HIV tests do not indicate whether "seropositive" individuals (those who test positive for HIV) have AIDS, a later stage in HIV disease. Also, infected individuals may not test positive for HIV for a period of weeks after infection. Thus there is a distinction between "HIV-infected," "seropositive," and "AIDS." When applied to newborns, standard HIV tests react to maternal antibodies, which are present in all children of HIV-infected mothers, up to 18 months after birth, whether the child is HIV-infected or not. Newborns who test positive for HIV antibodies are said to be ''HIV-affected."

Serum HIV tests first became available in the United States in 1985 and were originally used to protect the safety of the blood supply by excluding blood from HIV-positive donors (IOM, 1995c). At the time, there was great concern about the safety of the blood supply, so the improved ability to accurately detect infected individuals (especially compared to the surrogate measures that were the best tools before this time) made serum HIV tests attractive public health measures. Tests also became available at this time for individuals, but stigma and discrimination associated with homosexuality, drug use, and AIDS itself, coupled with the fact that there were no measures available to alter the disease process in HIV-infected individuals, limited their acceptability. Some assumed that the primary purpose of testing was to facilitate the adoption of risk reduction behaviors. Over time, however, it became clear that knowledge of HIV status was insufficient to stimulate behavior change in all affected persons, and that many other factors contribute to decisions about risk reduction behaviors (Coates et al., 1988).

It was not until the discovery of effective interventions such as ZDV and Pneumocystis carinii pneumonia (PCP) prophylaxis in the late 1980s that HIV testing carried medical benefits for the individuals tested. Soon afterwards, some professionals advocated moving beyond testing solely as a means to stop the spread of HIV. Rhame and Maki (1989), for instance, reported that HIV testing had benefits for infected persons and the general public health. As an example, they noted that early detection of HIV status was one means to counteract denial, facilitate early treatment, and ultimately improve the health status of people infected with HIV. More generally, Rhame and Maki (1989) note that more general HIV testing would

  1. reduce the reluctance of those at risk to pursue testing;
  2. undermine the existence of the we/they mentality and stigma associated with HIV disease;
  3. motivate risk reduction behaviors;
  4. serve as the basis for partner notification programs; and
  5. facilitate the identification of candidates for clinical research.
  6. In a review of the factors associated with the acceptability of voluntary HIV testing in the United States, Irwin and colleagues (1996) concluded that the factors associated with high acceptance rates include (1) the person's perception



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