Q/A: HIV Testing
Updated March 2019 by Aisha Khan, DO, and Christine Kerr, MD
What does the NYSDOH AIDS Institute guideline recommend for HIV screening in the general population? Healthcare providers should offer HIV testing to all individuals aged >13 years as part of routine healthcare.
What does NYS public health law require with regard to HIV testing? New York State public health law requires that all individuals aged >13 years receiving care in a primary care setting, an emergency room, or a hospital are offered an HIV test at least once and mandates that care providers offer an HIV test to any person, regardless of age, if there is evidence of activity that puts an individual at risk of HIV acquisition.
Who should be offered ongoing testing for HIV? Healthcare providers should offer an HIV test at least annually to all individuals whose behavior increases their risk for exposure to HIV (such behavior includes condomless anal sex, sex with multiple or anonymous partners, needle-sharing, or sex with partners who share needles). Since many people choose not to disclose risk behaviors, care providers should consider adopting a low threshold for recommending HIV testing.
Also, any individual who has been diagnosed with a sexually transmitted infection (STI) should be offered HIV testing.
How often should HIV screening be performed in individuals who engage in high-risk behavior? Healthcare providers should screen patients who engage in high-risk behavior every 3 months and should provide or refer these individuals for ongoing medical care, risk-reduction counseling and services, and HIV prevention, such as pre-exposure prophylaxis (PrEP). Access to care and prevention are important to maintain the health of individuals at risk and to prevent transmission by those who acquire HIV.
How often should HIV screening be performed in individuals who would not fall into a high-risk behavior category? According to data from the CDC [Dailey, et al. 2017], 1 in 2 individuals with HIV have had the virus at least 3 years before diagnosis. Many of these individuals did not acknowledge themselves to be at high risk. The U.S. Preventative Health Task Force notes that for individuals not engaged in the high-risk behavior outlined above, but are still at increased risk, a somewhat longer interval (for example, 3 to 5 years) may be adopted [U.S. Preventive Services Task Force 2016]. A change in sexual partner or marital status merits repeat HIV screening. Routine rescreening may not be necessary for individuals who have not been at increased risk since they were found to be HIV-negative. Women screened during a previous pregnancy should be rescreened in subsequent pregnancies.
Is written consent required before an HIV test is ordered? As of May 17, 2017, neither written nor oral consent is needed before ordering an HIV test; however, patients must be informed that an HIV test will be performed and they may opt out.
Recommended HIV Test
What is the best test to use for HIV screening? The optimal test for screening is a 4th-generation HIV 1/2 antigen/antibody (Ag/Ab) immunoassay, which is a laboratory-based test that uses serum or plasma.
Can a rapid point-of-care test be used for HIV screening? Yes, although it will detect antibodies later in the course of HIV infection and may miss early infection in many cases. There are also newer point-of-care tests that detect antigen and, therefore, earlier infection. It is worth clarifying with your facility which rapid test is used.
Which HIV test should be performed in an individual who has been diagnosed with an STI? The optimal HIV test is always a 4th-generation HIV Ag/Ab blood test.
Should a 4th-generation Ag/Ab HIV test be used to screen for HIV in individuals who are taking PrEP? Yes, that is the optimal test. A rapid point-of-care test can be performed at the same time so patients have an immediate answer, but the rapid test should not replace the 4th-generation Ag/Ab test. If exposure is recent (within past 10 days) or patient has signs or symptoms of acute HIV, an HIV RNA test should be ordered.
HIV Testing Follow-Up
What follow-up is recommended if the 4th-generation HIV Ag/Ab test is reactive but the confirmatory HIV-1/2 differentiation assay is indeterminate or negative? An HIV-1 viral load test will differentiate acute HIV infection from a false positive screening result.
What follow-up is recommended if an individual has a reactive point-of-care rapid test (such as OraQuick)? As follow-up, the healthcare provider should:
- Perform a 4th-generation HIV Ag/Ab test and counsel the patient that the result of the rapid test is preliminary pending the result of the confirmatory HIV test and follow-up differentiation assay.
- Discuss the patient’s option of starting antiretroviral therapy (ART) while awaiting confirmatory test results.
- Screen for suicidality and domestic violence and make sure the patient is safe.
- Make sure a return appointment is scheduled so test results can be delivered in person.
What follow-up is recommended when a patient’s 4th-generation HIV Ag/Ab test is reactive? In this scenario, the healthcare provider should:
- Have the patient’s specimens tested for HIV-1 and HIV-2 antibodies. Order HIV 1/ 2 Ag/Ab assay with reflex. Always include “with reflex” so if indicated, additional recommended tests are conducted on the same specimen.
- If the results are negative or indeterminate, then perform an HIV-1 RNA test.
- Interpret the final result based on a combination of test results. The NYSDOH Testing Toolkit provides more information about HIV diagnostic tests and the CDC’s Recommended Laboratory HIV Testing Algorithm for Serum or Plasma Specimens. The NYSDOH AIDS Institute guideline HIV Testing may be consulted as well.
- Discuss ART initiation at the time of a positive result with the first rapid test. Initiation of ART during acute infection may have a number of beneficial clinical outcomes.
- When a diagnosis of acute HIV infection is made, discuss the importance of notifying all recent contacts and refer patients to partner notification services, as mandated by New York State Law. The Department of Health can provide assistance if necessary.
What follow-up is recommended if an individual’s HIV test is negative but they remain at high risk of acquiring HIV? In this scenario, the healthcare provider should discuss and/or recommend PrEP and ensure that the patient has access to PrEP services. The healthcare provider should also provide risk-reduction counseling (e.g., safer sex practices, needle exchange, post-exposure prophylaxis [PEP]) and advise retesting for HIV every 3 months for as long as the individual is at risk.
Detection of HIV
How soon after infection can HIV be detected with existing HIV tests? The length of time depends on which HIV test is used. The “window period” is the time between acquiring HIV infection and the time when a specific diagnostic test can detect HIV. For example, approximately 10 days after infection (window period), a 4th-generation Ag/Ab test will be positive for HIV. It takes approximately 7 days after infection for HIV viral load to be detectable on an HIV RNA test. For an HIV antibody test with reflex to Western blot, there is a window period of up to 3 months.
Can a person who has HIV transmit the virus to another person during the window period? Yes.
Acute HIV Infection
What is acute HIV infection and when should it be considered? Acute HIV infection is the very early initial stage of HIV infection when the virus is multiplying rapidly and the body has not yet developed antibodies to fight it. Clinicians should consider acute HIV infection if a patient presents with a clinical syndrome consistent with acute HIV.
What are the symptoms of acute HIV infection? Symptoms of acute HIV infection are similar to those of influenza and may include fever, fatigue, malaise, joint pains, headache, loss of appetite, rash, night sweats, myalgia, nausea, diarrhea, and pharyngitis.
Which laboratory tests should be ordered for an individual who is suspected to have acute HIV? The healthcare provider should order an HIV-1 RNA test (viral load) and a 4th-generation HIV Ag/Ab HIV test.
- If HIV RNA is not detected, then no further testing is needed.
- Detection of ≥5,000 copies/mL of HIV RNA indicates a preliminary diagnosis of HIV infection.
- Detection of HIV RNA with <5,000 copies/mL requires repeat HIV RNA testing.
- If a diagnosis of HIV infection is made on the basis of HIV RNA testing alone, then the clinician should collect a new specimen 3 weeks after the first and repeat HIV diagnostic testing.
Is a person with acute HIV able to transmit the virus to others? Yes. A person’s HIV viral load rises quickly during the acute phase, which makes the virus highly transmissible.
When treating a pregnant individual who has acute HIV, should the healthcare provider consult with a specialist? If acute HIV infection is suspected in a pregnant individual, the care provider should first order HIV RNA testing and a 4th-generation (recommended) or 3rd-generation (alternative) HIV test. If the HIV RNA test is positive or the HIV test is reactive, then, as soon as possible, the care provider should consult with or refer the patient to a clinician who is experienced in diagnosing and evaluating acute HIV infection.
PrEP and PEP
Should all patients who are tested for HIV be offered PrEP? PrEP should be offered to all individuals whose behavior may expose them to HIV. PrEP should be prescribed as part of a comprehensive prevention strategy that includes risk-reduction counseling about safer sex practices, condom use, and safer injection practices, as well as referral to syringe exchange programs and drug treatment services when appropriate.
What is the recommended response to an individual who reports a possible exposure to HIV? Exposure to HIV is a medical emergency that requires prompt response.
- A person who reports a potential exposure to HIV should be given a first dose of antiretroviral medications for PEP immediately (ideally within 2 hours of the exposure). The effectiveness of PEP diminishes over time, and PEP is not effective if initiated more than 72 hours after a potential exposure.
- Once the first dose of PEP has been administered, then the evaluation of the exposure and recommended testing of the exposed individual and the source (if available) can be performed.
- Refer to the NYSDOH AI guidelines on PEP for more information, including recommendations for PEP regimens and follow-up HIV testing. Guidelines are available for PEP following occupational and non-occupational exposure to HIV and following sexual assault.
Should an individual who has been exposed to HIV be tested more than once? The NYSDOH AI guideline recommends serial HIV testing, with the first test at baseline (at the time the person presents for PEP) and then at 4 and 12 weeks after the exposure.
How to Find an Expert in HIV Care
How do I locate a healthcare provider with experience in treating patients with HIV, for consultation or referral? The NYSDOH Clinical Education Initiative (CEI) provides access to HIV specialists through their toll-free CEI Line: 1-866-637-2342.
How to Learn More
- Related NYSDOH AI Clinical Guidelines:
- NYSDOH: HIV Testing, Reporting and Confidentiality in New York State 2017-18 Update: Fact Sheet and Frequently Asked Questions
- NYSDOH: 2018 Guidelines for use of the HIV Diagnostic Testing Algorithm for Laboratories
Dailey AF, Hoots BE, Hall HI, et al. Vital Signs: Human Immunodeficiency Virus Testing and Diagnosis Delays – United States. MMWR Morb Mortal Wkly Rep 2017;66(47):1300-1306. [PMID: 29190267]
U.S. Preventive Services Task Force. Final Recommendation Statement Human Immunodeficiency Virus (HIV) Infection: Screening. 2016 Dec. https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/human-immunodeficiency-virus-hiv-infection-screening#consider [accessed 2019 Mar 19]
Q/A: HIV Window Period, Testing, PEP, and Acute Infection
Updated December 2018
Can an infected person transmit HIV to others during the window period? Yes. During the window period, and despite a negative test result, an HIV-infected person may transmit the virus to others.
What is the “window period”? The “window period” occurs between the time of HIV infection and the time when diagnostic tests can detect HIV. The length of the window period varies depending on the type of diagnostic test used and the method the test employs to detect the virus.
How long can the window period last? The window period varies slightly from person to person, but virtually everyone infected with HIV develops antibodies within 3 months of infection.
When is follow-up HIV testing warranted? If a person tests negative for antibodies 3 months after a potential exposure to HIV, he or she does not require further testing. However, follow-up testing is warranted for individuals with repeated potential exposures during that 3-month period or when the antibody test results are incompatible with the person’s clinical history.
What are the recommendations for routine HIV testing for adults in New York State? With the dual goals of routinizing HIV testing and ensuring that clinical practice keeps pace with the changing demographics of the epidemic, New York State updated its public health law in 2010 to require that HIV testing be offered to all individuals aged 13 years and older who receive care in hospital or primary care settings. Since then, key provisions were passed in 2010, 2014, 2015, and 2016, and a comprehensive updated version of HIV Testing, Reporting and Confidentiality in New York State regulations was finalized and published in the State Register on May 17, 2017. Among other changes, the requirement for written or oral patient informed consent before ordering an HIV-related test was removed. Accessible and routine testing for individuals over the age of 13 is intended to expand the number of people who know their HIV status and to facilitate entry into the continuum of care or prevention once HIV testing is completed.
Who should be offered ongoing HIV testing? Testing should be offered at least annually to anyone whose behavior increases his or her risk for exposure to HIV. Since many people choose not to disclose their risk behaviors, providers should consider adopting a low threshold for recommending the test.
How often should individuals who engage in high-risk behavior be tested? Clinicians should recommend testing every 3 months for individuals who engage in unprotected anal sex, sex with multiple or anonymous partners, needle-sharing, or sex with partners who share needles. In these high-risk cases, testing is used to ensure early access to care and to prevent transmission to others if the patient becomes infected.
Should pre-exposure prophylaxis (PrEP) be offered to individuals with high-risk behavior? Yes. PrEP to prevent HIV infection should be considered for persons with ongoing high-risk behaviors. PrEP should be prescribed as part of a comprehensive prevention strategy that includes risk-reduction counseling about safer sex practices, condom use, and safer injection practices, as well as referral to syringe exchange programs and drug treatment services when appropriate. The NYSDOH AIDS Institute guidance for PrEP is available online.
|NYSDOH, CDC, and USPSTF recommend HIV testing for all adults as a routine part of healthcare.|
HIV Diagnostic Testing Algorithm
What is the HIV diagnostic testing algorithm? This is a laboratory-based diagnostic algorithm that recommends a combination of laboratory tests performed in a defined sequence. Extensive evidence supports this algorithm for maximal sensitivity, specificity, and accuracy for HIV detection.
What is the initial test of the HIV diagnostic testing algorithm? The algorithm begins with an immunoassay (sometimes called a “4th-generation test”) that detects both HIV-1 and HIV-2 antibodies and HIV-1 p24 antigen. The HIV-1 p24 antigen appears before antibodies develop so that acute HIV infection can sometimes be detected.
What steps are taken when the initial test is reactive? Specimens reactive on the initial assay are tested with a supplemental assay that differentiates HIV-1 and HIV-2 antibodies. Specimens that are reactive on the initial assay but nonreactive or indeterminate on the antibody differentiation assay are then tested for HIV-1 RNA to differentiate acute HIV infection from a false-positive screening result. The final interpretation is based on a combination of test results. The NYSDOH Testing Toolkit provides more information about HIV diagnostic tests and the algorithm. The NYSDOH AIDS Institute’s guidelines on HIV Testing and Lab Monitoring of ART Side Effects and Allergic Reactions should be consulted as well.
|It is important to know which HIV tests are being used by your agency or laboratory so you can provide patients with accurate information regarding their HIV test results.|
Exposure to HIV and Post-Exposure Prophylaxis (PEP)
What are the recommendations for persons who report an exposure? HIV exposure is a medical emergency. If the patient reports a significant exposure, the first dose of PEP should be given. Other testing and evaluation can be continued following the first dose. When PEP is initiated immediately after an exposure (ideally, within 2 hours), it can prevent HIV infection. Please consult the NYSDOH AIDS Institute’s clinical guidelines on PEP for HIV Prevention.
PEP is most likely to prevent infection when initiated within 36 hours of exposure. The decision to start PEP later, beyond 36 hours post-exposure, should be made jointly by the clinician and the exposed individual, with the understanding that PEP is less likely to prevent HIV infection the longer it is delayed.
Can HIV infection be detected immediately after exposure? HIV infection is not immediately detectable.
How often should an exposed individual be tested? NYSDOH protocols recommend testing at baseline and at 4 and 12 weeks post-exposure.
Are the guidelines for PEP different for different types of exposure? The NYSDOH AIDS Institute provides specific guidelines for PEP following occupational exposure, non-occupational exposure, and sexual assault.
Acute HIV Infection
What is acute HIV infection? Acute HIV infection is the very early, initial stage of HIV infection when the virus is multiplying rapidly and the body has not yet developed antibodies to fight it.
What are the symptoms of acute HIV infection? Symptoms of acute HIV infection are similar to flu symptoms and may include fever, fatigue or malaise, joint pain, headache, loss of appetite, rash, night sweats, myalgia, nausea or diarrhea, and pharyngitis.
If acute HIV infection is suspected, what steps should be taken for testing? If a patient presents with signs/symptoms of acute HIV, then HIV RNA testing should be requested in conjunction with an initial 4th-generation (recommended) or 3rd-generation (alternative) screening test. In the absence of serologic evidence of HIV infection:
- If HIV RNA is not detected, no further testing is needed.
- Detection of HIV RNA with ≥5,000 copies/mL indicates a preliminary diagnosis of HIV infection.
- Detection of HIV RNA with <5,000 copies/mL requires repeat HIV RNA testing.
- If a diagnosis of HIV infection is made on the basis of HIV RNA testing alone, a new specimen should be collected 3 weeks later, and HIV diagnostic testing should be repeated.
|When acute infection is suspected, an HIV RNA assay should always be requested in conjunction with an HIV screening test.|
Why is it so important to diagnose HIV infection during the acute phase? In most infected persons, HIV viral load increases quickly after exposure, peaks at about 3 weeks post exposure, and then declines over the next several months. An HIV-infected person is most infectious during this acute phase because of the high viral load. The NYSDOH AIDS Institute Diagnosis and Management of Acute HIV Guideline recommends ART for all patients diagnosed with HIV infection.
Is specialty consultation required for pregnant women with acute HIV infection? Yes. If acute HIV infection is suspected in a pregnant woman, request HIV RNA testing in addition to a 4th-generation (recommended) or 3rd-generation (alternative) screening test. If reactive, consultation with a provider experienced in diagnosing and evaluating acute HIV infection is important. Earlier diagnosis and treatment can reduce the risk of mother-to-child transmission.
How can I locate an experienced HIV care provider? The CEI line, which is available through the NYSDOH Clinical Education Initiative, provides access to providers with experience in acute HIV infection: 866-637-2342.
Provider Guide to HIV Testing (Quick Reference Guide)
Medical Care Criteria Committee, January 2013
Testing Law, Information, and Consent
The requirement to offer testing applies to persons receiving inpatient or emergency department services at hospitals; persons receiving primary care services through hospital outpatient clinics and diagnostic and treatment centers; and persons receiving primary care services from physicians, physician assistants, nurse practitioners and midwives regardless of setting.
Provide the patient with the following key points of information regarding HIV testing:
- HIV is the virus that causes AIDS. It can be spread through unprotected sex (vaginal, anal, or oral sex); contact with HIV-infected blood by sharing needles (piercing, tattooing, drug equipment, including needles); by HIV-infected pregnant women to their infants during pregnancy or delivery, or by breastfeeding.
- There are treatments for HIV/AIDS that can help a person stay healthy.
- People with HIV/AIDS can use safe practices to protect others from becoming infected.
- Testing is voluntary and can be done without giving your name at a public testing center (anonymous testing).
- By law, HIV test results and other related information are kept confidential (private).
- Discrimination based on a person’s HIV status is illegal. People who are discriminated against can get help.
- Consent for HIV-related testing remains in effect until it is withdrawn verbally or in writing. If the consent was given for a specific period of time, the consent applies to that time period only. Persons may withdraw their consent at any time.
- Consider patient’s ability, regardless of age, to comprehend the potential outcomes of HIV testing. If the patient does not have the ability to understand these outcomes, defer testing or discuss with person who has legal authority to consent to HIV testing for the patient.
- If domestic violence (DV) concerns are raised, make referrals as appropriate (see Resources section, below).
- For information about consent in New York State, please see NYSDOH Authorization for Release and Complaint Forms.
Providing Test Results
Providing a Negative (Non-Reactive) Test Result
- A negative HIV test result may be provided in-person, by mail, by email, or by telephone as long as patient confidentiality is protected.
- Explain that a negative result almost always means that the person is not infected with HIV.
- Indicate that there is a possibility of recent infection if the person engaged in risk behaviors in the three months prior to the test and may need to be re-tested.
- Discuss the importance of avoiding future risky behaviors.
Note: If acute HIV is suspected, a negative antibody test would be expected and follow-up with viral load testing may be indicated.
Providing a Positive (Reactive) Test Result
When a patient has a reactive result on the rapid HIV screening, a second, confirmatory test must be conducted by a certified laboratory. If the second test is also positive, it is considered a positive test result that needs to be provided to the patient.
Post-Testing Counseling, Notification, and Domestic Violence Screening
Topics: Post-test counseling should cover the following topics:
- Coping with the consequences of learning the test result
- The potential for discrimination
- Preventing the transmission of HIV to others through risk behaviors and/or perinatally
- HIV reporting is required by law (see information about DOH-4189 Form below)
- The availability of treatment and their right to have a follow-up appointment made for HIV medical care
- How to access prevention and supportive services. Outside of New York City, the New York State Department of Health (NYSDOH) Partner Services staff can also assist in providing post-test counseling.
Partner notification: Discuss the provider’s responsibility to report name(s) of known partner(s)/spouse to NYSDOH.
- Review options for patient to notify his or her partners, and actively link the patient to the Partner Services (PS) program. For more information on PS, see What Health Care Providers Need to Know about Partner Services
Domestic violence screening: Conduct domestic violence (DV) screening for each partner, following these steps:
- Discuss domestic violence (DV) before eliciting partner names.
- Screen for risk of DV for each partner to be notified.
- Provide referral(s) for DV services and discuss release form.
- Make determination(s) regarding HIV Partner Services.
- Discuss and implement Partner Services option(s). For any partner where the provider defers notification based on DV risk, Partner Services staff will contact the provider in 30 to 120 days to discuss DV risk and steps in place to address it.
- Collaborate with the local department for Partner Services.
- Revisit Partner Services and DV risk throughout the continuum of care. For more information on the Required Domestic Violence Screening Process, please see NYSDOH Protocol – Domestic Violence Screening in Relation to HIV Counseling, Testing, Referral & Partner Notification.
|DOMESTIC VIOLENCE SCREENING RESOURCES|
Documentation and follow-up: Complete the Medical Provider HIV/AIDS and Partner/Contact Report Form (DOH-4189) within 14 days. Send one copy (yellow) to NYSDOH; keep one copy (white) for patient’s record if appropriate (call 518-474-4284 to obtain forms).
Provide or schedule a follow-up appointment for HIV medical care. If you do not provide HIV medical care, the patient’s medical record should reflect the name of the provider/facility where the appointment was made.
For ALL patients:
- Document the provision of post-test counseling, including the test results.
- For HIV positive patients, also document results of DV screening and arrangements for partner services.
- Wadsworth Laboratory (518-485-5378): To register as a limited test site to offer rapid HIV testing.
- New York State Department of Health: Lists information for HIV/AIDS programs, services, laws, regulations, training, materials, etc.
- To order Medical Provider HIV/AIDS and Partner/Contact Forms (DOH #4189/4189A), call 518-474-4284.
- NYSDOH Partner Services (1-800-541-2437): Referrals for free, confidential help in notifying exposed partners/spouse, outside of NYC area.
- New York City Department of Health and Mental Hygiene, Contact Notification Assistance Program (CNAP) (212-693-1419)
- NYS HIV/AIDS Hotline (English: 1-800-541-2437; Spanish: 1-800-233-7432): General information and referral to HIV counseling and testing, including anonymous HIV counseling and testing sites, prevention programs and health care and support services for people living with HV/AIDS.
- NYS HIV TDD Information Line (1-800-369-2437): Voice callers can use the New York Relay System: 711 or 1-800-421-1220 and ask the operator to dial 1-800-541 2437.
- ADAP Plus (1-800-542-2437): Free medications and care for uninsured HIV-infected persons.
- NYSDOH HIV Confidentiality Hotline (1-800-962-5065): General information, “Breach of Confidentiality” forms, and referrals for further assistance.
- NYS Division of Human Rights (718-741-8400)
- NYC Commission on Human Rights (212-306-7500)
- NYS Domestic Violence Hotline (English: 1-800-942-6906; Spanish: 1-800-942-6908)
- NYC Domestic Violence Hotline (Safe Horizons) (1-800-621-4673; Hearing Impaired: 1-800-604-5350)
- NY/NJ AIDS Education & Training Center (212-304-5530)
HIV Care Provider Definitions
New York State Department of Health AIDS Institute, April 2017
Experienced HIV care provider: Practitioners who have been accorded HIV-Experienced Provider status by the American Academy of HIV Medicine (AAHIVM) or have met the HIV Medicine Association’s (HIVMA) definition of and experienced provider are eligible for designation as an HIV Experienced Provider in New York State.
Nurse practitioners and licensed midwives who provide clinical care to HIV-Infected individuals in collaboration with a physician may be considered HIV Experienced Providers provided that all other practice agreements are met (8 NYCRR 79-5:1; 10 NYCRR 85.36; 8 NYCRR 139-6900)
Physician assistants who provide clinical care to HIV-infected individuals under the supervision of an HIV Specialist physician may also be considered HIV Experienced Providers (10 NYCRR 94.2)
Expert HIV care provider: A provider with extensive experience in the management of complex patients with HIV.
Online Resources for Education, Information, and Services
AIDSinfo: Training for Health Care Providers
Centers for Disease Control and Prevention (CDC):
E-patients.net: Salzburg Statement on Shared Decision Making
National Center for Transgender Equality: 2015 U.S. Transgender Survey
New York State Department of Health (NYSDOH):
Scientific American: Life Cycle of HIV Animation (2018)
UCSF: HIV InSite
US Occupational Safety and Health Administration:
US Department of Veterans Affairs:
AIDSinfo (DHHS guidelines): https://aidsinfo.nih.gov/
CDC HIV Guideline: HIV Testing: http://www.cdc.gov/hiv/guidelines/
IAS-USA Practice Guidelines: https://www.iasusa.org/guidelines
New York City (NYC) Health: Reporting Diseases and Conditions
U.S. Courts: courtsystem.org
New York City (NYC) Health: STD and HIV Services, including Clinic Locations and Hours
New York eHealth Collaborative: NYEC
New York State (NYS):
U.S. Occupational Safety and Health Administration: