“You’re only as negative as your last negative HIV test.” That was something I often said to the people I counseled as an HIV tester. Receiving the result of an HIV test is an incredibly powerful piece of information that gives each of us the ability to take control of our health and our future. For examples of what can happen after testing positive for HIV you can read Dr. Rich Wolitski’s personal posts here and here. But we do not talk enough about what happens afterwards for those who test negative—so I wanted to share my experiences as someone who is HIV-negative and taking HIV pre-exposure prophylaxis (PrEP).
Have you ever heard (or said) some variation of the phrase, “Oh yeah—I’m negative. I took an HIV test (some number of days, weeks, months, or years ago)”? While that may certainly be true, it’s important to remember that some of us should be tested more often based on our level of risk. Some people who know they might be at risk, consider their risk to be very low when compared to other people they know. It’s true that they might be at lower risk than many of their peers, but their risk could still be high enough that they should be getting tested regularly. For example the CDC recommends:
- All of us get an HIV test at least once in our lives as part of routine medical care.
- Annual screening for people who are at high risk for HIV including people who inject drugs and their sex partners, people who exchange sex for money or drugs, sex partners of people living with HIV, and gay, bisexual or other men who have sex with men or heterosexual persons who themselves or whose sex partners have had more than one sex partner since their most recent HIV test.
- More frequent testing (such as every 3 to 6 months) for those of us whose behavior might put us at an even higher risk for HIV infection or those of us who use PrEP.
Check out the CDC HIV testing guidelines page for more details and information about how often individuals, including pregnant women, should be tested for HIV.
Linking Those Who Test Negative to the HIV Prevention Continuum
Testing negative is an important opportunity for people to receive information and be linked to prevention services that address their needs and preferences. The HIV prevention continuum provides a more complete description of how testing is an important gateway to risk reduction. The continuum describes a comprehensive, cyclical HIV-prevention model that begins with HIV testing. (For those who test positive, knowing their status serves as an entry point to the HIV care continuum with the ultimate goal of achieving viral suppression for improving health outcomes and preventing new infections.) For those who test negative, the HIV prevention continuum indicates that healthcare providers/counselors should do a risk and needs assessment to determine what resources each of their clients who tests negative may need and what steps they can take to reduce their risk of becoming infected. This may include linkages to, engagement in, and, where appropriate, retention in appropriate medical services (e.g., PrEP services, sexually transmitted disease treatment) and social support services (e.g., mental health treatment, substance use disorder treatment, employment and housing assistance). In the ideal HIV prevention continuum cycle, people who remain at risk for HIV after a negative test should continue to be routinely tested depending upon their level of risk—essentially starting over in the prevention cycle with each new HIV test.
So how does someone stay HIV-negative? There are a number of ways to reduce the risk of acquiring HIV infection. It must be said that not all of these methods are equally effective. And, none of these work if they are not used. To visualize and learn more about how some of these strategies compare to one another, check out the CDC’s HIV Risk Reduction Tool*. Strategies include:
- Abstaining from sex
- Using a condom correctly every time (especially with those whose HIV status you do not know)
- Reducing your number of sexual partners
- Taking PrEP consistently
- Seeking post-exposure prophylaxis (PEP) if you may have very recently been exposed to HIV
- Being treated for other sexually transmitted infections since STIs increase the risk of HIV infection
- If you’re HIV-negative and your partner is HIV-positive, encourage your partner to get and stay on treatment. People living with HIV who take HIV medications daily as prescribed and achieve and then maintain an undetectable viral load for at least 6 months have effectively no risk of sexually transmitting the virus to an HIV-negative partner.
- Engaging in less risky behaviors
It’s important to remember that there is no “one-size-fits-all” option for HIV prevention. So, while I might use PrEP as my primary means of HIV prevention, someone may not be comfortable taking a pill every day, may be facing stigma and discrimination from peers and providers, or may not be aware of how to cover the costs of using it (e.g., daily medication, doctor visits, and lab tests). (Note: We must do more to raise awareness about PrEP and ensure access for those whom PrEP is indicated and for those who desire to use it. To learn more about the federal response for scaling up PrEP, check out the HIV PrEP Framework). It may be that using condoms consistently or reducing the number of sex partners is a more realistic HIV-prevention strategy for others. Or maybe there are those who want to take a break from having sex for a little while. The goal is for people to take control of their health and find the best HIV prevention fit.
It’s vital that we do more to ensure that everyone can be and is tested for HIV so that we can all use the power that the knowledge of our HIV status grants us. This includes creating a safe and welcoming testing environment and encouraging testing among those who have never been tested and those at increased risk who need to be tested more often.
*HHS including the CDC will be updating content to reflect the latest data that shows people living with HIV who take HIV medications daily as prescribed and achieve and then maintain an undetectable viral load for at least 6 months have effectively no risk of sexually transmitting the virus to an HIV-negative partner.