I had forgotten what terror feels like. While at my physician’s recently for a physical, I casually asked him to add an HIV antibody test together with the usual blood and urine analyses. I went to the lab on a Thursday, and by the afternoon of the following Tuesday, I received a call from the nurse requesting that I come in right away for a test result. You never get called in if everything is normal, and I was amazed that I got an appointment for two days later. The nurse sounded particularly cold and clinical, and after I got off the phone, I started thinking. It was thinking that made the next 40 hours or so a living hell. I convinced myself that the most likely reason for the haste in giving me the results was that I had become HIV positive.

I couldn’t work while I waited, and I found myself frequently crying, praying, and feeling desperate. Although I have mostly practiced safer sex, the truth is that “safer” does not mean “absolutely safe.” I obsessed in trying to recall every sexual experience I have had since I was tested maybe 18-months earlier, but I was hopeless in this. I can hardly recall what I ate for breakfast this morning, let alone the details of my every sexual experience.

I remember having flu-like symptoms at one time about 14-months ago, and I am aware that the first symptoms of HIV infection can resemble symptoms of common cold or flu viruses, such as fever, fatigue, rash, headache, swollen lymph nodes, and sore throat. Most perplexing is knowing that some people who contract the HIV virus have very strong symptoms, yet others have none. For those who do test as HIV positive, once the primary or acute infection is over, most people do not experience any visible symptoms for another 8-10 years following the first symptoms referred to earlier. Left untreated, the immune system becomes increasingly weaker and the disease progresses to AIDS. [1]

Anyway, I received the best news of my life when my physician told me I was HIV negative, and that the test result he wanted to review with me was not life threatening. This was a huge reminder to me that none of us are immortal, and HIV infection can happen to any of us if the right three conditions are met: (a) HIV must be present, (b) it must be in sufficient quantity, and (c) it must get into the bloodstream through an open cut or sore, or through contact with the mucous membranes in the anus and rectum, the genitals, the mouth, and the eyes. [2]

All sexual behaviour between two people that involves physical contact with contaminated semen, blood, vaginal secretions, and breast milk carries some risk of HIV transmission. That is why receptive anal sex is considered the highest risk sexual activity – the rigorousness of anal sex leaves the bowels open to minor haemorrhaging (i.e., bleeding), and the efficient absorption ability of the intestinal lining provides still more opportunity for contraction of the virus into the bloodstream. The penetrator is also at risk because of having contact with the receiver’s blood.

The mouth is an inhospitable environment for HIV (in semen, vaginal fluid, or blood), meaning the risk of HIV transmission through the throat, gums, and oral membranes is lower than through vaginal or anal membranes. There are however, documented cases where HIV was transmitted orally, so we can’t say that getting HIV-infected semen, vaginal fluid, or blood in the mouth is without risk.

HIV global infection rates continue to increase dramatically – particularly in developing countries – and between 75% and 85% of all HIV infections in adults worldwide are transmitted through unprotected sexual intercourse. [3] Over 50 percent of all new HIV infections worldwide are in people 15- to 24-years old, despite the fact they only make up about 30 percent of the world’s population. [4]

It is probably not surprising to you that not everyone who should get tested does. Whereas about 45 percent of Americans seek out voluntary HIV antibody testing, only 35 percent of Canadians do so. Women are most likely to get tested if they (a) have or are considering having children, (b) have multiple sex partners, (c) engage in anal sex, or (d) use condoms infrequently. Men are most likely to get tested if they (a) have sex with other men, (b) have a history of substance abuse, (c) perceive a partner as being a high HIV risk, or (d) are single. [5]

You would think that getting tested – and perhaps experiencing high anxiety while waiting for test results – would lead people to sexually protect themselves better in the future. Unfortunately research suggests that a large percentage of previously tested individuals continue to engage in unsafe sex, and a large number of newly diagnosed people have had previous negative test results. [6]

Why is it that many people refrain from getting tested? Available research indicates that one of the strongest reasons for this is that many individuals are concerned that they cannot remain anonymous (which is actually not true – see my note later about the STD clinic in Calgary). Other reasons include (a) they do not perceive any benefit from finding out, (b) they are in denial, or (c) they view themselves as healthy and not needing testing (a form of denial). [7] Still others experience moderate to intense anxiety while getting tested, while waiting for their results, or while receiving their results. [8]

Furthermore, after getting tested for HIV antibodies, many people do not return for their results. In one American study done at an STD clinic, 55 percent of those who were tested never returned for their results. [9] For those who do find out that they have become HIV positive, between 33 and 88 percent do not follow the regimen of antiretroviral treatments (ART), [10] despite how amazingly effective ART is at curbing the progression of the disease. “However, successful antiretroviral treatment requires that patients maintain nearly perfect adherence to the prescribed regimen.” [11] Non-compliance has been associated with the complexity of the ART regimen (sometimes involving 10 to 20 pills a day), the side effects that may occur, and the lifelong commitment required in taking these medications. [12]

I have provided you a few facts that show that you are not alone. If you have felt reluctant to get the HIV antibody test, you must confront your fear and embrace courage instead. If you have consistently practiced safer sex, your HIV risk is low. If you have been inconsistent in practicing safer sex, you have put yourself at higher risk. There is still no certainty, however, until you get tested and find out the result.

I wrote the following as a note to myself before getting my own results back: “What if I am HIV positive? Will I keel over and die because of this? Nonsense! I will make the most out of a bad situation.” Although there is no cure for HIV/AIDS, the antiretroviral medications are amazing in how they can keep your immune system functioning at a high level. But you need to find out if you need them. After all, they will save your life.

In Calgary, you can receive anonymous and free HIV antibody testing at the Sexually Transmitted Disease Clinic. Their location is #404, 906 - 8th Ave SW, Calgary, AB, T2P 1H9, phone (403) 944-7575. Their hours of operation are (a) Monday, Tuesday, Wednesday, 08:30 AM to 6:00 PM; (b) Thursday 11:30 AM to 6:00 PM; and (c) Friday, Saturday 08:30 AM to 4:00 PM. Website address: http://www.calgaryhealthregion.ca/hecomm/std/STDclinic.htm. There is also a toll free STD and AIDS Information Line at 1-800-772-2437.

Dr. Alderson is an assistant professor of counselling psychology at the University of Calgary who specializes in gay and lesbian studies. He also maintains a private practice. He can be contacted by confidential email at alderson@ucalgary.ca, or by confidential voice mail at 605-5234.

References:

1) What are the symptoms of HIV infection? How can I tell if I have HIV? (n.d.). Retrieved April 30, 2006 from http://www.whatudo.org/whatudo?page=learn-01-11-02
2) SF AIDS Foundation. (2006, April 14). How HIV is spread. Retrieved April 30, 2006 from http://www.sfaf.org/aids101/transmission.html#requirements
3) Colpin, H. (2006). A comprehensive sex education approach for HIV testing and counselling. Sex Education, 6, 47-59.
4) HIV/AIDS facts, options, and action. (2006). Retrieved April 30, 2006 from http://www.whatudo.org
5) Awad, G. H., Sagrestano, L. M., Kittleson, M. J., & Savela, P. D. (2004). Development of a measure of barriers to HIV testing among individuals at high risk. AIDS Education and Prevention, 16, 115-125.
6) Colpin, H. (2006). A comprehensive sex education approach for HIV testing and counselling. Sex Education, 6, 47-59.
7) Awad, Sagrestano, Kittleson, & Savela (2004).
8) Worthington, C., & Myers, T. (2003). Factors underlying anxiety in HIV testing: Risk perceptions, stigma, and the patient-provider power dynamic. Qualitative Health Research, 13, 636-655.
9) Hightow, L. B., Miller, W. C., Leone, P. A., Wohl, D., Smurzynski, M., & Kaplan, A. H. (2003). Failure to return for HIV posttest counseling in an STD clinic population. AIDS Education and Prevention, 15, 282-290.
10) Starace, F., Massa, A., Amico, K. R., & Fisher, J. D. (2006). Adherence to antiretroviral therapy: An empirical test of the information-motivation-behavioral skills model. Health Psychology, 25, 153-162.
11) Cote, J. K., & Godin, G. (2005). Efficacy of interventions in improving adherence to antiretroviral therapy. International Journal of STD & AIDS, 16, 335-343.
12) Starace, Massa, Amico, & Fisher (2006).