[From 2009. The new generation of HIV tests in 2018, which have a "window" of merely a month, are great but don't draw the wrong conclusion; they mean a responsible sexual ethics is possible if you want it - I'm HIV negative and I guess I know why, and
you can too.]

Now for a medical observation. I have felt for some time that the US is not effectively able to cultivate a “culture of health” because it is too beholden to medical professionals, who are beholden to corporate and other interests. The quality of
information previously available from medical journalists and interested “laymen” was definitely of variable quality, but in the absence of a proper government health care plan (and of course that means an NHS-style public agency) figuring out what
you should do with your health should definitely include thoughts from one’s peers and your own personal observations.

I have taken an interest in the science of HIV disease for a long time, being initially very frightened of it (as most people probably still are), and then at quite a bit of risk for it, and I have an observation to make about the ELISA test (the first-
line diagnostic tool for confirming HIV infection). There are newer “rapid” tests today that require less labwork, but I gather they have some of the same problems as ELISA and suspect they have other problems, so I will restrict my comments to ELISA
(which is still what most people get).

Compared to tests for diagnosing other STDs, the ELISA test is very good: the standard syphilis test only catches 70% of infections, whereas ELISA eventually detects nearly 100% of HIV antibodies in the bloodstream — and the “window period” after
which those antibodies show up when tested has been shrinking for years, thanks to improvements in the test. The test has a slight problem with “false positives”, but the rate is much lower than that of the oral HIV test, and other diagnostic tools
like Western Blot and PCR can be used to establish whether HIV is truly present.

All this is widely known — or should be — but here is my observation. The ELISA test is imperfect, and our knowledge of HIV disease is imperfect. But since it is the best diagnostic available for HIV at this time, “worried well” people who do not
accept the results of an ELISA test at the time which is “determinative” relative to their risk factors (it’s rather obvious who should determine that, and a determination may be made based on information you provide that you were at no credible
risk for transmission and need no test) are medically irrational. Of course it could be wrong, and of course our knowledge of what is happening with HIV could be incomplete. Those are realities of medicine and biology.

However, people who continue to obsess about the possibility of disease after a determinative negative test are failing to understand what medicine can do for them, and their personal responsibilities to others. Whoever you are, you are not so important
that science needs to change for you, and it’s pretty dubious that it really can; whoever you are, you are not so important that finite medical resources should be lavishly allocated to fix a problem that the best medical science suggests is not actual,
or is possibly actual but beyond us.

Once the healers are done with you, you need to heal yourself and think about who you are and what you owe others in life; get it together and fulfill your obligations to family, friends, country, and humankind. On the other hand, though, people who duck
ELISA tests or accept nondeterminative negative tests — or, I guess, good diagnostic results after HIV infection has been confirmed — as “good enough” are medically unrational: they care too much about what other people think — including
maintaining other people in the illusion that it would be okay to have risky sex with them. Those people have an obligation to themselves to not have their behavior refract on the aforementioned groups.

That’s how I see it, anyway.

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