Hiv Testing Consent (Page 2 of 2) in pdf

You will be tested for HIV antibodies today, unless you tell

us you would prefer not to be tested.

What is HIV?

HIV (Human Immunodeficiency Virus) causes AIDS. When people have sex or share needles with a person who is

infected with HIV, they may be exposed to HIV. Some of these people who have been exposed become infected.

Infected people stay infected for life and can pass HIV on to others. No cure for HIV infection exists at this time.

Many people do not know that they are infected with HIV; they feel and look healthy and may not become sick because

of HIV infection for 10 years or more. At some point, however, they will probably develop AIDS.

What is AIDS?

AIDS stands for Acquired Immune Deficiency Syndrome. When HIV damages the immune system, infected people

cannot fight off illnesses and get rare diseases that most healthy people don’t get. When HIV-infected people get one of

these rare diseases or become very ill, then they have AIDS. Although many treatments are used to treat these rare

diseases, little can be done to repair the immune system, and no cure exists for AIDS.

How Can People Avoid HIV Infection?

The best way to avoid being infected through sex is to not have sex at all. No one can tell just by looking if someone is

infected with HIV. If people have sex, they can help prevent HIV infection by being in a long-term relationship with a

partner who is only having sex with them, and has tested negative for HIV. Another way to help prevent HIV infection

is by using a latex condom each time they have sex.

The best way to avoid being infected because of needle use is not to use needles to inject drugs, vitamins, or steroids at

all. In addition, using alcohol or other drugs may make people more likely to do things that put them at risk of being

infected with HIV. People who use needles can help prevent HIV infection by not sharing needles or other “works”

which may have blood in or on them. If people share needles or “works”, there is no way to take away the risk of HIV

infection.

What is the HIV antibody test?

When a person is infected with HIV, the immune system makes antibodies. Antibodies show that a person has been

infected. If a test does not find HIV antibodies, the result is “negative”. If a test does find HIV antibodies, it is

“positive”. Sometimes a test result is not clear. An unclear result is called “indeterminate” and usually requires further

testing be done.

What do the test results mean?

If an HIV antibody test result is negative, most of the time it means that the person is not infected. However, it may

take the body up to six months to make enough antibodies to show up on the test. People who may have been exposed

in the last six months should be tested again, just to be sure.

If an HIV antibody test result is positive, it means the person is infected and can pass HIV on to others through sex or

sharing needles. Infected mothers can infect their babies before or during birth, or through breastfeeding. A positive

test result does not tell if a person has AIDS or when the person may develop AIDS.

I have read the above information, have had an opportunity to have my questions answered, and have decided that I do

not wish to be tested for HIV at this time. I understand that if at any time I do wish to be tested for HIV, the services

will still be available to me.

Print Name:_______________________________ Signature______________________________________

Reason for Declination:  Don’t want blood drawn

 Don’t want to know HIV status

 Other (please specify):

Witness_____________________________________ Date:________________________________________

CTR Program

Rev 11/07

Hiv Testing Consent Page 2

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