‘That AIDS Test’ Suffers From Some Common Misconceptions

When acquired immune deficiency syndrome first made headlines in the early 1980s, many Americans looked upon the devastating disease as something that happened only to other people. But as AIDS continues to spread, a growing number have become concerned--realistically or not--that somehow they might have been exposed to the virus.

From heterosexual singles to gay men to friends, relatives and even casual acquaintances of people with AIDS, more and more Orange County residents are inquiring about “that AIDS test.” Some ask their family doctors; others call the AIDS Response Program’s hot line, the Red Cross or other agencies.

“That’s actually one of the most frequent things people call us about,” says Tim Miller of the AIDS Response Program. “They think they may have put themselves at risk, or they’ve already decided but they’re looking for a test site, or they want more information about anonymity vs. confidentiality.”

But misconceptions abound when it comes to AIDS, and the same holds true for AIDS testing.

First, what is generally referred to as an AIDS test is actually a test for antibodies to the human immunodeficiency virus (HIV). There is no direct test for the virus itself. And if a person does have HIV antibodies, that is not the same as having either AIDS or AIDS-related complex (ARC). Someone who is antibody-positive may have no symptoms at all for years after being exposed, if ever.

Those at risk for HIV exposure include: men who have had sex with other men; intravenous drug users who have shared needles and sexual partners of such drug users; transfusion and blood-product recipients between 1977 and March, 1985, as well as their sexual partners; and people who have had multiple sexual partners or engaged in unprotected intercourse or unprotected oral sex, Miller says.

For several years after the HIV-antibody test was developed in 1985, many of those in legitimate risk groups avoided taking it because they felt there was nothing to be gained. Now, however, “there is a very good body of medical research which tells us that early intervention and treatment of people who are HIV-positive but asymptomatic can effectively delay or maybe even prevent the onset of the disease,” Miller says.

Still, many of those at risk remain reluctant. “We know that there are a lot of people out there who are still very scared to take the test,” Miller says. “There are so many implications with it: discrimination, people rejecting you, and also just a lot of fear about knowing. Despite the fact that there’s this very optimistic news, a lot of people look at a positive diagnosis as the next thing to a death sentence.

“But something can be done if you’re HIV-positive. We’re looking at the place where we may be able to make HIV infection a chronic manageable disease on the order of diabetes. And we really need the people to step forward who have put themselves at risk. We have people who can assist them in discussing their fears and help them see the benefit of taking the test.”

Conversely, there are those who aren’t in any high-risk category--and some who have no possibility of exposure--who insist on being tested. AIDS can be transmitted only by direct contact with blood, semen or vaginal secretions of an infected person, Miller explains. “And that potentially infected fluid has to have contact with your blood system.

“You can’t get AIDS from a doorknob, or if a person with AIDS is in the same room or on the same planet with you,” Miller says. “But we still get calls from people who don’t understand that. It gets pretty far-fetched.”

Miller says many of the calls to the AIDS Response Program are from people who “have had a casual sexual encounter that they feel guilty about, when in fact they didn’t put themselves at risk at all, or that risk was extremely minimal.”

Dr. Thomas Schaaf, a family practitioner who works out of Saddleback Memorial Medical Center, says the question “comes up quite a bit” in his practice. “Patients bring it up in a lot of different circumstances,” he says. “Most commonly, it’s someone who is young, single and still out in the dating world who really doesn’t know what their exposure has been, and they’re having a little trouble sleeping at nights worrying about it. Or you have somebody who’s been married for a couple of years, and they’re starting to worry about their dating life before they got married. And you also get people who have a relative or friend who has come down with AIDS.”

For those who are confused, Schaaf explains how the disease is transmitted. “But generally, if they’re worried, we go ahead and have (the test) done.”

Although the HIV-antibody test is more than 99% accurate, false positives are possible. To be certain, the blood of all those who test positive is put through another kind of test for confirmation.

Also, there is a “window” of about six months in which a person who has been exposed may not yet have developed antibodies.

“Generally, if the patient brings the subject up, I’m kind of nosy,” says Dr. John Quinn, a family practitioner in Garden Grove. “I want to know if they have a risk factor, and if it’s a valid one, then by all means we do the test.”

With callers to the AIDS Response Program’s hot line, Miller says: “We try to determine whether there’s any need for testing based on where, and how frequent, the exposure may have been. If a person has had a blood transfusion prior to 1985, or if a person has used IV drug needles, particularly in high-risk geographical areas such as New York, any time in the last seven years, definitely.

“In any situation where a man has had sex with a man, we would always recommend HIV-antibody testing. For heterosexual intercourse in Orange County, there’s less of a chance that they had contact with an infected person than in someplace like New York.” Of course, contact with a person from a high-risk area, or someone who has had contact with that person, makes exposure more likely.

Although California law requires that HIV-antibody test results be kept confidential, Miller believes that complete anonymity is the best guarantee.

“We only recommend that people go to the . . . test sites around the county where testing is done anonymously,” he says. “We still do not have discrimination protection for people who are HIV-positive.

“Also, (these) test sites use the highest quality testing procedures, so that by the time a person gets back a positive test result, the blood has been divided four ways and tested three times by one test and one more time by another.”

Yet another advantage to these test sites is the counseling that is an integral part of the process, Miller says. “All the sites we recommend have both pre-test and post-test counseling. And that’s very important both for understanding the process and for risk reduction.”

Quinn, however, says there are advantages to being tested through your family doctor. “Whenever the subject comes up, that gives me the opportunity to bring up safe sex, even if the test is negative. Even if we find out that AIDS is not much of a risk in this particular patient, we can talk about other matters, such as birth control, for example.”

Some of his patients may blush, but Quinn says he uses questions about AIDS as a springboard to explain the proper use of condoms (“Most guys don’t know how to use them properly--you should always leave a little room at the end, withdraw immediately and hold the condom as you do”) and explain the risk factors. “People may listen to us when they might not be willing to hear it from anybody else,” he says.

In any case, experts say, those who have been at risk for AIDS should never use blood donation as a testing method. Although all donated blood is tested for HIV antibodies, there is always the slight possibility that infected blood could slip through undetected, particularly if a person has been exposed but has not yet developed antibodies.

The Red Cross does notify donors who test positive, but it is legally required to wait 60 days before doing so. The delay is intended to discourage blood donations for the purpose of AIDS testing.

The AIDS Response Program recommends these Orange County test sites:

* Orange County Health Care Agency, Special Diseases Clinic, 1725 W. 17th St., Santa Ana. Monday, Wednesday, Thursday and Friday, 8:30 a.m. to 4 p.m.; Tuesday, 8:30 a.m. to 6:30 p.m. No appointment necessary. (714) 834-8787. Free.

* Laguna Beach Community Clinic, 460 Ocean Ave., Laguna Beach. By appointment. (714) 494-0761. Donation requested.

* Huntington Beach Community Clinic, 17692 Beach Blvd., Suite 200, Huntington Beach. By appointment. (714) 847-HBCC. Free.

* Orange County Center for Health, 503 N. Anaheim Blvd., Anaheim. By appointment. (714) 956-1900. Donation requested.

* Planned Parenthood, 1801 N. Broadway, Santa Ana. (714) 973-1733. Free.

* AIDS Response Program, Gay & Lesbian Community Services Center, 12832 Garden Grove Blvd., Suite A, Garden Grove. (714) 534-0961. Every other Saturday. Donation requested.

For more information, contact the AIDS Response Program at (714) 534-0961.