The Ins and Outs of Gay Sex (19 page)

Home Access Health Corporation manufactures the only “home” HIV test currently available.
The name is somewhat misleading, because the test itself is not performed
in your home, as are typical home pregnancy tests.
Instead, you prick your finger for a sample of blood and mail it back to the laboratory.
There the standard ELISA test is run on your blood, followed by Western blot confirmation for all HIV-positive cases.
The company promises a standard turnaround time of less than one week, but an express service is available in three business days if you can’t wait.
The kit is available in many pharmacies without prescription or directly from the company for approximately $46.
(The express kit costs $10 more.
) You call an 800 phone number for results, and if you are HIV positive, an operator comes on and offers counseling.
Your identity is protected by an eleven-digit number known only to you.
No name or return address is needed on the enclosed mailer.

Home Access Health Corporation promises telephone counseling both before and after testing for anyone who requests it.
The company even maintains a referral network by area code if you need to talk with someone in person.
Many physicians oppose “home” testing because they feel that one-to-one counseling in a personal setting is crucial and not adequately provided by a voice at the end of a toll-free phone number.
If “home” testing is the only way you’ll agree to be tested, go for it.
It is certainly far better than not being tested at all.
Home Access Health Corporation can be reached at 1-800-HIV-TEST.

All these tests require the presence of HIV antibodies for a positive result.
Because antibodies don’t appear for up to two months after infection (occasionally as long as six months), a window period exists wherein you are highly contagious but your test is still negative.
Some physicians advocate viral load measurements that detect the actual HIV virus in your blood as an earlier indication of infection.
This test should be positive within one month of infection and shortens the window in which a false negative
result can occur.
The viral load test has significant clinical implications:
Not only can it give you a true answer sooner, but it might be useful if immediate treatment is planned in an attempt to wipe out HIV before it takes hold.
The downside of viral load testing is that results can take up to a week to obtain and your insurance company may not pay for it.

If you had risky sex and worry about HIV, get tested.
You might already be positive.
If you test negative, repeat the test in one month and again in three months.
By then most men with HIV will have developed antibodies and test positive.
Just to be sure, however, repeat your test in six months.
(Some doctors combine viral load testing with antibody testing.
)

For gay men, HIV testing is not a simple matter—not only because a positive result still feels like a death sentence, but also because of the psychosocial and economic issues it raises.
Most HIV-positive men can look forward to many years of good health during which their positive status should remain private.
Colleagues at work, acquaintances, and anyone else you don’t feel like telling should not be able to find out you’re positive.
How might a bank view you if you applied for a mortgage?
Or a prospective employer looking to hire you away from your present job?
Sure, laws protect you from this type of discrimination, but who knows the real reason behind the bank’s denial or why the job offer suddenly fell apart?
We have enough trouble living as gay men in our homophobic society to have issues muddied by HIV test results.

Many states, including California and Florida, allow anonymous testing.
Your blood is sent to a laboratory with only a number or pseudonym to keep your identity secret.
Unfortunately, fewer states every year are allowing this type of testing.
If your doctor uses a commercial lab (Smith-Klein, Quest, LabCorp, etc.
) to test samples, then the results will not be confidential if your tube of blood is sent with your name on it.
The lab bills your insurance company for the test unless you specify that you want to be billed directly.
Although your insurance company won’t know your result, it will know you were tested.
If anonymity is important to you, check with your doctor, local health department, or gay community center first to find out which options are available.

Some states, including New Jersey, Colorado, and Ohio, do not allow anonymous testing.
A name
must be
submitted with each test.
(
Table 5.
1
presents a list of states that required name reporting in 1998.
Note that the list is only a guide, as laws change constantly.
) I know how your mind works; you’re already thinking about using a pseudonym.
Some states are lax in requiring proof of identity.
If you go to your own doctor, forget the pseudonym.
(We’re not that stupid.
) Choose a clinic instead.
Call ahead and find out if positive identification is required.

Whether your state allows anonymous testing or not, all require health department notification of patients with AIDS.
When your T-cells drop below 200 your name will be added to the list.
Names, however, are supposed to be kept confidential.
The information is also passed on to the Centers for Disease Control, anonymously, for epidemiological purposes.

Many people use the phrases “anonymous testing” and “confidential testing” synonymously.
They are not.
Anonymous testing refers to any HIV test where your identity is unknown, and you use a pseudonym, special number, or some other code to identify your tube of blood and to retrieve your result.
No one will be able to find out your result unless you tell them.
If you submit to confidential HIV testing, your name is used but your results remain confidential.
Most doctors offer confidential testing because they clearly know your identity.
Your HIV status will probably end up in your medical record (it’s relevant), but your doctor would never divulge the result or the fact that you were tested unless you first authorized it.

TABLE 5.
1
STATES REQUIRING NAME REPORTING OF HIV+ PATIENTS (AS OF 1998)

In most states, HIV testing cannot be performed without your prior
written
consent.
But what constitutes consent varies greatly.
In some states, and New York is one, this involves your actual signature on a document specific for HIV testing.
The facility is also required to provide counseling before and after testing.

It is sad that many states do not protect your anonymity or choice by mandating safeguards.
Be aware that some states allow routine HIV testing in situations such as hospital admissions or as part of pre-employment physicals (as in the Job Corps).
You may not even be told you were tested.
Some places that require informed consent prior to HIV
testing bury the actual permission for the test within a general consent for medical treatment you sign as part of any hospital admission.
If it is important to you, always ask before you sign.
Whenever someone sticks you for a sample of blood, ask what tests are being performed.
If the technician is evasive, then ask specifically if an HIV test will be done.

New Jersey allows uninformed testing if a healthcare worker was exposed to your blood through a needle stick or other accident.
(Many states have similar provisions.
) A patient of mine was asleep on the operating table, and while I repaired his hernia the anesthesiologist stuck herself with a needle.
A sample of my patient’s blood was taken for HIV and hepatitis screening, and even I wasn’t told.
You can imagine my shock one week later when the man’s positive test results crossed my desk.
Telling him he was HIV positive when he didn’t even know he had been tested was one of the hardest tasks I’ve ever faced as a physician.

When you apply for most insurance policies, whether life, health, or disability, prepare for routine and sometimes uninformed HIV testing.
(California is the exception.
) Always ask your agent if the policy requires HIV testing.
Since a positive test almost universally carries a denial of insurance, know your status before you apply.
When an insurance company denies coverage, it usually comes in an impersonal form letter and your HIV status may not even be listed.
This is no way to find out you’re positive.

There are certain instances when you cannot refuse HIV testing.
Blood donations are universally screened for HIV, so if you don’t want to be tested, don’t give blood.
The armed services require it, as does the Job Corps.
Most prison inmates are tested.
People applying for citizenship must be HIV tested; if positive, they will be denied citizenship.
Some healthcare workers may face mandatory testing.
Employers can require you to be tested as part of a pre-employment physical as long as testing is required for all
employees.
Individuals cannot be singled out for testing.
If you have HIV, you cannot be denied a job based solely on your HIV status.
(I’m sure they’ll find another reason if they want to.
)

There are other ways people determine your HIV status without seeing definitive test results.
Do not hide your status from any physician or healthcare worker.
This information is an important part of your medical record, but be careful whom you allow to see these records.
If your employer needs a letter before you can return to work after illness, your HIV status does not have to be included.
A simple “the patient was recently hospitalized” or “he was seen today for a routine examination” is more than enough.
And don’t forget that most savvy secretaries can tell that you have HIV just from a list of your medications.
(Who else takes AZT?
) Know who sees your insurance claims before they are sent for payment.

At the bottom of every health insurance form you sign is a statement giving the company access to your medical records should it be deemed necessary.
What constitutes “necessary” is at the sole discretion of your insurance company.
If you are HIV positive, this information will be forwarded as part of your record, but, fortunately, no insurance company can drop your coverage because of this.
If you have HIV, do not expect your physician to hide it from your health plan or other healthcare providers.
But that doesn’t mean that it has to be sent to anyone else who asks for it.
Most doctors use the utmost discretion when divulging patient information.
You cannot forbid your doctor from including any information deemed relevant from your medical records.
Your HIV status is certainly relevant, so just assume it’s in your chart.

I am all for privacy as long as it doesn’t interfere with your HIV treatment or other health problems.
No physician can evaluate you properly for any illness unless he or
she knows you’re HIV positive—and not because the doctor or nurse has to be extra careful when handling your blood.
Healthcare workers take universal precautions with every patient.
HIV exposes you to a myriad of otherwise rare diseases that doctors may not consider unless they know your status.

Some gay men refuse HIV treatment because they don’t want medication bills sent to their insurance companies for reimbursement, and the out-of-pocket costs are prohibitive.
One flight attendant I treated worked a route to London, where he obtained his medications for free.
When the airline stopped flying to London, his treatment stopped too.
He refused to buy medicines in the United States, fearing his international flying would end if the company knew he had HIV.
His logic was quietly suicidal.
By the time I saw him years later his T-cells were so low and his viral load so high that he never recovered.