It is the uncertainty--and the waiting--that can be the most wearing. Earlier that same day, a 25-year-old woman who had just taken the HIV-antibody test for the second time remembered with fearful clarity how she received her test results a year before.
The time she spent waiting for her number to be called "was the worst five minutes of my life," she said. "I didn't have any worries when I came in for the test, but then you start thinking about that time back then that you should have skipped. While I was waiting (at the clinic) I saw a little kid walk by and I thought, 'I'm never going to have kids.' "
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Sometimes, the fear of the consequences of the test can be blunted.
Increasingly common are people who come to be tested in groups: a bridge club, an office pool or a group of friends, said Penny Weismuller, the manager of the disease control division of the Orange County Health Care Agency. Sometimes, the mutual support that arises in these groups helps to dispel some of the uneasiness, she said.
Occasionally, the test is used--or, rather, misused--as a kind of absolution for unsafe sexual behavior. Test counselors are more than familiar with faces who show up for a test, like clockwork, every half a year. They know that the period between infection with HIV and the point at which it can be fairly reliably detected by the test--the accuracy level is about 97%--is six months.
"We do have a lot of repeaters," Harper said. "When they test negative, they assume they're immune. A lot of people have difficulty in modifying their behavior. They breathe a sigh of relief and six months later they're back again."
Taylor said that the repeaters "use the test as a validation that their behavior is safe, until they get caught. We had a gay man recently who tested 20 times, possibly. Then he came in and tested positive."
In counseling, said Burrell, "I just have to repeat and repeat and repeat to them that what they've been doing in the past is not OK. They've been lucky."
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\o7 There is no light banter at the Planned Parenthood facility among counselor and patient. Neither is the talk somber; the counselors are easily spoken and matter-of-fact. The speech is, however, absolutely clinical, plain and direct. No one's attention wanders for even a second. The patients nod often and blink rapidly, a sign that they are listening and thinking, hard. Body language is often tense: tightly crossed legs, tightly clasped hands.
"No one," said Michelle Tibbs, center manager at the facility, "is more stressed out, no one is more wiggy than the patients who come in for HIV tests."\f7
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At the county facility, the visit begins by following a blue line on the floor to a window, where the testers give their first names and ZIP codes to a clerk. They then move on to a small waiting room and wait until their names are called by a counselor.
The brief session that follows is a direct, dispassionate primer on the most baffling killer of our times.
"We do our HIV 101 course for everyone who comes in: what it is, how it's transmitted, what are the risk factors, what they see as problems," said Harper. "And we tailor a risk-reduction plan for each person. If they're one of the 'worried well' we tell them to relax, that if (an unsafe sexual encounter) was seven years ago and they're still asymptomatic, they're probably OK."
When the subject of past and present sexual behavior is broached, Harper said\o7 ,\f7 there is surprisingly little reluctance to reveal the details.
"Most people have worked up to doing this, and for them it can be a real release," she said. "They've been frightened about this AIDS thing, but they don't want to talk to their friends or family members because of the stigma attached to it, and they're scared. You can't shut them up sometimes. Sometimes I hear things that I don't want to hear."
Identification numbers are then assigned and compared, and blood is drawn. Throughout, the person being tested is known only by a first name and a number.
There is more than one reason for the anonymity.
Apart from avoiding possible ridicule or discrimination that might result from full public knowledge of the person's name and test results, an anonymous test also ensures that no medical records are available to insurance companies. Many companies, say health professionals, routinely deny health insurance to applicants who have taken HIV tests--whether the results are positive or negative.
"A record of an HIV test in a person's medical records would mean that person has a pre-existing condition and may disqualify them for medical insurance," said John Duran, a gay rights and AIDS attorney with offices in Anaheim and West Hollywood. "The result isn't as important as the process. The record tells the insurance company that you may have engaged in high-risk behavior. It's a health history issue to hang the disqualification on."
But, said Walter Zelman, the California Insurance Commissioner's special deputy on health issues, that's illegal.
