How to Know If You Have HIV: Early Signs, Risk Factors, Testing

Many people who have been infected with HIV 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.

There are a number of early signs and symptoms that may suggest you have the virus, but the only way to know if you have HIV is to get an HIV test.

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.

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

HIV is transmitted through:

Anal sex
Vaginal sex
Shared needles and other drug paraphernalia

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. The virus can enter the body either through porous mucosal tissues (such as those in the vagina or rectum), through breaks in vulnerable tissues (which occurs during intercourse), or directly through the bloodstream.

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 less common modes of HIV transmission, including:

Oral sex
Needlestick injury
Blood transfusions
Female-to-female sex
Tattooing and piercing
Kissing
Dental procedures
Biting

Early Signs and Symptoms

Many people do not have any symptoms in the early stage of the infection. However, after HIV transmission, newly-infected people can develop acute signs and symptoms within days of the exposure, including:

Fever
Chills
Headache
Fatigue
Muscle aches
Sore throat
Swollen lymph nodes
A widespread, non-itchy rash
Diarrhea
Loss of appetite
Night sweats
Genital, anal, or mouth ulcers (a sign of a co-occurring sexually transmitted disease)

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 strongly suggest the need for immediate HIV testing.

With that said, not everyone experiences ARS in the same way. The symptoms are non-specific and often mild and are sometimes attributed to other conditions, such as the common cold or simple exhaustion.

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

Less commonly, 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.

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Risk Factors

Even though anyone can get HIV, some individuals are at higher risk than others due to risk behaviors. By identifying your personal risk factors for HIV, you can better determine whether you need HIV testing.

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
Sex work or having sex with someone who does sex work
Sex with someone who uses IV drugs

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. Additionally, women have 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 contributing factors to 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.

The risk is even higher if you share needles with someone who has a high viral load, inject in non-private places (such as in alleys or parks), or use cocaine and crack cocaine (the drugs of which are associated with drug binges).

Additionally, drug use is associated with sex work (which can lead to HIV exposure), as some people who are addicted to drugs engage in sex work to pay for drugs.

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 increase vulnerability to HIV.

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

Ulceration: STDs like syphilis and genital herpes manifest with open, ulcerative sores that can allow the HIV virus 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.

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.

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, some people who might otherwise seek diagnosis and treatment might 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 more likely to remain undiagnosed and untreated and 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."

There are several different HIV 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 nucleic acid tests (NAT) that detect the virus.

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 higher 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. Keep in mind that each test has a window period, so it is important that you understand whether you are having the test in the right window to know whether you are infected.

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," your HIV test results will guide your treatment and prevent the virus from undermining your immune defenses.

Starting treatment early when your immune system is still intact gives you a better chance of having 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.