What Tests Can Diagnose HIV?

What to Expect When Undergoing an HIV Test

This article is part of Health Divide: HIV, a destination in our Health Divide series.

An HIV test is used to determine if someone has been infected with human immunodeficiency virus (HIV). The test is commonly performed on a blood or saliva sample, but a urine-based test was approved for use in the United States in 2015. 

Both point-of-care tests used in hospitals and clinics and at-home tests used at home are extremely accurate if used correctly. However, they can deliver an incorrect result if the test is performed too soon after an exposure.

HIV testing options
Illustration by Emily Roberts, Verywell 

This article details what tests are available, how accurate the tests are, how the tests are performed, and what to expect if you test positive for HIV. It also looks at gaps in testing among people living with HIV. Gaps in testing among Black and Latinx people, men who have sex with men (MSM), transgender women, and the broader transgender community are discussed in this article. 

Purpose of Test

There are an estimated 1.2 million people living with HIV in the United States, 13% of whom remain undiagnosed. In response, the U.S. Preventive Services Task Force issued updated guidance recommending that everyone between the ages of 15 and 65 undergo HIV testing as part of a routine doctor's visit.

Testing every three to six months is advised for people who belong to groups more likely to be diagnosed with HIV, including:

  • Injecting drug users
  • Sexually active men who have sex with men
  • Trans people, especially Black trans women and transfeminine people (people assigned male at birth but identify as female)
  • People who exchange sex for money
  • Anyone who engages in high-risk sex, including sex without condoms or sex with multiple partners
Undiagnosed Cases of HIV

Verywell / Julie Bang

Testing Types

There are both indirect and direct methods of HIV testing. Indirect methods do not detect the virus but rather proteins, called antibodies, that are produced by the immune system in response to the virus. Direct testing methods detect either proteins on the surface of the virus, called antigens, or the genetic material of HIV in the form of RNA (ribonucleic acid, which is important in regulating gene expression).

There are a few testing options, which vary in their speed, accuracy, and ease of use and include:

  • Rapid point-of-care tests can deliver preliminary results in around 20 minutes. These may require a blood drop from your finger, an oral swab from your gums, or a sample of urine. Of these, the preferred method is the blood-based combination HIV antigen/antibody (Ag/Ab) test.
  • Standard point-of-care tests are lab-based tests that detect HIV antibodies only. Also known as the HIV ELISA, the test requires a blood draw. The results are usually returned within five to 10 working days. The test is less commonly used today and has been largely replaced by the combination HIV Ag/Ab test.
  • Rapid at-home tests are saliva-based antibody tests that can be purchased online or at many retail drugstores. While less accurate than a point-of-care test, this test offers privacy and can deliver results in around 20 minutes.
  • Home collection kits can also be purchased online. This antibody test requires a drop of blood placed on a test card, which you then send to a lab via Express Mail. You can then receive the results either by phone or online as early as one business day after your sample is delivered.
  • Nucleic acid tests (NAT) are blood-based tests that detect HIV RNA. While expensive, the NAT can detect HIV earlier than other forms of testing and may be appropriate if you have had a recent high-risk exposure or are experiencing acute symptoms of early infection. The NAT is also used to screen donated blood or test newborns suspected of having HIV. Results are usually returned within a couple of days.

Any positive result—called the preliminary positive—would require a second confirmatory test to ensure the diagnosis is correct. The only exception is the NAT, which does require confirmation.

Stigma and HIV Testing Among Black People

Stigma plays a large part in why 15% of Black people with HIV remain undiagnosed in the United States. Chief among the concerns is the fear of being labeled "promiscuous" or being judged or shamed by community or faith-based leaders.

Test Accuracy

HIV tests are highly accurate if used correctly. However, some testing methods are more reliable than others. Improper use or storage can also undermine the accuracy of a test.

By and large, point-of-care tests are more accurate than home-based tests due in part to user error. Similarly, blood tests tend to be more accurate than saliva or urine tests because there are higher concentrations of HIV in blood.

Clinics in the United States report a 98.5% accuracy rate when using an antibody test and a 99.9% accuracy rate when an antibody test is combined with a confirmatory test. This translates to one false-positive result for every 250,000 tests.

Certain conditions can also trigger a false-positive test result, meaning that the test shows positive for HIV while the person is not actually HIV-positive. Conditions that can trigger a false positive include syphilis, lupus, and Lyme disease. Confirmatory testing will almost always weed out these incorrect findings.

According to the Food and Drug Administration (FDA), at-home rapid HIV tests have an 8% false-negative rate. This means that 1 of every 12 negative results is incorrect and is actually positive. This is not only due to user error but also to the fact that the saliva-based test is less sensitive.

Risks and Contraindications

There are no contraindications for HIV testing, meaning there is nothing that makes getting tested inadvisable. Also, there are few risks. If a blood draw is required, you may experience soreness, swelling, and bruising at the injection site. Light-headedness and testing HIV positive are also possible.

If you are afraid of needles or squeamish about blood, let the nurse or phlebotomist (healthcare professional who draws blood) know in advance. Other testing options may be available. Additionally, if you have hemophilia (a blood disorder that interferes with blood clotting) or if you are taking blood thinners, a child-sized butterfly needle may be used to reduce the risk of bleeding.

Before the Test

The HIV test requires no preparation other than your readiness to take the test. With that being said, HIV remains highly stigmatized, and people often avoid HIV testing out of fear of disclosure.

If you are concerned about your privacy, find a clinic that offers either confidential testing (in which your name is shared only with your healthcare provider, your insurance company, and a government reporting agency) or anonymous testing (in which your name is shared with no one).

Confidentiality and HIV Testing

Concerns about confidentiality discourage many people from getting tested for HIV. Among stigmatized groups such as MSM and trans people—especially Black trans women—those fears are compounded by the fact they may be forced to come out about their sexuality and/or gender identity. For some, these "secondary disclosures" are more distressing than the fact they have HIV.

Timing

Timing is an important part of HIV testing. If you have been exposed to HIV, there will be a period of time, called the window period, when the test cannot deliver an accurate result.

Because HIV tests generally detect antibodies and/or antigens, you need to wait until your body has produced enough of these to elicit a positive result. If you test too early, you will get a false-negative reading. Even with the nucleic acid test, you need to wait until the virus has replicated to detectable levels.

Because detectable levels can vary by individual, most clinics will advise you to wait to be tested for HIV after possible exposure, according to the following timetable:

  • One to three weeks before getting a NAT
  • One month before getting a combination HIV Ag/Ab test
  • Three months before getting any of the other HIV tests

The procedure itself involves three steps: pre-test counseling, the HIV test, and post-test counseling. Depending on the test being performed, the process can take 30–45 minutes. Walk-in centers may take far longer.

Location

HIV tests are available at many medical and public health facilities. These include hospitals, clinics, retail pharmacies, community-based HIV organizations, antenatal and family planning clinics, youth drop-in centers, mobile testing sites, and drug and alcohol treatment centers.

To find a testing site near you, use the online locator offered by the Department of Health and Human Services (HHS). Many of the sites offer walk-in testing. Others require an appointment.

Confidentiality and HIV Testing in Black People

Black people in the United States often have limited options for healthcare. Many within the community will avoid getting tested because it forces them to go to a local clinic where others may see them. Even buying an at-home HIV test at a local drugstore poses risks.

Food and Drink

There are no food or drink restrictions for an HIV test. However, if you are using an at-home oral test, avoid brushing your teeth or using mouthwash 30 minutes beforehand as this may affect the results.

What to Bring

Even if you are undergoing anonymous testing, the facility may require government-issued ID to confirm your residency. Call in advance for details. You should also check to see if the site accepts your insurance, if you have a plan. If so, bring your insurance card.

You may also want to consider bringing someone with you if you are unsure how you might react to a positive HIV diagnosis. Having support can be very important.

Cost and Health Insurance

Most insurance plans, including Medicare and Medicaid, will cover the cost in full as part of the Affordable Care Act’s essential health benefits.

It is important to note that, while point-of-care tests are typically covered by insurance, at-home test kits may not be. Check with your insurance provider to better understand your benefits in this regard.

If you are uninsured, you can find low- to no-cost testing sites through the GetTested locator offered by the Centers for Disease Control and Prevention (CDC).

HIV and Health Insurance Among Black People

Despite increased access to healthcare under the Affordable Care Act, 1 of every 9 Black people is without insurance. Black trans people, especially Black trans women, often experience hostility in health settings. Black transmasculine people are often excluded from HIV discourse despite testing positive at higher rates in comparison to the general population.

Poor community access to health insurance, provider hostility, and lack of provider knowledge about trans communities may increase a person's likelihood of testing HIV-positive. Among Black MSM, the lack of insurance increases the risk of HIV by 2.5 times compared to those who have insurance.

HIV Disclosure Laws

Despite whether your HIV test is anonymous or confidential, any positive test result will be reported to your local health department who will, in turn, disclose the information—without your name—to the CDC in Atlanta. The information is not shared with any other government agency.

A positive result may also be shared with your insurance company and the doctor who referred you for testing. It cannot be shared with any other doctor or agency without your expressed written consent under the Health Insurance Portability Accountability Act (HIPAA) of 1996.

Many states and some cities have partner-notification laws, meaning that your healthcare provider may be legally obligated to tell your sex or needle-sharing partner if someone they have been with has tested positive for HIV. Your name or personal information is not shared in the disclosure.

If you are married and test positive for HIV, be aware that health departments funded by the federal government's Ryan White HIV/AIDS Program are required to show "good faith" efforts in notifying married partners of the result. Implementation of this requirement varies significantly.

HIV and Medical Mistrust in Black Men

High rates of distrust of public health services have seeded doubts about medical confidentiality in many Black communities. This, in turn, has led to lower HIV testing rates, particularly among Black men.

Other Considerations

It is a mistake to think that there is nothing you can do if you’ve been recently exposed to HIV. If you have had sex without a condom, have shared needles, or have some other form of exposure, you may be able to avert the infection by starting HIV postexposure prophylaxis (PEP) within 72 hours.

PEP involves a 28-day course of two or three antiretroviral drugs depending on the severity of your exposure. Used by healthcare workers and in cases of rape, the strategy may reduce your risk of transmission by as much as 79%.

During the Test

On the day of the test, after registering and confirming your insurance information, you will be asked to sign a consent form acknowledging that your test results may be shared with the relevant agencies and individuals as directed by HIPAA. Speak with the office administration if you do not understand any part of the consent form.

Many sites will also ask you to fill out a questionnaire to get some background information on you, including your ethnicity, sexual orientation, sexual activity, and substance use, and whether you have had an HIV test before. Some of the information will be used for confidential reporting purposes; some to assist with counseling.

Pre-Test

Pre-test counseling is performed in a private room with a qualified health professional. During the counseling, you may be asked about your recent exposure, if there was one, as well as your sexual or recreational drug practices. The questions are not meant to judge or embarrass you. Rather, they help the counselor gain a better understanding of your personal risk of transmission.

The counselor will then explain what HIV and AIDS are, how the test is performed, what a window period is, and what a positive and negative result means. If it is determined that you are testing too soon, the counselor may request that you come back when the test is more likely to be accurate.

Feel free to ask any questions you need. There is no such thing as a bad question.

Throughout the Test

The testing procedure in a clinic can vary based on whether you are taking a rapid HIV blood or oral test, or an HIV antibody blood or saliva test. (The urine test, while approved, is rarely used in a clinical setting. This is, in part, because it is less accurate than any of the other tests.)

A rapid HIV blood test is performed as follows:

  1. Your finger is cleaned with an antiseptic wipe.
  2. Using a spring-loaded tool called a lancet, the health professional pricks your finger to draw a drop of blood.
  3. The blood is drawn into a tiny glass tube called a pipette, which is then placed in a reagent called a buffer.
  4. The buffer and two other chemicals (a dying agent and clearing solution) are poured into a plastic well called a membrane.
  5. After 15–20 minutes, the membrane is checked. If the membrane has one dot on the bottom, the test is nonreactive (negative). If the membrane has two dots, the test is reactive (preliminary positive).
  6. A confirmatory blood test is then performed. Results are available a few days later.

A rapid HIV oral test is performed as follows:

  1. An oral swab called a wand is swiped between your teeth and upper and lower gum. The wand should be swiped no more than once.
  2. The wand is placed in a buffer solution for 20 minutes.
  3. The wand has a results window similar to those in at-home pregnancy tests. If the window in the handle has one line, the test is nonreactive (negative). If the window has two lines, the test is reactive (preliminary positive).
  4. A confirmatory blood test is then performed. You will get your results the same day you take the test.

Note that if you used a home kit, the toll-free support helpline listed on the test's instructions will advise your further.

An HIV antibody blood test is performed as follows:

  1. An elastic band is placed on your upper arm to make a vein swell.
  2. The skin around the planned injection site is cleansed with an antiseptic swab.
  3. A wing-shaped device called a butterfly needle is inserted into the vein. This needle, which is attached to a narrow catheter, is less prone to jiggling as your blood is being drawn than other types.
  4. Between 1 and 4 milliliters (mL) of blood are extracted into a vacuum-sealed test tube called a vacutainer.
  5. The needle is then removed and your arm is bandaged.
  6. The tube is sent to a lab. If the sample is reactive (preliminary positive), the lab immediately runs a confirmatory test using the same blood sample.
  7. You will be informed of your results in a week or two.

An HIV ELISA saliva test is performed as follows:

  1. An oral swab called a wand is placed between your cheek and gum for two to five minutes.
  2. The wand is placed in a buffer solution.
  3. The wand handle is then snapped off.
  4. The buffer solution is sealed and sent to the lab.
  5. If the sample is reactive (preliminary positive), the lab immediately runs a confirmatory test using the same sample.
  6. You return for your test results in a week or two.

After the Test

Some people will tell you that the hardest part of an HIV test is not taking the test but waiting for the results. This is especially true if you have a preliminary positive result and have to wait several days or more for the final results.

The wait can often be agonizing; so much so, in fact, that as many as 1 in 15 people will not return for their results, according to a study published in the International Journal of STDs and AIDS.

There are several measures you can take to remain composed during the wait, including:

  • Surround yourself with friends and family who support you.
  • Take things one step at a time. Do not spend hours scanning the web for all of the what-ifs.
  • Exercise to help elevate your mood and fight depression.
  • Avoid alcohol, recreational drugs, or even caffeine to remain calm and present.
  • If worry begins to consume you, remind yourself that there are effective treatments and ways to pay for HIV treatments, whatever your income.

If you are unable to cope and don't have someone to talk to, call the 24-hour, toll-free HIV hotline in your state for a referral to a qualified counselor in your area.

HIV Testing Follow-Up in Black Men

Black men are 24% less likely to return for HIV test results than other groups. The fear of stigmatization paired with an underlying conspiracy belief (such as HIV being created in a government lab) account, in part, for this disparity.

Interpreting the Results

The time it takes to get your results can vary. Many states mandate that the test results be delivered only in person. While some states will allow doctors to deliver negative results over the phone, the practice is frowned upon by most healthcare professionals. This is because a phone call doesn't allow for adequate post-test counseling, and it poses the potential of a breach of confidentiality that you've been tested (something you may not want shared). HIV test results are not sent by mail.

Test results are interpreted as follows:

  • If the preliminary test is nonreactive, you are HIV-negative, meaning that you either do not have HIV or you have tested too soon. While you won't require further testing (unless the timing of your test was not optimal), you will be advised on ways to reduce your future risk and whether routine testing is needed if you are at high risk of infection.
  • If the preliminary test is reactive, the result is considered a preliminary positive. To confirm the result, the lab will use a more sophisticated test called the HIV differentiate assay and possibly the NAT. If the confirmatory tests are both nonreactive, you can be assured with a high level of confidence that you are HIV-negative.
  • If your preliminary and confirmatory tests are both reactive, you are HIV-positive, meaning that you have HIV. Post-test counseling will be focused on both your emotional and medical needs.

Post-test counseling is always performed, no matter your test results. The aim of counseling is twofold: to help you understand what the results mean and to provide you with information on next steps to stay safe and healthy.

A positive HIV test result may be shared with the CDC, your insurance company, or your doctor, or certain individuals in accordance with the rules you agreed to before your test. If your confidentiality is breached, you can file a complaint with HHS and seek legal damages as laid out in the laws of your state.

Follow-Up

Upon receiving an HIV-positive diagnosis, you will be advised that there are treatment options and support systems to link you to medical care. You may also be referred to a care navigator, who can assist you with referrals and any financial, emotional, family, legal, or drug treatment services you need.

If you feel overwhelmed, you can request to discuss your options on another day or use the time to ask as many questions as you need. Coming to terms with an HIV diagnosis is a process. Don’t feel rushed.

HIV Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Man

However, if you are ready to proceed and the test was performed in a clinic or hospital, you may be asked to undergo additional tests called a CD4 count and HIV viral load. The CD4 count measures the number of immune cells (called CD4 T-cells) in your blood and helps establish how strong your immune system is. The viral load uses a similar technology to the NAT and counts how many viruses there are in a microliter (µL) of blood.

Both of these tests help establish your baseline status before treatment and will be routinely repeated to assess your response to therapy.

HIV treatment should ideally be started at the time of diagnosis. Genetic tests may be used to identify which drugs work best for you. The drug therapy itself typically involves a once-daily dose and, if taken as prescribed, can ensure a normal quality of life and a near-normal life expectancy.

You will have ongoing medical evaluations to monitor your condition for the rest of your life. A testing schedule will be determined by your doctor.

A positive HIV diagnosis does not mean the same thing that it used to. Advances in HIV therapy are such that you can now live a long and healthy life and may never be faced with the prospect of a serious HIV-related illness or AIDS.

Accessing HIV Care in Black Communities

According to the CDC, only 63% of Black people in the United States receive some medical care after an HIV diagnosis, while only 48% remain in care. Many of the factors that discourage people from getting tested discourage them from staying with their treatment.

A Word From Verywell

Receiving an HIV diagnosis can be a life-altering event, and there is often no way to know how you will react to the news. Whatever your response, accept that it is normal. Some people might even feel a sense of relief from no longer having to wonder about their status. By knowing your HIV status, you can make an informed choice on how to protect yourself from testing positive for other strains of HIV and others.

This is not to suggest that living with HIV is without its challenges. If you are having trouble coping, consider joining a support group or seeking one-on-one counseling from a qualified therapist.

On the other hand, if you are experiencing extreme depression or anxiety, ask for a referral to a psychiatrist who may be able to offer medications and therapy to help you better cope.

Frequently Asked Questions

  • What can cause a false-positive result on an HIV test?

    While it's unusual to get a false-positive, it can sometimes happen if you've participated in an HIV vaccine study or have certain medical conditions, such as an autoimmune disease. It can also happen for technical reasons in the lab, such as improper handling or misinterpreting a result. A follow-up test can help verify if your first test result was accurate.

  • Can you have HIV antibodies but not have HIV?

    Infants born to HIV-positive birthing parents can have HIV antibodies but not HIV. For these babies, the birthing parent's HIV antibodies are transferred across the placenta and stay in their system for 18 months. To get an accurate result, children up to 18 months need viral diagnostic testing. After that time, an antibody test should be accurate for detecting HIV.

Was this page helpful?
18 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Centers for Disease Control and Prevention. HIV Surveillance Report 2019. Updated May 2021.

  2. U.S. Preventative Services Task Force. Human immunodeficiency virus (HIV) screening. June 11, 2019.

  3. National institutes for Health. HIV testing overview. Updated September 25, 2020.

  4. Arora DR, Maheshwari M, Arora B. Rapid point-of-care testing for detection of HIV and clinical monitoring. ISRN AIDS. 2013;2013:287269. doi:10.1155/2013/287269

  5. Food and Drug Administration. First rapid home-use HIV kit approved for self-testing. Updated June 25, 2020.

  6. Mathews A, Farley S, Conserve DF, et al. Meet people where they are: a qualitative study of community barriers and facilitators to HIV testing and HIV self-testing among African Americans in urban and rural areas in North CarolinaBMC Public Health. 2020;20:494. doi:10.1186/s12889-020-08582-z

  7. Pant Pai N, Balram B, Shivkumar S, et al. Head-to-head comparison of accuracy of a rapid point-of-care HIV test with oral versus whole-blood specimens: a systematic review and meta-analysis.Lancet Infect Dis.2012;12(5):373-80. doi: 10.1016/S1473-3099(11)70368-1

  8. Centers for Disease Control and Prevention. False-positive HIV test results. May 2018.

  9. Food and Drug Administration. Information regarding the OraQuick In-Home HIV test. Updated June 3, 2020.

  10. Pharr JR, Lough NL, Ezaonolue EE. Barriers to HIV testing among young men who have sex with men (MSM): experiences from Clark County, Nevada. Glob J Health Sci. 2015 Nov 3;8(7):9-17. doi:10.5539/gjhs.v8n7p9

  11. Center on Budget and Policy Priorities. African American uninsured rate dropped by more than a third under Affordable Care Act. June 1, 2017.

  12. Lacombe-Duncan A. An intersectional perspective on access to HIV-related healthcare for transgender women. Transgender Health. 2016;1(1):137-141. doi:10.1089/trgh.2016.0018

  13. Dorell CG, Sutton MY, Oster AM, et al. Missed opportunities for HIV testing in health care settings among young African American men who have sex with men: implications for the HIV epidemic. AIDS Patient Care STDS. 2011 Nov;25(11):657-64. doi:10.1089/apc.2011.0203

  14. Doshi RK, Malebranche D, Bowleg L, Sangaramoorthy T. Health care and HIV testing experiences among Black men in the South: implications for "Seek, Test, Treat, and Retain" HIV prevention strategies. AIDS Patient Care STDS. 2013 Feb;27(2):123-33. doi:10.1089/apc.2012.0269

  15. HIV.gov. Post-exposure prophylaxis. Updated April 20, 2021.

  16. Ngangue P, Bedard E, Zomohoun HTV, Payne-Gagnon J, Fournier C, Afounde J, Gagnon MP. Returning for HIV test results: a systematic review of barriers and facilitators. Int Sch Res Notices. 2016 Dec 15;2016:6304820. doi:10.1155/2016/6304820

  17. Centers for Disease Control and Prevention. HIV and African American people, Updated September 23, 2021.

  18. Stanford Children's Health. AIDS/HIV in children.