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	HIV frequently asked Questions and Answers

		What is the difference between HIV and AIDS?


		HIV (Human Immunodeficiency Virus) is the virus that causes the condition referred to as AIDS. This virus may be transferred from one person to another when infected blood, semen or vaginal secretions come in contact with an uninfected person’s skin or mucous membrane. In addition, infected pregnant women can pass HIV to their baby during pregnancy, delivery as well as through breast-feeding.

		Tell me more about the Department of Health’s Rapid HIV / AIDS testing policy and guidelines and where do rapid diagnostic screening tests fit into it?


		“Rapid HIV testing must be conducted according to the same ethical standards as for other HIV testing, including pre and post test counselling, informed consent, privacy and confidentiality. Rapid tests to detect antibodies to HIV can enable healthcare providers to supply definitive negative or positive results to patients at the time of testing. It can increase the number of people undergoing HIV testing, facilitate the diagnosis of HIV infection, facilitate HIV testing capabilities in facilities without access to laboratories and facilitate post exposure prophylaxis in health workers.” Government Rapid HIV testing Policy and Guideline document, August 2000

		I have read in the news media some negative comments on rapid diagnostic HIV / AIDS screening tests. Why is this?


		HIV / AIDS are a very emotional issue. If sourced from a reputable supplier, rapid diagnostic HIV / AIDS screening tests are highly accurate and very sensitive. Important performance factors, however, rest in the hands of the individual performing the test and the product storage conditions. Three key concerns with rapid diagnostic HIV / AIDS tests are that the tests are not used correctly or the results are interpreted incorrectly or that without counselling patients may take inappropriate behavioural and emotional actions based on the outcome of the test. Both negative and positive test outcomes have lifestyle implications for patients. Although the test are easy to perform at home, medical authorities advise not to do the test at home without proper pre-test and post-test counselling.
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		For optimal test results:
		Use a quality product. Credibility of the supplier – number of years in the industry, range of products they sell. Quality and detail of information provided on the package insert. Does the supplier provide contact details if you need to contact them for assistance? Carefully read the full instructions and perform the test as instructed by the manufacturer Blood sample volume – number of free falling drops. Buffer solution – number of drops. Reaction time – waiting period before reading the results. Time limit – the time period after which the results should not be interpreted any longer, discard and ignore. Correct procedure to follow. Correct interpretation of results Carefully read the full package insert before starting the test or interpreting the results. When in doubt, repeat the test. Store the test as recommended by the manufacturer. If the rapid diagnostic test was stored incorrectly e.g. exposed to direct sunlight or frozen, the reagent used to develop the test result will be damaged and rendered ineffective, and give a wrong test result. Rapid diagnostic tests should be protected from humidity at all times. Rapid diagnostic tests are packed in a foil sleeve to keep the test dry and protect it from humidity. If a test is removed from its protective packaging and left in the open (especially at the coast), the humidity will render the test useless.
		It is important to know that the rapid diagnostic HIV / AIDS screening test:
		Is not a substitute for seeking proper medical help. Is not a replacement but a supplement for laboratory diagnostic services. It is a screening aid. A diagnosis should not be based on the results of a single test but should be confirmed and made by a medical professional in conjunction with other medical evidence.
		Always treat all blood and blood containing products e.g. the used test and swab as hazardous material and dispose of it in a safe manner.

		Why should you get tested and do you know your status?


		One of the most effective weapons in the fight against HIV / AIDS is testing.
		It prevents the further spread of HIV. The key to a healthy life with HIV / AIDS is being diagnosed early. Anti-retroviral treatment combined with a healthy lifestyle, diet and exercise allows you to continue to enjoy a normal life. Many patients living with HIV / AIDS have survived for many years, enjoyed a full life and continued to work. The key is early detection and management of the disease! Knowing your status protects you, your partner, your family and your community. Knowing your status allows you to make informed decisions regarding your future, well-being and your life. It empowers you.

What does a negative HIV/AIDS rapid diagnostic screening test result mean?

A negative HIV/AIDS rapid diagnostic screening test result indicates that there is no HIV antibodies present in your blood at the time when you did the test. After exposure to the virus there is a time period known as a “window period” where the patient may be infected with HIV / AIDS but the HIV / AIDS antibodies have not yet been produced by the body’s immune system or the concentration of antibodies are still too low to detect (below the cut-off value). Therefore, if there has been a possible exposure to HIV / AIDS and the test result is negative, the test must be repeated in 3 months.

Patients on anti-retroviral treatment will also test negative for HIV antibodies. This does not indicate that the patient is cured from HIV / AIDS but only that the disease is under control as the result of the anti-retroviral treatment.

What does a positive HIV/AIDS rapid diagnostic test result mean?

A positive HIV/AIDS rapid diagnostic test result indicates that HIV antibodies are present in the blood. A diagnosis of HIV / AIDS should not be based on the results of a single test but should be confirmed by a medical professional in conjunction with other medical evidence.

If your test is positive, please contact your doctor or clinic as soon as possible for further advice and counselling.

Is it possible to obtain a false positive HIV / AIDS rapid diagnostic screening test result?

Yes, it is possible. Most often “false” positive HIV / AIDS rapid diagnostic screening test results are the result of user error or incorrect product storage conditions. Rapid diagnostic screening tests sourced from reputable suppliers and that are performed as per the manufacturer’s instructions are reliable and accurate. Another common error is misinterpretation of test results by the end user.

It is recommended that no diagnosis or treatment decision should ever be based on the result of one test alone. Diagnosis or treatment decisions should always be done by a medical professional based on clinical evidence and laboratory test results.

Cases of false positive HIV / AIDS diagnostic test results have been documented in the medical literature. These are very rare, most often only isolated cases! These false positive HIV / AIDS diagnostic test results are not only for rapid diagnostic HIV / AIDS screening tests but includes laboratory diagnostic tests.

All “HIV / AIDS tests”, laboratory (ELISA and Western Blot – gold standard tests) and rapid diagnostic screening tests are antibody tests. This test result is based on the detection of viral antibodies in the blood. Prior to the notion that HIV causes AIDS, viral antibodies were considered a normal, healthy response to infection and an indication of immunity. Antibodies alone were not used to diagnose disease or predict illness. A variety of viruses, bacteria and other antigens can cause the immune system to make antibodies that also react with HIV. When the antibodies produced in response to these other infections and antigens react with HIV proteins, a positive result is registered. Many antibodies found in normal, healthy, HIV-free people can cause a positive reading on an HIV antibody test, including laboratory tests. Just because a medical condition is on the list of potential causes, it doesn't mean that it will definitely, or even probably, cause a false-positive test result. It depends on what antibodies the individual carries; as well as the characteristics of each particular test kit.

A false positive test result can have serious emotional consequences and this is one of the reasons why pre-test and post-test counselling is so important.

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