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National HIV Testing Day

Ian Kirkland
Features
4 min read
Ian Kirkland

With the discourse surrounding viral infection, immunodeficiency, access to healthcare, and stigmatization coming to a head throughout the COVID-19 pandemic, it seems that our health (as well as that of our communities) has never been more on our minds.

However, infection and immunization have always been a charged topic in queer spaces; both a valuable resource to rally and protect queer communities from harm, and a testament to the history of the politicization and stigmatization queer bodies face.

But, as another year of Pride gets clipped and pasted into the photobook, we still have one extra reminder of our communal strength and capacity for mobilization left: National HIV Testing Day. 

First organized in 1995 by the National Association of People with AIDS (NAPWA), National HIV Testing Day now takes place annually on June 27th as a joint effort between AIDS.GOV and the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention.

While at-home and over-the-counter tests are now freely available across the nation, this was impossible to imagine 40 years ago, and would remain a politicized fantasy for far too long despite scientific backing, risking and sacrificing the lives of hundreds of thousands of US citizens. 

HIV Testing: A Timeline

Early 1980s: First-Generation HIV Testing

  • 1983: HIV first gets isolated and linked with AIDS
    • Diagnostic tests adapted from HTLV III (Abbot and Electronucleonics) and lymphadenopathy virus (LAV) isolates. Possibility of a false negative before 12 weeks post-infection, but the test’s high sensitivity also led to false-positive results due to other variables including infection, autoimmune disease, pregnancy, and unspecified conditions.
  • Second Level Added to the Test to Improve Accuracy and Specificity
    • FDA clears two procedures for HIV-1 antibody detection: Western Blot assay and HTLV III Immunofluorescence assay (IFA); antibody-negative window of 6 weeks post-infection.
    • Reactive specimens undergo repeated screening and duplication tests before a positive result is confirmed, yet positive predictive value of tests remained less than 50% in low-risk populations.

Late 1980s: Second and Third-Generation HIV Testing

  • Specificity of testing improved with the addition of recumbent antigen screenings including HIV-1 p24 and HIV-2 and HIV-1 Group O proteins; antibody-negative window of 4-6 weeks post-infection.
  • IgG/IgM detection reduces the antibody-negative window to 3 weeks post-infection

Late 1990s-2010s: Fourth Generation HIV Testing

  • Antivirus manufacturers develop HIV assays combining antibody and antigen detection, yet these tests fail to specify whether a positive result indicates the presence of HIV-1 p24 antigens or HIV-1/HIV-2 antibodies; the antibody-negative window is reduced to only 2 weeks post-infection
  • 2004: FDA approves Pre-exposure Prophylaxis for HIV prevention (PrEP).
  • 2007: The “Berlin Patient” case sees the first person in the world cured of HIV, meaning the patient has no detectable HIV infection three years after a bone transplant from a genetically HIV-immune donor.
  • August 2010: the Abbot Architect testing method becomes the first fourth-generation testing procedure approved by the FDA.
  • 2011: Bio-Rad’s GS ELISA test follow suit, boasting 100% antigen sensitivity and 99.9-100% antibody specificity.
  • 2014: A new standardized HIV testing algorithm is introduced to match fourth-generation testing capabilities.
  • 2015: Siemen’s ADVIA test gets FDA approval.

2015-Today: Fifth Generation and Rapid HIV Testing

  • 2015: FDA approves Bio-Rad’s BioPlex 2200 HIV screening test analysis method as a diagnostic test, allowing for separate results for HIV antibody and HIV-1 p24 antigen analytes.
  • Rapid and at-home tests hit the market, screening for HIV through whole blood, serum, and/or oral fluid samples.
  • January 2021: FDA approves Cabenuva, the first extended-release injectable HIV treatment administered once a month.

HIV Testing Resources

Bibliography

“Gilead Sciences Statement on Inaccurate Reporting on Truvada®.” Gilead Sciences Statement On Inaccurate Reporting On Truvada®, www.gilead.com/news-and-press/company-statements/gilead–sciences–statement–on–inaccurate–reporting–on–truvada#:~:text=The%20government%20did%20not%20invent,antiretroviral%20agents%20to%20treat%20HIV. Accessed June 5th, 2023. 

“HIV Testing near Me: Where to Get Tested for HIV?” HIV.Gov, www.hiv.gov/hiv-basics/hiv-testing/learn-about-hiv-testing/where-to-get-tested/. Accessed June 5th, 2023. 

TS;, Alexander. “Human Immunodeficiency Virus Diagnostic Testing: 30 Years of Evolution.” Clinical and Vaccine Immunology : CVI, pubmed.ncbi.nlm.nih.gov/26936099/. Accessed June 5th, 2023.