How‌ ‌to‌ ‌Know‌ ‌If‌ ‌You‌ ‌Have‌ ‌HIV‌

Knowing the Symptoms, Risks, and Testing Options

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One of the biggest challenges to diagnosing HIV is that many people are unaware that they have been infected until years after exposure to the virus.

According to the U.S. Department of Health and Human Services, of the estimated 1.2 million people living with HIV in the United States, 1 in 7 do not know that they have been infected and require immediate testing and treatment.

In the end, the only way to know if you have HIV is to get an HIV test. Even so, there are a number of early signs and symptoms that may suggest you have the virus. Pair this with risk factors that are known to increase a person's likelihood of infection and you have may enough information to warrant an immediate investigation.

A young woman sick in bed with a towel on her forehead
Tom Merton / OJO Images / Getty Images

How HIV Is Transmitted

The first step in determining whether you are at risk of HIV is to better understand how the virus is transmitted—and not transmitted—from one person to the next.

HIV thrives in certain body fluids, including blood, semen, vaginal secretions, and breast milk. Most people get infected when exposed to these fluids, typically through:

HIV can also be passed from mother to child during childbirth, although this is less common in the developed world due to advances in prevention and treatment.

It is important to note that HIV cannot penetrate intact skin. Instead, the virus will typically enter the body either through porous mucosal tissues (such as those in the vagina or rectum), through breaks in vulnerable tissues (something that frequently occurs during intercourse), or by directly inoculating the virus into the bloodstream.

Moreover, there must be ample quantities of the virus at the site of exposure to breach the body's frontline defenses. This is why not every act of exposure will result in an infection. Even so, HIV infection can occur with just one exposure, particularly in high-risk individuals.

By contrast, HIV does not thrive in saliva, urine, tears, or feces and cannot survive in infectious quantities when exposed to air and environmental conditions.

Unlikely Modes of Transmission

There are several theoretical modes of transmission that are highly unlikely to cause an HIV infection. These include:

Early Signs and Symptoms

When an HIV transmission occurs, a percentage of newly-infected people will develop acute signs and symptoms within days of the exposure, including:

This range of symptoms, typically referred to as acute retroviral syndrome (ARS), generally begin within five days of exposure and usually last for around 14 days (although some cases have been known to last for months).

If you have had a recent exposure—such as unprotected sex with a partner of unknown status—these early signs and symptoms may strongly suggest the need for immediate HIV testing.

With that said, not everyone experiences ARS in the same way. In some cases, the symptoms may be mild or non-specific and easily attributed to other conditions, such as the common cold or simple exhaustion. Even more concerning is the fact that not everyone will develop symptoms.

According to a 2016 review in Emerging Infectious Diseases, as many as 43% of acute HIV infections are entirely asymptomatic (without symptoms).

On the flip side, some people may develop atypical symptoms of HIV soon after exposure, some of which may be serious. These include tonsillitis, meningitis, herpes zoster (shingles), gastric bleeding, and esophageal thrush. In such cases, HIV may go undiagnosed if the doctor fails to recognize that HIV is the underlying cause of these complications.

Risk Factors

Even though anyone can get HIV, not everyone is at the same risk of infection. Some groups are at higher risk than others due not only to biological vulnerabilities but also psychological and social factors that influence risk behaviors.

Some of these factors are modifiable, meaning that you can mitigate them by changing certain behaviors, while others are non-modifiable and simply something that you are born with.

By identifying your personal risk factors for HIV, you can better determine whether HIV testing is needed.

Sexual Risk Factors

Sex is by far the most common mode of HIV transmission. With that said, there are variables that can increase or decrease the risk of infection. These include:

  • Whether you engage in anal and vaginal sex
  • If you are the receptive or insertive partner
  • The viral load of the HIV-positive partner
  • How many sexual partners you have
  • Whether or not there is ejaculation during intercourse
  • Whether or not the male partner is circumcised

Anal sex poses the highest risk of transmission with a per-episode risk of roughly 1 in 70 (1.43%) for the receptive partner and 1 in 161 (0.62%) for the insertive partner. Rectal tissues are especially prone to rupture, allowing the virus direct access to vulnerable tissues and cells.

Vaginal sex is the second most common mode of transmission with a per-episode risk of 1 in 525 (0.19%) for the female partner and 1 in 1,000 (0.1%) for the male partner.

This translates to a higher rate of new infections among women compared to men—18% versus 8%, respectively—as well as a 1.6-fold greater risk of progression to AIDS.

Rather than playing the odds, you can reduce your risk of HIV by using condoms, limiting your number of sex partners, and taking HIV pre-exposure prophylaxis (PrEP) to prevent getting the disease.

Intravenous Drug Use

Intravenous drug use is one of the growing concerns of the HIV epidemic in the United States, driven in part by the ongoing opioid crisis. People who inject drugs (PWID) account for around 9% of all new HIV infections due mainly to the shared use of contaminated syringes and needles.

But, needles and syringes are not the only concerns. Studies have shown that roughly one in 12 PWIDs are infected not by sharing needles but rather by sharing cotton, cookers, or water used to prepare the drugs for injection.

Additional risk factors include a high viral load in the HIV-positive partner, injecting in non-private places (such as in alleys or parks), and the use of cocaine and crack cocaine (the drugs of which are associated with drug binges).

Injecting crack cocaine or cocaine is associated with a 2.1-fold to 3.7-fold increased risk of HIV transmission.

Sexually Transmitted Diseases

Studies suggest that 1 in 7 people with HIV are co-infected with another sexually transmitted disease (STD) at the time of their diagnosis. These co-infections not only increase a person's vulnerability to HIV but increase the potential for transmission from the HIV-positive partner.

STD can increase the risk of HIV transmission is three distinctive ways:

  • Ulceration: STDs like syphilis and genital herpes manifest with open, ulcerative sores that allow HIV greater access to deeper tissues.
  • Inflammation: STDs, including chlamydia and gonorrhea, provoke inflammation, providing immune cells greater access to the site of exposure. Among these are CD4 T-cells that HIV preferentially targets and infects.
  • Genital shedding: The inflammation spurred by an STD co-infection can also increase the number of HIV in the genital tract (referred to as genital shedding). So, even if a person has an undetectable viral load in the blood, they can still potentially infect others due to detectable HIV in their semen, vaginal fluid, or rectal secretions

Viral STDs like herpes simplex and human papillomavirus (HPV) and bacterial STDs like gonorrhea, chlamydia, and syphilis can increase the risk of HIV transmission by up to 300% and 500%, respectively.

Race and Ethnicity

Race and ethnicity are integrally linked to HIV infection in the United States with people of color disproportionately affected compared to Whites.

At the center of this disparity are high rates of poverty and a lack of access to quality healthcare among Blacks and Latinos who represent only 13.4% and 18.5% of the population, respectively, but account for more than half of all new and existing HIV infections.

Higher rates of STDs, smaller sexual networks, and a greater incidence of undiagnosed HIV infections also play a role, particularly in Black communities that have the highest rate of HIV-associated deaths of all racial and ethnic groups.

HIV Stigma

HIV remains a highly stigmatized disease. Because it is linked to behaviors that many in society disapprove of—including homosexuality, drug use, sexually active youth, and sexually active females—people living with HIV are frequently discriminated against or "blamed" for the spread of infection.

When faced with HIV stigma, people who might otherwise seek diagnosis and treatment will go into hiding, fearing that the disclosure of their status may cause them harm, abandonment, loss of income, or worse.

Feeling of shame, guilt, and fear will often become internalized, leading to depression and an increased risk of isolation, alcohol and substance abuse, and risk-taking behaviors.

When paired with homophobia, misogyny, and racism, HIV stigma can exponentially increase the risk of infection.

A 2016 study from the Centers for Disease Control and Prevention reported that gay and bisexual Black men, trapped in the crosshairs of homophobia, racism, and poverty, have a 50/50 chance of getting HIV in a lifetime.

Youth

People under 25 account for 1 in 5 new HIV infections in the United States each year, with the majority occurring through male-to-male sexual contact. Compared to adults, teens and young adults with HIV are not only more likely to remain undiagnosed and untreated but also fail to achieve an undetectable viral load if they are treated.

Young people are also more likely than older people to be homeless, uninsured, recently incarcerated, or living in households with low incomes. Those between the ages of 20 and 24 also have the highest rates of STDs overall, increasing the risk of HIV transmission and infection.

High rates of substance abuse also plague younger people, with 2% and 12% of all new infections in young men and young women, respectively, attributed to injecting drug use.

HIV Testing

Symptoms and risk factors may point you in the direction of HIV testing, but the lack of symptoms or risk factors should not suggest that you are "in the clear." In the end, the only way to tell if you have HIV is to get a test.

There are several different tests to choose from. Some are more accurate than others, while others are faster, more convenient, or offer greater privacy or confidentiality.

The tests can either check for antibodies (defensive proteins that the body produces in response to the virus) or antigens (the part of the virus that triggers the immune response). There are also combination tests that detect both HIV antibodies and antigens as well as expensive nucleic acid tests (NAT) that are able to detect the virus itself.

Different tests require different testing samples. Rapid HIV tests, including at-home and mail-in tests, typically require a saliva sample or drop of blood. Some in-office tests require a sample of blood.

Although tests that utilize a blood sample are typically more accurate, newer generation rapid tests are demonstrating exceptionally high sensitivity and specificity rates than in years past.

Test Type Sample Tests for Turnaround Accuracy
At-Home Rapid Test Saliva HIV antibodies 20 minutes Specificity: 99%
Sensitivity: 92%
Mail-In Test Fingerprick HIV antibodies 2-5 days Specificity: 100%
Sensitivity: 83%
In-Office Rapid Test Saliva, fingerprick HIV antibodies 20 minutes Specificity: 100%
Sensitivity: 98%
Standard Antibody Test Blood sample HiV antibodies 2-3 days Specificity: 99%
Sensitivity: 95%
Combination Antigen-Antibody Test Blood sample HIV antibodies and antigens 2-3 days Specificity: 100%
Sensitivity: 99%
Nucleic Acid Test (NAT) Blood sample HIV RNA 2-3 days Specificity: 100%
Sensitivity: 99%

As accurate as these newer generation tests are, they still have their limitations.

Window Period for HIV Testing

Because it takes time for the body to produce enough antibodies to reach detectable levels, you may need to wait for three weeks or more—known as the window period—before an antibody test can return an accurate result. Newer combination tests may be able to cut that time to 14 days.

A Word From Verywell

As scary as an HIV test may seem, the benefits of testing invariably outweigh the risks. Rather than wondering if you "have it or not," HIV testing allows you to access treatment if needed and prevent the virus from undermining your immune defenses.

Starting treatment early when your immune system is still intact better ensures a normal to near-normal life expectancy. It also slashes the risk of HIV-associated and non-HIV-associated illnesses by more than half compared to starting late.

So dramatic are the benefits of HIV therapy that the U.S. Preventive Services Task Force currently recommends HIV testing for all Americans 15 to 65 as part of a routine doctor's visit.

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