seven days later, you can call a toll-free number to hear the results. Unfortunately, the quality of home test kits is highly variable. Although many kinds of kits are available online, currently only one—the Home Access HIV-1 Test System (home access.com/HIV_Test.asp)—is approved by the FDA. A drawback of home kits is that they do not include provider counseling or referrals.

•
PCR.
This new type of test looks for HIV in a cell's RNA. This test can help make the diagnosis earlier in the course of infection than an antibody test, but because it is very expensive it isn't widely used.

If your test result is negative (and you are not in the window period), you may feel relief and gratitude, especially if you have been exposed to HIV. You may also ask, “Why not me?” if you have friends who suffer from the disease.

Finding out that you are negative may give you additional motivation to do what you can to stay negative. Or you may find, as some people do, that once you hear that you are negative, it is difficult to keep practicing safer sex or using clean needles. A support group, counselor, or friend may help you find your balance.

If your test result is positive for HIV, it is important to talk about your status with someone you trust and to give yourself time to take in the diagnosis. Help and guidance are available; to find out more, visit AVERT's section, Learning You Are HIV Positive: avert.org/positive.htm.

Finding health care is a crucial step, especially finding a provider experienced in treating HIV infection. So is negotiating whatever insurance or disability benefits might be available to you.

Because there are so many variables in treatment and new treatments are evolving, people with HIV do best when they see a physician who specializes in HIV. This may not be easy in rural areas or in smaller cities where there are fewer cases of HIV. In larger urban areas, there are specialized HIV centers and clinics that address the medical and socioeconomic aspects of the disease. Not everyone who is positive needs to be treated, but it is important to find an HIV specialist you trust so that you can learn where you stand, how to stay healthy, and how to protect your partner(s) from infection.

What follows is what should be the basic, minimal standard of care for all people with HIV or AIDS.

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Evaluation.
A full physical exam with blood work, including CD4 cell (or T cell) monitoring and viral load testing, will help you plan and assess treatment. T cell monitoring indicates how well your immune system is doing; viral load and genotype testing indicate how much HIV is in your body and whether the virus is resistant to any of the currently available treatments. Other parts of routine care include a thorough review of your medical and medication history; periodic screening for other STIs, hepatitis, and TB exposure; review of vaccination history; referrals to a dentist and an eye doctor; and a referral to a gynecologist to screen for cervical cancer.

•
Vaccinations.
Vaccinations should be brought up to date, especially for pneumonia, hepatitis A and B, tetanus/pertussis, and flu, and possibly HPV. Your health-care provider may also want to discuss and assess your risk for conditions such as tuberculosis, herpes simplex virus, yeast infections, and other opportunistic infections.

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Treatment.
Treatment should be based on the best available guidelines for the management of
HIV and AIDS
.

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Support.
Emotional well-being is important, as are nutritional advice and the assistance of a social worker. Many if not most HIV-specialized care centers can refer you to appropriate support networks if they are not available on-site.

For more information on getting the best health care possible, see
Chapter 23
, “Navigating the Health Care System.”

CHAPTER 12
Unexpected Pregnancy

I
thought I was pregnant because I missed my period, but I tried not to think about it. I didn't want to talk to anybody because I was too scared. My mother would never let me forget it, so I didn't want to tell her, and I didn't want to tell any of my friends because I was afraid word would get around school
.

Are you worried that you might be pregnant? You're not alone. Almost half of all U.S. women become pregnant without planning to at some point in their lives.

If you think you are pregnant, you may feel joyful and excited about the possibility of becoming a mother. You may also feel shocked, terrified, ashamed, or simply not ready to be a parent.

The first thing to do is to confirm whether you are pregnant. The earlier you know, the more time you'll have to plan. If you are nervous about the results, try to find someone who will provide support when you take the test and as you make your way through the process of finding out about and deciding among your options. You have the right to whatever support and advice you want, as well as the right to make your own decisions.

If you are pregnant, you might know what you want to do immediately, or you might find the decision agonizing. Many of us change our minds once we are faced with the reality of being pregnant, even if we always thought we knew what we would do. Be gentle with yourself. Remember that there is help to guide you through this time, regardless of your circumstances.

Any woman who has begun her periods, has not experienced menopause, and has vaginal intercourse with a man can become pregnant. Most unexpected pregnancies occur when the couple is not using birth control or is using birth control inconsistently or incorrectly. However, birth control methods can occasionally fail, even when used correctly. (For more information, see
Chapter 9
, “Birth Control.”)

There are two different kinds of tests you can take to find out if you are pregnant.

•
Home pregnancy tests:
These generally test for human chorionic gonadotropin (hCG), a pregnancy-related hormone that can be found in urine. These tests are very accurate and can be used starting about the time when you would have gotten your period. Most home pregnancy tests work similarly: You either put a test stick into your urine stream while urinating, or you collect urine in a cup and then put the test stick into the cup. After you wait a certain number of minutes, the results window on the stick will show either a line (bold or faint) or no line. A line is a positive test, which means you are pregnant. If the test is negative and it is less than one week past the time when you would have gotten your period, you should take the test again in several days.

You can buy home pregnancy tests at most grocery stores and drugstores. They usually cost between $5 and $15. You don't need to be over a certain age and you don't need a prescription to buy them.

•
Blood test:
Done at a doctor's office or at a health clinic, a blood test identifies if there is hCG in your blood. It can tell if you are pregnant about a week before you would expect to get your period.

© Lynda J. Banzi