Screening

Our junior doctor Dr.SP was very much in favor of the clinic buying some HIV, HCV, HBV and syphilis screening tests. 'Madam', he told me, 'The number of people I know who don't get screening done because it is not private in the government hospitals, or who don't believe their test results because they feel their samples got mixed up with other people's....!'

Okay then.

I ordered the tests and as the scientist at hand, offered to perform the tests. They are fairly easy.
I told Dr.SP, Bring your friends over and we'll do these tests right in front of them. Privacy, reliability assured! It's a piece of cake!

A few days later, a tall young man, boy really, walks in. I am alone at the clinic, but for the nurse. He looks around and whispers, Dr.SP sent me. I'm here for the HIV screening test.

I quickly assume my counselor avatar (thank you, lactation counseling!). I talk to him about his life, about what he does, about why he wants to take the screening test. We discuss his sexual experience, his knowledge of safe sex and his practices of safe sex. Then I tell him how the test will be done, how long it will take and what the possible results might mean.  I also speak about future steps after the test. If it is a positive, then what. If it is negative, then what.

Then we discuss whether he wants to sit in the room and watch me perform the test or go to the reception area and wait. He decides he wants to watch the test being performed.

I open the kit and we go over the steps of the test together.

I ask the nurse to draw blood, I spin the blood to get the plasma (why, oh why, are screening tests with whole blood so difficult to come by?),  and we begin. I add the plasma drop to the little window,  wait for the plasma to get absorbed, then I add two drops of diluent and we watch the liquid disappear into the window and the line of the liquid climb slowly through the narrow strip.

The boy starts to shake. His legs are drumming a tattoo on the floor, his fingers are trembling, he hasn't exhaled since we added the diluent. He stares at the test kit without blinking. I watch him watch the strip. When I look down, the liquid has climbed through the entire strip and a light pink line is seen where the plastic rim says HIV-1 and a clear blue line is seen where the rim says "control".

He looks up at me, hope and devastation in his eyes. Hope that I will say something that negates the test, devastation because he knows what the test results mean.

I grip his hand and I say, As you can see, the blue control line is present. This means that the test has worked. The light pink line says that HIV-1 antibodies are present. However, we will need to do a confirmatory test to make sure.

His mouth twists. He starts to weep. Courage, courage, I whisper gently. We will only know for certain once the confirmatory test comes back.

We begin the 4th generation confirmatory ELISA test for HIV. This time the boy does not look at me or the test strip. He stares at the table, his knees knocking against each, his fingers tapping the table. I perform the steps. I look up and say, I am sorry.You are HIV+

He breaks down. I hold his hand while he sobs. After a few minutes, I whisper It's okay. It's okay. You'll be fine. We spoke about this, remember? It's not the end of the world. There are medicines that can control it. You'll be fine.

Just then, Dr. SP walks in. I brief him on what has gone on. Then I turn to the boy and tell him, Dr. SP will talk to you now.

In the reception, I sit. I realize my hands are covered in a thin sheen of sweat and I feel like I haven't taken a breath in a long time. I inhale and exhale slowly.

Not a piece of cake at all.