Union government agencies—primarily the National AIDS Control Programme, or Naco, through the State AIDS Control Programmes, or Sacos—encourage voluntary, rather than mandatory, testing for HIV and voluntary disclosure of HIV status.
The first step is to register at an integrated counselling and testing centre (ICTC). Once you’ve done this, you undergo pre-test counselling. This is to determine the period when you may have exposed yourself to the virus and to prepare you for the possible result.
Then comes the actual test. There are mainly two kinds of tests: ELISA (enzyme-linked immunosorbent assay) and the Rapid HIV test. The latter gives results quicker and is preferred by many hospitals and pathological labs. If you test positive, you should get a second test to confirm the result. Depending on the hospital or lab, this second test may be an ELISA, Western blot (considered the gold standard internationally, but not widely available in India), or indirect fluorescent antibody test.
(Note: The conventional tests do not work for newborns, since they may not have the infection, but may have the antibodies if their mother is HIV-positive.)
Depending on the conclusions your counsellor draws after pre-test counselling, you may be advised to get a second test even if the result is negative the first time. If the results of your first two tests are different (one positive, one negative, whatever the order), a third test should be done.
Once a positive status is confirmed, the ICTC puts you in touch with an antiretroviral therapy (ART) centre. Here you are first tested to determine how far the virus has progressed (this can be assessed through tests such as CD4). ART centres are the only places authorized by the government to treat free of cost if you meet certain guidelines; these are available on the Naco website ( www.nacoonline.org/NACO ). Only those who have been tested positive by a government clinic or government-authorized clinic are eligible for free treatment.
Throughout therapy, ARTs make it mandatory for you to seek counselling, either from a private counsellor or the centre’s counsellor, to support you through emotional issues and the behavioural changes you will need to make.
Get tested by the government
The World Health Organization (WHO) and Naco both recommend up to three rounds of tests, over several months, to confirm HIV infection. Besides accounting for possible errors, this is because the antigen used in the first ELISA test can also respond to other infections such as malaria, tuberculosis or even flu, resulting in a false positive; also, antibodies can take about three months to form in sufficient numbers, so an early test can give a false negative.
There are two strains of HIV: HIV-1, the more virulent, and the cause of the majority of infections globally, and HIV-2.
Whether positive or negative, an incorrect result can be devastating for the patient. Some private hospitals, however, do just one test and pronounce a verdict. This is why activists and doctors advise going to Naco- or Saco-supported ICTCs, which do adhere to the triple-testing guidelines.
Getting treated right by the government
Naco guidelines for antiretroviral treatment, both first-line and second-line therapy, are fairly stringent. First-line therapy is initiated immediately if the CD4 count of the person getting tested is lower than 200—also called T-cells, these specialized cells protect the body against infection. The second-line therapy is started only when the first-line therapy has proven ineffective.
It is important to know that non-adherence to first-line treatment can leave you ineligible for second-line treatment drugs. Not all ART centres undertake the first series of mandatory tests that decide whether you are eligible for antiretroviral drugs. Also, the first stage of treatment (six months) is offered at the ART where the eligibility tests are done, though the patient may be referred to a more convenient location for subsequent treatment. ARTs also may not fund prescribed medication for opportunistic infections (OIs), which are a huge health threat for the HIV-positive (since the immune system is depressed, even simple infections can cause complications).
Citywise Helplines, Support Groups Testing centres, NGOs and specialists
Also See | More AIDS resource database (PDF)
AIDS = Acquired immuno deficiency syndrome; ART = Antiretroviral therapy; DIC = Drop-in centre; ELISA = Enzyme-linked immunosorbent assay ; HIV = Human immunodeficiency virus; ICTC = Integrated counselling and treatment centre ; MSM = Men who have sex with men; NACO = National AIDS Control Programme; OI = Opportunistic infections; PLHA, PLWHA = People living with HIV/AIDS; PPTCT = Prevention of parent-to-child transmission; SACO = State AIDS Control Programme; STI = Sexually transmitted infections; VCT = Voluntary counselling and testing; CBO = Community-based organization; NGO = Non-governmental organization
—Blessy Augustine, Pavitra Jayaraman, Karuna Amarnath, Varuni Khosla, Manidipa Mandal, Anupama Chandrashekhar, Shruti Chakraborty
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