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Testing

The first effective test for HIV infection was the ELISA test that was developed to test blood in blood banks. This test has been widely used to test high-risk individuals for infection. At the time the test was first marketed, it was thought that alternative test sites were needed to keep people from using blood banks as a way to find out if they were infected. These alternative sites were to be for people who wanted to find out their antibody status easily and confidentially. The only way they were expected to affect the control of the epidemic was to keep high-risk people out of the blood banks. These test sites quickly came to be viewed as an alternative to the traditional disease control program of testing, reporting, and contact tracing. This deprived patients of the safeguards found in properly run public health programs. One the most prevalent problems was the improper use of the ELISA test.

Following up on a positive ELISA is an important problem, both medically and legally. Patients who are incorrectly identified as HIV positive based on an unconfirmed ELISA are needlessly subjected to extreme anxiety. The ELISA is a screening test, not a diagnostic test. It is very sensitive but not very specific. The ELISA, as with all other screening tests, is designed to have very few false-negative results, at the cost of many false-positive results. Every positive ELISA test should be followed by a more specific test, such as the Western blot. The problem has been that the Western blot is expensive and takes more time than the ELISA. In testing programs with limited resources, there has been a tendency to rely on the ELISA test alone if the individual being tested is at high risk. This should never be done. Many factors can cause false-positive ELISA tests. Positive ELISA results should not be reported until they have been confirmed by Western blot or other highly specific tests, such as the pneumocystis carinii pneumonia reaction.


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