Why should I get tested?

You have never been tested, are starting a new relationship, had sex without a condom, or are pregnant or trying to get pregnant? Getting tested for HIV and other sexually transmitted and blood-borne infections (STBBIs) is the only way to detect an infection and get access to medical care and support if you need it

It is confidential and free! Because these infections don’t always have symptoms/can often go undetected getting tested will give you peace of mind and keep you and your partners healthy.

How often should I get tested?

How often you get tested depends on several factors. The most important thing to remember is that getting tested regularly is the best way to quickly detect an infection.

You should think about getting tested if:

• You have a new sexual partner
• You have multiple sexual partners
• You have had sex without a condom
• You use drugs
• You want to get pregnant

Be proactive. Talk to your doctor. You do not need to wait until he or she brings it up to ask for information about getting tested for HIV and other sexually transmitted and blood-borne infections (STBBIs). It is important to be able to speak openly and unreservedly with your healthcare professional. The more they know, the better they will be able to determine what tests you need, and how often you should get tested.

Where and how to get tested?

There are many places where you can get tested for HIV and other sexually transmitted and blood-borne infections (STBBIs). Every region of Quebec has at least one CLSC offering HIV and STBBI testing. Your local community HIV organization may even offer this service. For more information on the services offered in your area, refer to the Where can I get tested?

Testing is confidential and free for anyone with a RAMQ Health Insurance Card. It only takes a few minutes. Testing involves a blood test and may involve other exams such as giving a urine sample.

You can get tested as of age 14 without parental consent.

How is the test done?

You will generally have to meet with a doctor or nurse. Before taking samples, they will usually ask you a few questions to determine which tests to perform. Some of us may feel shy about revealing the number of sexual partners we have had or the type of sexual activities we engage into. Know that anything said during the appointment with the healthcare professional is confidential. The more precise the information you share with your doctor or nurse, the better they will be able to assess which tests are needed.

Next, the doctor or nurse will take samples: this generally involves a blood test, urine test, and swabs from the vagina, throat, and/or anus, for example

The results of the tests are generally communicated by phone, with the exception of HIV which requires you to return to the clinic for a second visit to hear the results.

There is also the possibility of doing a rapid HIV test. This test is not free, and is typically offered only in specialized clinics. You will get results from this test on the same visit. If you are interested in this option, ask about its availability when you arrive at the clinic.

What if I don’t have a Health Insurance Card?

A Health Insurance Card is generally necessary to get tested for HIV and other sexually transmitted and blood-borne infections (STBBIs).

If you do not have a Health Insurance Card, visit your nearest CLSC. Many CLSCs will see you even without a card. In addition, they can provide you with information on how to get one.

Anonymous testing is a second option, since this does not require you to show your Health Insurance Card or any other piece of identification. This service is offered in at least one CLSC in each administrative region of Quebec. This service is not offered automatically, you will need to ask for it when you make your appointment.

There is also Médecins du Monde Canada which provides services to certain populations, including refugees and the homeless.

I got tested… Now what?

What if the results are negative?

If your results are negative, it does not mean that you are immune, and will never get an STBBI. Your healthcare professional will discuss with you the strategies to keep up or put in place to reduce the risk of a new infection, or of contracting HIV. In addition, they will let you know when you should get tested again.

What if I test positive for an STBBI

Your healthcare professional will provide you with treatment that should eliminate the infection fairly quickly. Most STBBIs can be treated with medication. For treatment to be effective, you must take every dose, even if you have no symptoms. It is recommended to abstain from sex through the duration of treatment.

Some infections, like herpes and the human papilloma virus (HPV) cannot be cured. However, with herpes for example, there are treatments to relieve symptoms, reduce the duration and frequency of flare-ups, and lower the risk of transmission.

What if I test positive for HIV?

Today, HIV treatments are more effective than ever. The life expectancy of a person living with HIV is nearly as long as the life expectancy of an uninfected person. The more rapidly the infection is detected and controlled after a person is infected, the better their chances of living a long, healthy life. Effective treatment can also greatly reduce the risk of transmitting HIV. Knowing your HIV status is a good way of maintaining your health and protecting your partners.

After diagnosis, you will have regular check-ups in order to control the infection and stay healthy.

HIV treatment is covered by both private and public (RAMQ) health insurance.

Should you disclose your HIV status?

Telling someone that you are living with HIV can be stressful. It is impossible to predict how the other person will react. As a result, the vast majority of women living with HIV are selective about whom? They disclose to, and when. For more information about disclosure or non-disclosure of your HIV status, refer to the site Pouvoir partager / pouvoirs partagés (French).

Choosing to disclose your HIV status involves real risks. In spite of scientific advances in the treatment of HIV, social prejudices have not changed very much. Discrimination, rejection, and even the criminalization of people living with HIV are still real challenges. And the fear that people living with HIV experience as a result of these realities is legitimate.

There is no magical, one-size-fits-all answer when it comes to deciding whether to disclose that you are living with HIV. The rule of thumb is to act with integrity, and make decisions that will allow you to protect yourself, and allow your partners to make informed decisions. One thing is certain, the decision to have sex and the responsibilities that come with it, whether you use protection or not, rests equally on both partners. This moral obligation on the part of both partners is widely recognized throughout the HIV community. However, legally, you should know that you could be prosecuted for failing to disclose your HIV-positive status to your partner.

Getting help from a doctor or nurse

Some people do not feel comfortable, for a number of reasons, telling their current and previous partners themselves. If this is the case for you, a healthcare professional can notify your partners for you. They will ask you for information (your partner’s phone number, for example) then will attempt to anonymously make contact and suggest that they see a doctor.

You can also visit the website of the Portail VIH/sida du Québec (in French only), which offers the option of anonymous, confidential and free notification of your partners.

Receiving a disclosure

You might also find yourself in the reverse situation: your partner reveals that he or she has an STBBI. It is normal to feel worried and upset by what the person has told you. However, remind yourself that this information was shared with you because that person was worried about your health and wanted you to be able to be treated quickly if necessary.

Touching, kissing, massaging

Stimulating the erogenous zones by touching, kissing, massaging, enjoying a bath together, etc. are all activities you can practice with no reservations. They involve no risk of HIV transmission.

If you insert your fingers in your partner’s anus or vagina, keep your nails short and filed to avoid cuts. You could also use latex or vinyl gloves and lots of lubricant for this type of activity.

Genital to genital contact presents a negligible, even non-existent risk of HIV infection. In fact, there is very little risk of HIV transmission during sex between women, except during your period or if you engage in activities involving blood. There is, however, the risk of transmitting other STBBIs. If this is a practice you enjoy and do often, make sure you Oral sex

To protect yourself and reduce risk:

• Keep your mouth clean and avoid oral sex if you have cuts, lesions, ulcers, gingivitis (inflammation of the gums), or other infections in your mouth.
• Avoid oral sex on a day when you have been to the dentist.
• Avoid brushing your teeth, using dental floss, or using mouthwash for an hour before and an hour after oral sex. This will minimize the possibility of lesions, irritations, or blood in your mouth.
• Avoid getting semen or vaginal secretions in your mouth.
• When you are being tested for sexually transmitted and blood-borne infections (STBBIs), ask the doctor to take a sample from your throat.
• sing a condom or latex square (dental dam) for oral sex is another way to minimize risk. Flavoured ones exist, as well as those without lubricant.

Vaginal and anal sex

To reduce risk:

• Correctly use a latex, polyurethane, or polyisoprene condom for vaginal and anal penetration.
• Use water- or silicone-based lubricant. Do not hesitate to reapply, as this reduces your risk of lesions. Be careful! Oil-based lubricants are not compatible with latex condoms. This information will be indicated on the package.
• If you are practicing vaginal and anal sex, remember to change condoms when you change orifices to avoid transmitting bacteria from the anus to the vagina.
• Flavoured condoms can be used for penetration. However, some women may be prone to infections as a result. Flavoured condoms are best kept for oral sex.
• Remember that condoms also protect you from unplanned pregnancies.
• When you are being tested for STBBIs, ask your doctor to take a sample from the anus if you practice anal sex.
• For cultural reasons or personal hygiene, some women use vaginal douches or other substances to clean their vaginas before or after sex. These substances can irritate the mucus membrane of the vagina and potentially increase your risk of STBBIs. It is recommended that you wash your vagina daily with water, nothing else.

There are other prevention strategies, including PrEP and PEP (see the Treatment as Prevention section).

Kink

Role-playing games and sadomasochism are not high-risk practices for transmitting HIV and other STBBIs. You can play out your favourite scenarios safely, as long as you stick to the precautions mentioned on this site, depending on which sexual activities are involved.

Hardcore practices that can cause bleeding or lesions on the surface of the skin, as well as practices involving surgical tools, can involve the risk of bacterial infection and, in some circumstances, the risk of transmitting of hepatitis C and HIV. Make sure you are familiar with basic precautions you should be taking, and play out your scenarios with an experienced partner.

Sex toys (Dildo, butt plug, vibrator)

A sex toy has the same potential for transmitting an infection as a penis. If you plan on sharing toys, it is important to put a condom on them. In addition, if you and your partner decide to go from vaginal penetration to anal penetration, you should change condoms.

Toys are often porous, which means that viruses and bacteria can get trapped. After each use, make sure to clean your toys thoroughly. You can use dish soap and hot water, making sure to rinse well. Specialized stores also sell cleaning products specifically designed for different types of toys. Depending on what they’re made of, you can boil them to sterilize them. 

Vaccines

There are currently vaccines for hepatitis B and the human papilloma virus (HPV).

The hepatitis B vaccination program in schools means that many people have now received this vaccine, which is known to be effective for life. If you have not been vaccinated or are not sure if you have been, speak to your doctor.

The HPV vaccine has been offered to young girls and boys in schools for a number of years now, and to women with weakened immune systems or who are living with HIV. Its effectiveness is highest if it’s given before a person’s first sexual relations or before age 26. Speak about it with your doctor.

Post-exposure prophylaxis (PEP)

PEP, for post-exposure prophylaxis, is a treatment available if you have had unprotected vaginal or anal sex with a partner whose HIV status is positive or unknown. Your doctor will evaluate your risk level before prescribing this treatment.

In order for this treatment to work, it needs to be initiated as quickly as possible and no more than 72 hours after the risk occurs. Not all healthcare professionals are familiar with this treatment, particularly those who are not specialized in HIV. In view of this, it is strongly recommended that you visit a clinic specialized in HIV and sexually transmitted and blood-borne infections (STBBIs).

You can make an appointment in a specialized clinic or go to the ER of your nearest hospital. Remember that it is important to be seen as quickly as possible within the first 72 hours after the high risk sexual activity takes place. Do not hesitate to call your local community HIV organization for guidance.

Pre-exposure prophylaxis

You may also have heard of PrEP, or pre-exposure prophylaxis, an HIV treatment used to prevent infection before it happens.

In Québec, PrEP is provided to people who are at high risk of being infected with HIV. For instance, it’s offered to couples in which one person is living with HIV and the other is not. In this context, PrEP can be a way to prevent infection.

To have access to PrEP, you need a prescription from your doctor.

Viral load and non-transmission of HIV

In the last few years, many scientific studies have shown that effective treatment, taken as prescribed for at least six months, prevents the sexual transmission of HIV.

Several measures serve to monitor the development of the HIV infection. One of these measures is viral load, meaning the quantity of HIV in the blood. It’s measured in number of virus copies per millilitre of blood. The risk of transmitting HIV fluctuates with the viral load: the lower the viral load, the lower the risk of transmission.

As soon as a person living with HIV begins to take effective treatment against the virus, the viral load drops considerably. When you take treatment without missing any doses, go for regular medical follow-up, and maintain your viral load at a very low level, HIV will not be transmitted.

HIV non-transmission is a recent development which comes from advances in treatment as well as the conclusions of major international studies. The scientific community has come to a consensus on this along with the HIV prevention field as a whole and public health agencies the world over.

In Québec, the Ministère de la Santé et des Services sociaux affirms that there is no proof of HIV transmission from oral, anal or vaginal sexual relations without a condom when:

• The person living with HIV takes their treatment as prescribed
• The quantity of virus in the blood is measured (viral load measurement) every four to six months
• The quantity of virus is maintained at a very low level, meaning below 200 copies per millilitre of blood. 

For more information on this subject, speak with your doctor.

It is important to remember that, though this is the position of Quebec public health, it does not protect you from the risk of criminal prosecution if you have not told your partner(s) that you are HIV-positive. For more information, see the section of the COCQ-SIDA website (in French only) on criminalization of HIV exposure or the website Pouvoir partager / pouvoirs partagés (French).

Do I still need to use a condom?

If you are in a relationship and meet the above-listed conditions, the choice is yours. However, we suggest that you and your partner meet with a doctor beforehand to discuss your options before making a decision.

Antiretroviral therapy and condom use are both recognized as effective strategies for reducing the transmission of HIV. Condoms also protect you against other STBBIs and unplanned pregnancies.