Email 503: OFW, Oral HIV Test and Disclosure

Posted by Pozziepinoy on 8:38 AM

Hi Pozzie,

I would like to get advise from you regarding on what I am facing now. I have possible risk last June 22, 2013. I got sick after 2 weeks. I felt that I have fever but my temperature is not showing that I have fever. I have sore throat too. July 9, 2013 I went for HIV test and it turns out to be negative but the doctor said that this test is to clear you for your pass encounter but not the latest encounter and ask me to go back on September 22, 2013 for retest. I so worried that I cannot even concentrate on work and don't have enough sleep. I have sore throat for 5 days and counting so I decided to go for HIV test to confirm. The doctor said that he ask me to go back after 2 weeks because the Oral Test shows very faint line that you need to use magnifying glass. He said that if your positive it will show a solid line but mine is not. He said that I need another test after 2 weeks but he put on the data non-reactive with notes need to do test after 2 weeks. I don't know what to do.

1. How can I tell to my boss that I am planning to resign (I am working abroad and HIV here is not accepted)? What is the best reasoning without disclosing my status if I am a positive.

2. How accurate is the Oral Test?

3. I am a Christian and I don't know how to disclose my status with my parent and brothers?

Please help me. I am so scared.

Thank you.


Hi C.

Thank you for your email. Thank you for finding the blog and sharing your experience with me and my readers. Also, I hope that the blog entries here will give you wisdom and strength.

Now let me answer you questions.

1. If you plan to resign because a non citizen HIV positive worker is not allowed in the country where you are working for right now, you can tell your boss that you are resigning for "personal reasons". Usually it is the most acceptable way for one to tell his employer. 

2. With regards to the accuracy of the Oral Test, I researched about it and this s what I found from the CDC website:

OraQuick Rapid HIV Test for Oral Fluid

What is the significance of the Food and Drug Administration’s (FDA) approval of the OraQuick rapid HIV test for oral fluid on March 26, 2004?
The FDA has approved the OraQuick Advance HIV1/2 Antibody Test for use with oral fluid and for use on plasma specimens. Until now, the test, manufactured by OraSure Technologies, Inc., was approved only for whole blood specimens. This is the only rapid HIV test to be approved in the US by the FDA for use with oral fluid.
What is the difference between the OraQuick Advance Rapid HIV 1/2 Antibody Test for oral fluid and the OraQuick Rapid HIV-1 Antibody Test for blood approved by the Food and Drug Administration in November 2002?
The FDA approved the new version of the test for the detection of HIV-2 antibodies and for use with additional types of specimens. Until now, the OraQuick rapid HIV antibody test required a whole blood specimen, either from a fingerstick or a tube of blood. The OraQuick Advance test can now be used with oral fluid specimens taken from the mouth, with plasma, and with whole blood. Additionally, the new version of the test can be performed in a wider range of operating temperatures (59°F to 99°F).
Is the OraQuick test a saliva test?
No. The test uses oral fluid, which is slightly different from saliva. To perform the test, the person being tested for HIV gently swabs the device completely around the outer gums, both upper and lower, one time around and inserts it into a vial containing a developer solution. After 20 minutes, the test device will indicate if HIV antibodies are present in the solution by displaying two reddish-purple lines in a small window in the device.
What does a reactive or preliminary positive result mean?
A reactive HIV test result on oral fluid is a preliminary positive and needs to be confirmed by an additional, more specific test to verify whether HIV antibodies are present.
How well does the test work?
In the clinical studies by the manufacturer, the OraQuick oral fluid test correctly identified 99.3% of people who were infected with HIV (sensitivity) and 99.8 % of people who were not infected with HIV (specificity). The Food and Drug Administration expects clinical laboratories to obtain similar results.
Who can perform the OraQuick oral fluid rapid HIV test?
The OraQuick rapid HIV test for use with blood was waived under the Clinical Laboratory Improvements Amendments of 1988 (CLIA) in January 2003, and waived for use with oral fluid in June 2004. A waived test can be used in any facility with a CLIA certificate, rather than only in traditional laboratories. As such, a waived test can be used in many non-clinical settings.
Will the test for oral fluid be sold over the counter?
No, the OraQuick test, either for oral fluid or blood specimens, is restricted for use by trained persons. However, if waived, the oral fluid test could be performed by trained persons in the home setting as a part of partner notification or HIV prevention outreach activities.
What type of training is needed to conduct the oral fluid test?
Training requirements are similar to those for the OraQuick rapid test for blood use, which include obtaining a certificate of waiver from the CLIA program and following the manufacturer’s instructions for the test procedure. In addition to the training for using OraQuick with blood specimens, personnel require training on the proper collection of the oral fluid specimens. For all waived rapid HIV testing, programs must obtain a certificate of waiver from the CLIA program, follow manufacturer’s instructions for the test procedure, and maintain an adequate quality assurance program.
What are the advantages of testing oral fluid rather than blood?
The test’s approval for oral fluids will provide a safe, accurate, and rapid HIV test for persons who don’t like to have blood drawn or their finger stuck with a lancet. In addition, healthcare workers face a much lower risk of exposure to infectious diseases from oral fluid than from blood. Contact with saliva has never been proven to result in HIV transmission.
Are there disadvantages to testing oral fluid rather than blood?
As when used on blood, the OraQuick test device can quickly and reliably detect antibodies to HIV in oral fluid. It can be stored at room temperature, requires no specialized equipment, and takes the same amount of time to process (20 to 40 minutes). However, it has slightly lower sensitivity and specificity than when used with blood. In particular, testing programs can expect more false positive results with oral fluid than with blood. As with the blood test, an additional specimen must be collected for confirmatory testing of persons who test preliminarily positive.
Can the new oral fluid test detect antibodies to both HIV-1 and HIV-2 (a variant of HIV that is prevalent in parts of Africa but rarely found in the United States)?
The OraQuick test is approved to detect antibodies to HIV-1 and HIV–2 when used with blood, oral fluid, and plasma.
Has the test been approved to screen blood donors?
No. The OraQuick test should not be used to screen blood donors.

3. I know that most times you think of religion as a hindrance to disclosure, however, disclosure is a process that will entail your level of acceptance of the virus itself and your readiness to disclose. Christian or not, you are what you are and if you are ready, then just tell your family and/or your friends. It is really better to tell your loved ones about your health so you can look straight in their eyes without pretensions and inhibitions, and for an incurable disease such as HIV, you need all the love and support that you can get.

I hope I was able to answer your concerns. Feel free to email me again if you have other questions.

Stay healthy,

NO PLHIV is alone with his or her struggle with HIV!"


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