Medical reasons for taking the test

Recent developments in the treatment of HIV infection have strongly shifted the balance of medical opinion in favour of identifying people who are HIV–positive before they develop AIDS. Starting antiretroviral treatment (combination therapy) while the immune system is relatively strong may improve the chance that this treatment will keep you healthy indefinitely, in the view of most doctors.

Antiretroviral therapies are being used in conjunction with viral load tests, which can monitor the levels of HIV in your blood. HIV levels increase gradually in infected people, and as the level of HIV rises, the immune system usually declines. This means your body will not be able to fight off many illnesses and you could die from one of these opportunistic infections.

The viral load tests can also show very quickly whether or not an anti–HIV drug combination is working. They have also shown that the people who do best on combination therapy are those who experience the biggest falls in viral load after beginning treatment for the first time. The greater the fall in viral load, the more likely it is that your viral load will remain very low for a long time, keeping you healthy.

There are two reasons why some people experience bigger falls in viral load than others after beginning treatment:

• They are taking a more powerful combination of drugs.
• They have lower viral load when starting treatment, so the drugs need to do less work.

However, whilst many researchers and people with HIV are very optimistic about the potential of the new treatments, it is still early days and there is still a lot to learn about how best to use these drugs. You may find you get much better treatment options in a few years' time because scientific knowledge has advanced so much.

On the other hand, if you remain untested, you have no idea whether or not you are infected and how HIV disease might be progressing in your body. You may not learn that you are infected until you become unwell, whereas if you had taken an HIV test earlier you might have been able to benefit from treatments which could keep you healthy for a long time. Nowadays, the majority of people admitted to hospital with AIDS-related illnesses are there because they did not know their HIV status until they developed AIDS.

If you are actually ill, and a doctor who is experienced in dealing with HIV infection considers the test to be a useful part of the diagnosis, then the potential value of the result in terms of treatment almost always outweighs the drawbacks.

Give yourself time to consider all the issues

Give yourself a week or two to think about all these issues and decide if you really want to take the test or not. It's such an important decision that you must not rush into it.

You might find it useful to talk anonymously in confidence to a trained telephone advisor on one of the national helplines.

These are:

National AIDS Helpline

0800 567123

daily - 24 hour service

Terrence Higgins Trust Helpline

THT Direct 0845 1221200

Weekdays 10am - 10pm

Weekends Noon - 6pm

Some arguments against taking the test

It is very difficult to construct a decent argument against HIV testing in light of the availability of effective antiretroviral treatments, which can prevent disease progression and improve quality of life. That said, it may still be important for you to think about how you would cope with a positive result. It can cause a very great deal of stress. Some people have become suicidal about a positive result. But the bottom line is that people who are diagnosed and accessing regular monitoring and decent treatment live longer, healthier and more fulfilling lives. Some people are concerned about the effect of having an HIV test on future applications for life insurance or mortgages. Insurance companies now say that a negative test for HIV will not affect your chances of getting life insurance cover, but if you are considered to be at high risk of infection (e.g. gay men), you may be charged more for life insurance. Despite advances in treatments, people diagnosed with HIV infection may still experience psychological complications as a result of their diagnosis. Most clinics have access to psychological services once someone has received their diagnosis. It is worth considering the possible adverse impact on relationships including family, partners and work. Additionally there are possible restrictions for those who are positive on testing, for example international travel.