About HIV testing and Viral Load. Why should I go for an HIV test?

It is recommended that you determine your HIV status if you have, experienced the following:

Bottom line is: If you think you might have been at risk of contracting this infection, it is better to do a HIV-antibody test, to determine your status. If you do have HIV infection, it is much better to find out in an earlier stage of the infection, when your immune system is still strong, and you’re not ill yet. That way your chances of keeping your immune system strong and staying healthy for a long time are more likely. You would need to do regular check-ups with your doctor, and at a certain time your doctor could recommend that you to take medicines to slow down the virus and keep it under control.

If you find out about your HIV infection once you are already ill, it is still very likely to become healthy again and regain strength in your immune system, once you receive treatment for your opportunistic infection and start on so called antiretroviral treatment. These are the medicines that can control the virus from multiplying, and can give your (even weakened) immune system a chance to recuperate.

It's better to know your HIV status, and control the infection, instead of HIV controlling you.
On St. Maarten, all medicines necessary for proper treatment of HIV infection are available, and covered by most (but not all) insurance plans. If you have doubts about the coverage of your insurance plan, read the policy details. No one who ever became infected with HIV ever thought that they would get this disease.

It is better to think ahead, and make sure your insurance covers this infection, even when there is only the slightest chance of you ever getting HIV. The chance is hardly ever zero. (Your partner could sleep around; the condom could burst, etc.)

Some advantages of knowing your HIV status are:
If you know you are HIV positive, you can take advantage of immune system monitoring, early treatment and intervention, as well as self help activities such as good nutrition and hygiene. By taking the test, you can find out whether or not you can infect others.

Testing often increases your commitment to overall good health habits. If you test negative, you may feel less anxious after knowing your HIV status, and be more committed to keep it that way.

A person that has HIV infection has a responsibility towards his/her sexual partner(s) not to infect them.

At the same time it is unhealthy for the person living with this infection to become re-infected again. Not only will the disease become bad faster, re-infection puts you at risk of becoming infected with a so called resistant virus, which does not respond to treatment. This would decrease your chances for effective treatment.

Therefore using a condom correctly and consistently is extremely important for everyone who has HIV infection and has sex. It protects your partner, but also yourself.

Women and their partners considering pregnancy can take advantage of treatments that can help prevent transmission of HIV to the baby.

There are also some disadvantages of knowing:
If you test positive, you may show an increase in anxiety and depression. However, with proper information, support from friends and family and access to services you can learn how to live with the infection.

Make sure you do your test via your doctor or at a confidential testing site. Only you can disclose your infection to others. No one should do this for you.

Disclosure may have consequences for your job. But over the past few years there has been an increase in awareness among employers about HIV infection and the workplace.

If you ever run into problems with your employer due to issues concerning HIV infection, you can contact the St. Maarten AIDS Foundation. Counselors have intervened and assisted in such situations and where successful in these interventions by educating the employers about this infection. The workers were always able to keep their jobs if they wanted to.

If you have HIV infection, knowing about your status can pose questions about disclosure when taking out certain insurances. Sometimes there are other ways to find coverage but sometimes, insurance companies will deny your coverage.

The St. Maarten AIDS Foundation, the HIV/AIDS Platform, and Government are striving to improve laws to better protect persons living with HIV/AIDS. Any obstacles you may encounter are worth mentioning to the foundation, because they may help identify and eventually change these regulations.

The decision to take an HIV test is an extremely personal one. No one can make this decision for you. No one should insist that you do a test.

What does the test for HIV check for?
These tests use a small blood-sample to determine if you have been infected with HIV. Certain tests on the market use saliva or urine to do the test, but a blood test could also confirm the presence of the virus.

The tests look for antibodies to HIV, not for HIV itself. Antibodies are present in blood, and other body fluids like saliva and urine, but the latter two do not contain the virus (in transmittable quantities) and have never shown to transmit the virus to others. Only blood, semen, vaginal fluids, and breast milk can transmit the virus from one person to the other.

Labs use two tests to look for these antibodies:

1) The ELISA (Enzyme Linked Immunosorbent Assay) test is done first as a general screening test. If the ELISA test is positive, a second test is done to confirm the results. This is the so-called Western Blood test, (but there are other tests available for this purpose of confirmation).

2) When both tests are positive, it means that the antibody to HIV is present. This also means you have HIV infection.

There is only one exception to this rule, and that is when babies are born to HIV infected mothers, they always have some antibodies against HIV in their blood. In such cases the baby should have, a special test done that determines if it also has the infection.

This test looks directly at the presence of the virus, but is much more expensive and not suitable for regular screening and testing. After 18 months, the antibodies of the mother will have disappeared from the blood of the baby, if the baby did not become infected. Without treatment, there is about a 30% chance that babies can contract the virus from HIV infected mothers, but with preventative medicines, the risk can be reduced to about 2%.

If the test comes back negative, this means you do not have HIV infection or you are in the so-called Window Phase (3 weeks to 6 months) in which a test will not be able to detect the antibodies for HIV. It therefore makes sense to repeat the test in 6 months and use condoms to protect you from infection in the meantime.

What is the Viral Load?
Viral load refers to the amount of HIV present in the blood. It is measured in number of viral copies per milliliter of blood.

Viral load is a very important measure used to monitor HIV patients on antiretroviral treatment. A high viral load can indicate a greater risk for the progression to HIV disease. The risk of transmission of HIV from a woman to her fetus also increases if the viral load is higher.

What is the CD4-count, or the T4, or T-helper count?
This test helps determine how strong your immune system is. It literally counts the CD4 cells. Those are the white blood cells (immune cells) most affected by HIV. The lower your count, the weaker your immune system and the more chance of disease (AIDS).

Guidelines when to start treatment for HIV infection (at which level of CD4 or Viral Load) have changed over the years. This has to do with the experience scientists and doctors have gained with the treatment for this infection. On one hand, we do not want to treat too soon, because this might cause long-term side effects of the medicines or resistance to the treatment. On the other hand, one does not want to wait too long, because this increases the change of disease.

The CD4 count is also used to monitor the immune system while taking treatment. When the virus comes well under control, one would expect an increase of the count (improvement of the immune strength).

Both Viral Load and CD4 test are part of the normal monitoring of any person with HIV infection, either on, or not on treatment. They help to decide when to start, or when to change treatment strategies.

How well the person is doing physically, mentally, and how well other blood tests that monitor liver, kidney, sugar, blood-levels, and other body functions are doing, are off course also important in the treatment of a person living with HIV/AIDS.

Will I know whether I was infected with HIV if I was tested right after I was, or believe I was exposed to HIV?
Infection with HIV causes flu like symptoms. The only definite way to determine if you are infected with HIV is by taking the HIV antibody test. The HIV antibody test looks for antibodies to the virus in a person's blood. For most people these antibodies take 3 weeks to 6 months to develop to such height that they can be detected with the test.

Sometimes a doctor will decide to do a Viral Load test if he/she thinks the patient has recently been infected. When the Viral Load indicates the presence of HIV, but the antibody test is still negative, this means most likely the patient became infected very recently.

Some doctors would recommend immediate treatment because this might slow down the infection in the earliest stage. There is off course the risk of long-term side effects and cost of treatment to consider in such situations.

Where can I go to be tested and counseled?
On St. Maarten, you can be tested through any of the doctors practicing on the island. Some doctors give good counseling on HIV, others might feel less confident to give counseling.

The St. Maarten AIDS Foundation has counselors available. You can contact us via this website, or call:

Mrs. Suzette Moses-Burton at Tel: 5422059 or Dr. Gerard van Osch at Tel: 5445374

The doctor will give you a request form, and send you to one of the laboratories on the island.

You can choose to do the test through the Dutch side Analytisch Diagnostisch Centrum (“the lab”) in the Medical Center in Cay Hill, or you can go to one of the three laboratories on the French side of the island.

Your doctor card will usually only be valid on the Dutch side, but some prefer to pay for their test.

All laboratories require a request form from a doctor. The St. Maarten AIDS Foundation recommends doing the test through one of these four laboratories.

All doctors and all these laboratories work according to strict and legal confidentiality laws. On the French side, there is the “Centre d’epistage”, the confidential test facility, next to the fire station on the road to the old hospital (opposite the Catholic Church) in Marigot. Testing and counseling are free of charge.
Tel: 00590 590 870117

What should I do after I have taken my HIV blood test and am waiting for the results?
While waiting for the results of your blood test it is important not to expose yourself to possible infection. Use a condom every time you have sex during this period and beyond.

Alternatively, until you and your partner have both done the HIV antibody test, and if necessary repeated it after 6 months, showed each other the results, and trust each other’s fidelity not to sleep around without the use of condoms. Such faithful and mutually HIV negative relationships are safe, as long as no one steps out of that relationship.

If in doubt, it is always advisable to use a condom, or abstain. It is your health, your life, and nobody but you can protect it.

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