Within a few months of being infected with HIV, most people develop antibodies to the virus, in a process called seroconversion. Seroconversion typically occurs sometime between 25 days and 6 months after initial infection. HIV infection can be detected by standard blood tests for blood serum antibodies to HIV. Most HIV tests are now performed with a simplified diagnostic test kit that uses a finger-stick sample of blood and provides results that are 99.6% accurate in as little as 20 minutes. HIV antibodies can also be detected with a high degree of accuracy in urine and saliva samples (Wright & Katz, 2006). A survey of 128 U. S. college health centers found that HIV tests are widely available at campus clinics (Smith & Roberts, 2009). For more information about HIV tests and test sites, contact the CDC National Hot­line at 1-800-232-4636 or go online to the website of the American Social Health Association.

Home testing for HIV, via the OraQuick HIV test, may soon be available. In May 2012, this test was approved by a 17-member FDA panel. The test, which utilizes a mouth swab, appears to be slightly less accurate than a professionally administered HIV test (Bacon, 2012).

Although quite uncommon, "silent" HIV infections can be present in some individu­als for 3 years or more before being detected by standard serum antibody tests. More costly and more labor-intensive tests for the virus itself can be performed to detect a silent or latent infection. Once infected with HIV, a person should be considered con­tagious and capable of infecting others indefinitely, regardless of whether clinical signs of disease are present.

Many public health officials are advocating for greater use of a new blood test for genetic traces of HIV. The advantage of this procedure, compared to standard HIV tests, is that it can detect an HIV infection within 7 to 10 days of occurrence (Tuller,

2009) . Identifying new HIV infections sooner may encourage infected people to seek counseling that will help them avoid transmitting the virus to other people, especially during the period of primary infection when they are highly infectious.

The development of better treatment strategies offers compelling reasons for people at risk to discover their HIV status as soon as possible. Presumably, once people become aware of their HIV-positive status, they will be much less likely to pass the infection on to others. This assumption was supported by a study which found that, of 615 men and women diagnosed with HIV infection, most adopted safer sexual behaviors after diagnosis, including regular use of condoms, less frequent or no sex, or engaging only in oral sex (Centers for Disease Control, 2000a). Another study found that a substan­tial majority of 1,363 HIV-infected men and women were using condoms during vagi­nal or anal intercourse with partners known to be HIV-negative and with partners of unknown HIV status (Centers for Disease Control, 2003).

Most HIV-infected people in the United States are not tested for HIV until they develop symptoms of disease, and most HIV infections are transmitted by people who are unaware of their status (Bowling, 2011; Koo et al., 2006). These alarming facts prompted the CDC to recommend, in September 2006, expanding HIV testing in the United States by including HIV screening in routine health-care services for people ages 13 to 64 and all pregnant women unless individuals specifically opt out (Bartlett et al., 2008; Bayer & Oppenheimer, 2011). The underlying goal of this recommenda­tion is to promote early entry into medical care for HIV-infected people and facilitate behavior changes that inhibit transmission of the virus to others (Bartlett et al., 2008). The percentage of U. S. citizens ages 18 to 64 ever tested for HIV remained stable at approximately 40% from 2001 to 2006 and increased to 45% in 2009 (Centers for Dis­ease Control, 2010h).

As discussed near the end of this chapter, we believe that all couples poised on the brink of a new sexual relationship should seriously consider undergoing medical exami­nations and laboratory testing designed to rule out HIV and other STIs before begin­ning any sexual activity that might put them at risk for infection. The following account expresses one man’s experience in this matter:

In the early stages of dating and getting to know one another, my future wife and I candidly discussed our prior relationship histories. Neither of us had been sexual with another for over a year, and we were both confident that we were free of diseases transmitted during sex. But since we were aware that the AIDS virus in an infected person’s body may go undetected for years, we decided to be tested for the virus. We had our blood samples drawn at the same time, in the same room, and later shared our respective lab reports. Thankfully, as expected, we both tested negative. This process, while clearly reassuring, was also helpful in contributing to a sense of mutual trust and respect that has con­tinued into our married years. (Authors’ files)