In the state of New York, where my private psychotherapy practice is located, the law requires the offer of an HIV test to patients between the ages of 13 and 64 in primary care settings, emergency departments, and inpatient settings. The law does not require anyone to accept the offer, of course; that would be tantamount to mandatory HIV testing. The law has numerous intentions, not the least of which is to get individuals thinking about their HIV status and to begin conversations between patients and their medical providers about HIV/AIDS.
As a psychotherapist in practice in New York City, I am often asked, “Should I take an HIV test?” and “Why should I take an HIV test?” These are both excellent questions. Since a good therapist is not in the business of giving advice, I typically respond with a question of my own: “What reasons can you think of for not taking an HIV test?” I’ve heard many answers over my nearly 20 years asking this question. Some of the most common responses are variations of:
- “I’m afraid to get a positive test result.”
- “Why bother when there is no cure?”
- “I can’t afford to get tested.”
- “I don’t know where to get tested.”
- “I don’t want my doctor or insurance company to know the results.”
- “I’m worried about confidentiality and stigma.”
- “I’m afraid of needles.”
For some people, these are very real concerns. However, much has changed—for the better—in the last 20 years. While there is still no cure or recognized vaccine for HIV, treatment has advanced significantly. Many HIV-positive people are living longer and healthier lives on treatment with medication consisting of only one pill taken once a day. Assuming you test regularly, learning you are HIV-positive can enable you to begin treatment with these medications as soon as possible.
Access to HIV testing has never been greater. Here in New York City, the Department of Health and Mental Hygiene offers free and confidential testing for HIV and other sexually transmitted infections. Many cities and towns across the country offer similar services. This allows even those individuals without access to affordable health care to be tested.
Access to HIV testing has never been greater. Here in New York City, the Department of Health and Mental Hygiene offers free and confidential testing for HIV and other sexually transmitted infections. Many cities and towns across the country offer similar services.
HIV tests can also be self-administered in the privacy of your home. These tests involve swabbing the lining of your mouth and waiting about 15 to 20 minutes for a result. They aren’t free, but they can be purchased at many pharmacies and they don’t involve needles and blood. Assuming your result is HIV-negative, no one else ever need know you took the test.
This leaves the issues of stigma and confidentiality. Although the stigma attached to HIV and AIDS, particularly in the 1980s and ’90s, has lessened dramatically, some remains. In certain ethnic and religious communities, HIV/AIDS remains a symbol of sin, mostly because of its early ties to drug use and sexual transmission. However, even in these communities, education and better treatment is eroding the fear and shame attached to HIV/AIDS.
Fear of stigma often leads to concerns over confidentiality (although there are other reasons our medical information should always remain confidential). In the early years of HIV testing, the tests could be anonymous. Anonymous testing meant no identifying information was connected to the blood sample or the ensuing result. Under confidential testing, identifying information is collected but protected by laws of confidentiality that cover your test facilitator, your doctor, and any other provider to whom you disclose your HIV status, including your therapist. Today, HIV testing done in the state of New York is confidential and not anonymous.
If you are contemplating taking an HIV test, talking about these issues with a knowledgeable, caring, and nonjudgmental therapist can help you make a decision you are comfortable with.
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