HIV Testing

HIV Testing

You may already know that standard HIV testing detects HIV antibodies (your body’s response to HIV), rather than the virus itself. We used to have to wait up to 3 months for antibodies to be at detectable levels to show up on an HIV test, testing in Ontario has improved and the guidelines have changed to reflect a new window period of 6 weeks as well as additional access points to testing in priority communities to try to ensure that people know their HIV status sooner.

• Antibodies: your body’s immune response to HIV, what shows up on an HIV test (rather than the virus itself).
• Antigens: the p24 antigen is a specific part of HIV itself that some tests use to determine if HIV is present.
• Window Period: the period of time from when a person is infected with HIV to the time when an HIV test can detect the infection.

Many people will develop antibodies or have a detectable level of antigens with current testing technology within 3 weeks of exposure to HIV. [1] Your tester will ask you to return after 6 weeks, and possibly again after 3 months to get tested, depending on the type of test being used.  They may use antibody testing which can take up 3 months to reach a high degree of accuracy;  or a  testing technology that uses both P24 antigen testing along with antibody testing to help detect infections with an equally high degree of accuracy as early as 6 weeks. [2]  (Note: a tester might also ask you to get tested right away to set up a baseline test.)

Note: Taking PEP (post exposure prophylaxis) will affect these testing timelines. PEP is a medical intervention involving HIV medications taken within 72-hours after a possible exposure to HIV in order to reduce chances of infection.)

Types Of HIV Test

The two main kinds of HIV tests available in Canada are the standard HIV test and the rapid HIV test.

Rapid HIV Test (Point Of Care Test, Self-Test)

With a rapid test, you get an initial result within a few minutes of doing the test. Rapid tests are screening tests involving a few drops of blood from your finger. This means that if the test shows a positive (“reactive”) result, you will need to get a confirmatory test to confirm the result. The Rapid HIV tests have 99.6% accuracy 3-months after exposure to HIV; your healthcare provider may ask you to get tested 3-weeks and 6-weeks after exposure using Rapid HIV tests as significant amounts of people develop antibodies at these time periods. [3] You might be able to get a rapid test from a healthcare provider or community worker, but this option isn’t available in every part of Canada. In regions where rapid tests are available, they are often provided at certain specialty clinics, such as sexual health clinics, or through HIV organizations. However, anyone in Canada can get a rapid self-test, which you can perform on yourself at home. Self-tests can be ordered online from the manufacture at low cost and may be available for free from community organizations or for purchase in some pharmacies. For more information on how to access free HIV self-testing, see the section below.

Standard HIV Test

Many people use what is known as a standard HIV test. A vial of blood is taken from a vein in your arm and sent to a laboratory for analysis. These tests will have 99% accuracy 6-weeks after exposure. [4] It can take up to two-weeks to get your result. Talk to the person who does your test about how you will get your test result. There are many places to get a standard HIV test, including family doctors’ offices, walk-in clinics, and sexual health clinics.

Anonymous Testing For HIV

This type of Rapid HIV testing does not involve a health card and doesn’t appear on any public record linked to you. In Ontario it is only offered for HIV and can only be done at designated site in Ontario. To find an Anonymous Rapid HIV test provider near you, contact:

Sexual Health Infoline Ontario (SHILO)

Toll-free: 1-800-668-2437
Local: 416-392-2437

Monday to Friday: 10 a.m. to 10:30 p.m.
Saturday & Sunday: 11 a.m. to 3 p.m.
Statutory holidays: Closed

Find out more about HIV testing strategies at CATIE and at the Ontario HIV Treatment Network.

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HIV Testing Locations In Toronto

(This is not a complete list of testing sites.)

Central Toronto

West End Toronto

North End Toronto

East End Toronto

Note: Scarborough does not have anonymous HIV testing services.

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HIV Self-Testing

HIV Self-Testing Kits are Rapid HIV tests, meaning that the results will appear within a few minutes. These HIV Self-Tests are available for anonymous delivery right to your doorstep, or for pickup at ACT’s office.

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When To Test

You should test for HIV if:

• you are not on PrEP, do not know the HIV status and viral load of your sexual partner(s), have had anal or vaginal/front hole sex with your partner and have not used  a condom (or the condom broke or used only partially during sex); or
• you have shared a syringe with your partner and do not know their HIV status.

Note:

-If you do know your partner’s HIV status and they have a viral load  above 200 copies/ml – you should consider testing if you have been in the above-described situations.

-If you are within 72 hours of the potential exposure of HIV as described above, you should consider PEP (post-exposure prophylaxis) to reduce the risk of seroconverting (becoming HIV positive).

You should also test for HIV if:

• your sexual or substance-using partner(s) have recently tested positive for HIV;
• you have recently tested positive for other STIs or blood borne infections your medical provider has seen in association with HIV (eg. syphilis, chlamydia, gonnorhea);
• you have been sexually active / or shared syringes in the past and have acute HIV infection symptoms; (Over 70% of people with a recent HIV infection experience fever, joint and muscle pain, swelling lymph nodes, sore throats and rash. Night sweats, nausea, diarrhea, and headaches can also be experienced.); or
• you get a call from public health asking you to get tested.

Note: Starting and maintaining PrEP or PEP (medications taken to prevent HIV infection) will also require different HIV testing timelines.

Routine Testing Makes Sense

If you are queer, routine testing makes sense. If you are queer and a member of another community that has also been affected by HIV disproportionately in Canada, testing becomes even more important.  These other communities include: African, Caribbean and Black communities, Indigenous peoples, and people who use drugs. (Cis and trans women whose sexual or substance sharing partners belong to the above communities are also at increased risk – so routine testing makes sense for them too.)

This can range from getting tested once a year (even for men in monogamous relationships with other men) to getting tested every three-months or after every high-risk exposure for guys who experience a lot of condomless sex with partners whose HIV status is unknown or are living with HIV and have a viral load count above 200 copies/ml of blood.  (PrEP should be considered as an option for people in this situation.)

It can also be a good idea to get an HIV test anytime a sexually transmitted infection happens, and when starting a new sexual relationship.

Travelling is often not seen as time to test for HIV, but if you have sex while travelling, even if its in your country of origin, you should consider getting tested upon your return to Canada. (Starting PrEP maybe a good thing to consider before travelling.) 

If you are a newcomer to Canada and came here on a work or student visa, testing may not have been part of your entry experience, so getting an HIV test would be important if you have been here less than 5 years.

Having HIV For A While And Not Knowing It

HIV testing is important to consider when a queer guy is experiencing unexplained infections repeatedly.

This can look like unexplained weight loss, shingles before age 55, repeated yeast infection or thrush outbreaks in mouth or throat (a white crust, aka: candidiasis), vaginal/front hole yeast infection, repeated skin lesions, a decrease in white blood cells, pneumonia or infections affecting the heart (endocarditis), tuberculosis or any other infection a medical professional would associate with immune systems not working properly.

Receiving Health Care Can Involve Testing For HIV

HIV testing should happen in case of:

• pregnancy,
• immune-suppressing therapies,
• HIV associated cancers,
• high dose steroid and other treatments for rheumatoid arthritis,
• taking PrEP or PEP, and
• anxiety over being HIV positive, even without evidence of a high-risk exposure. [5]

Other STI Testing

It makes sense that if you are testing for HIV, then you should test for other STIs or blood borne infections such a as syphilis, rectal bacterial STIs such as chlamydia or gonorrhea, Hep C and B. [6]

What You Should Expect When You Test For HIV In Ontario

When you choose to test, you should be informed about the process and counselling should be offered in a non-judgemental way that looks at your needs. You should walk away from the experience knowing what future options are open to you as referrals.

This can look like assessing your risk for HIV and preparing you for a possible positive (“reactive”) test result. If the counsellor can see that you know a lot about HIV, they can be shorter in their time with you, but they should tailor the discussion to your experience with HIV testing. (Some examples: You may not be comfortable talking about sex explicitly. You may have a lot of questions. You may need more support.)

Many queer guys have had negative experiences with the health care system, especially when they encountered judgemental attitudes about sex, substances, sexual orientation, gender expression, gender identity, race or ethnicity. HIV testing services are mandated to be nonjudgmental, culturally responsive, anti-racist and safe care spaces. [7]

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[1] Ontario Guidelines for Providers Offering HIV Testing. 2023. P.10.

[2] Ontario Guidelines for Providers Offering HIV Testing. 2023. P.10.

[3] Ontario Guidelines for Providers Offering HIV Testing. 2023. P.10.

[4] Ontario Guidelines for Providers Offering HIV Testing. 2023. P.10.

[5] Ontario Guidelines for Providers Offering HIV Testing. 2023. P.18.

[6] Ontario Guidelines for Providers Offering HIV Testing. 2023. P.13.

[7] Ontario Guidelines for Providers Offering HIV Testing. 2023. P.21.