My first HIV test
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June 27 is National HIV Testing Day. As an ID provider specializing in sexual health care, HIVMA Board member Joseph Cherabie, MD, MSc, shares their own experience with testing and reflects on how this year’s testing day theme — “Level up your self-love: Check your status” — captures what sexual health providers aim to accomplish with their patients.
I remember my first HIV test vividly and the anxiety and shame that accompanied it. Despite being knowledgeable about HIV and sexually transmitted infection testing, the stigma I had preached against still affected me deeply. It was almost 15 years ago: My partner and I at the time decided that before we did anything beyond oral sex, we should get tested for STIs. We said we would go together as a support mechanism, but that did little to ease my anxieties.
I recall heading to the clinic, being called back to get my blood drawn and having every sexual encounter I had had up to that point flash before my eyes, along with thoughts like: “I really should have been more careful … I’ve slept with too many people … I really shouldn’t have done that with the person whose name I can’t remember now …”
Recognizing shame and stigma
There is a word for what I was feeling — shame. Worse than that, I was inflicting stigma on myself. I had bundled up all those years of sex ed classes that told me STIs are dangerous, all the movies about gay men dying from HIV and society saying people who have sex “too much” get diseases, and worse than that, “they get what they deserve.”
Now, at that time, I was a sexual health peer educator and advocate, and I knew more about HIV and STI testing than the average college student. In fact, I promoted going and getting tested probably more than anyone I knew. But when it came to me, it was shocking how that same stigma I preached against insidiously ate away at my psyche.
It was almost comical, looking back now, how much was going on in my head and how little the person drawing my blood cared about me having an HIV test. Now, this was a regular lab. This wasn’t an HIV testing site that would go through counseling and check in on sexual partners. Thus, I was left to my own devices and anxieties and was told that my results would be available in a week. During that week, I tried to calm myself, but the thoughts kept popping up, “What if I was positive?”
Worries, a weight lifted and living with testing
Yes, we lived in the era of great treatment. Yes, this was a treatable condition. Yes, this was something I could definitely live with. But how would I hide it from my parents? What if I had it, and my partner didn’t? Would they leave me? How would future partners react? One week passed, and, low and behold, we received an envelope that said my test was nonreactive for HIV. A weight had been lifted, anxieties fled, and I could go about my life … until my next test, when all my slut-shaming guilt would flood back, sometimes from me, sometimes from the nurse or doctor who was seeing me.
Over time, I hardened to the guilt. The nervousness became routine. HIV PrEP came out, and I got tested so often that I didn’t have time to get nervous. Undetectable = Untransmittable became the norm, and I knew more and more people, not only living with HIV but thriving with HIV, and the fear dissipated. But I am not everyone, and when we as health care providers say “There is nothing to fear,” that isn’t necessarily the case.
Stigma against HIV is very real, just ask anyone living with it. HIV criminalization laws are still on the books in 34 states, meaning if you have HIV, you can still be arrested or have an enhanced sentence for transmitting HIV if you did not disclose your status. Sexual health is under attack, and youth know less and less about sex before their sexual debut due to lack of comprehensive sexual health education.
Embracing sexual health and helping our patients
On National HIV Testing Day, let us embrace the era of sexual health that prioritizes self-love. This year’s theme encompasses all that we as sexual health providers try and do with our patients every time they visit. I thank them for coming in and for taking control of their sexual health and invite them back whenever they need, especially if they have new partners, to get tested at least every 6 to 12 months. I ask if there is anything else we can do to help them in their sex lives, and I squash any mention of self-inflicted sexual stigma. No one in my clinic is allowed to say “I know it’s bad but …” or “I’m never having sex again” or “I’ll be better.”
Coming in and getting tested is great! It is, in itself, an act of self-love and sexual health goal setting. These people took time out of their busy days to come and get tested. They asked questions and sought help when they felt they needed it, despite years of possibly having the same experiences as I had. The least we can do is thank them for coming in and create a welcoming atmosphere.
Stigma and sex shaming don’t work with respect to lowering the rates of HIV and STI acquisition and haven’t worked for years. So why not try something new, like sex positivity, patient-centered care and encouragement of sexual health goal setting? We are entering a more positive era of sexual health, one of self-love, and I, for one, am here for it!
For more information on HIV and STI testing, including where to find testing locations, visit CDC’s website.
