HIV is the Human Immunodeficiency Virus. HIV is the virus that causes AIDS. AIDS is the Acquired Immunodeficiency Syndrome.
Being infected with HIV is often called “living with HIV” or being “HIV-positive”.
In the past, HIV testing was only accessible through a healthcare provider or a designated testing site. Recently, some people have been able to get HIV self-testing kits that allow them to test on their own or with the help of others such as community organizations. For more information about self-testing, see here.
Other than self testing, here are two main ways in Ontario to get tested for HIV infection: nominal testing (using your name) and anonymous testing anonymous (not using your name). And note that if someone tests positive for HIV using a self-testing kit, they will have to get a confirmatory nominal or test before they can get medical care for HIV. The key difference between getting a nominal or anonymous test is that the person’s name will automatically be reported to their local Public Health Unit if they test positive nominally.
For information about the differences between nominal and anonymous HIV testing, as well as details about what gets reported to Public Health authorities when people test positive for HIV, see here: https://www.cleo.on.ca/en/publications/hivtest. The guide also provides information about reducing the possibility of a person’s name being reported to Public Health authorities after testing positive anonymously and accessing HIV-related medical care. In addition, the guide includes some information about HIV self-testing kits.
For more information about Public Health Law in Ontario, please see our Public Health Law page: www.halco.org/areas-of-law/health/public-health-law .
For more information about the reporting of HIV to Public Health, please see below.
Informed consent for testing
In Ontario, there are two ways to get tested for HIV: nominal testing and anonymous testing. You must give “informed consent” before being tested, whether the test is done nominally or anonymously. Informed consent means that you:
- understand the procedures and the consequences of being tested, including Public Health reporting requirements;
- receive pre-test and post-test counselling to prepare for the test and test result; and,
- give your permission to be tested.
If someone tests you for HIV without your informed consent, you may want to get legal advice.
Nominal testing means you are tested using your own name.
If your nominal test is positive for HIV, the testing laboratory will report your HIV infection, your name, date of birth, gender, and contact information to Public Health. Your local Public Health unit (www.health.gov.on.ca/en/common/system/services/phu/locations.aspx) will contact you for counselling and support, and to refer you to HIV-related services, including treatment.
In Ontario, Public Health requires that your sexual and needle-sharing partners be notified that they may have been exposed to HIV. This is known as contact tracing, partner counselling, or partner notification. Depending on the circumstances, Public Health may let you or your doctor notify your partners, and may require proof that your partners were notified. Or, Public Health may do the partner notification directly. Public Health should not disclose your name to your partners, but your partners might figure out that it is about you.
Anonymous testing means you are tested without having to give your name or personal information.
In Ontario, only an anonymous testing clinic can test you without your name. See below for more information about anonymous testing clinics.
If your anonymous test is positive for HIV, the testing laboratory will tell Public Health about the positive test result but will not share your name or contact information. If you received counselling about preventing the transmission of HIV before you had the test, the doctors and registered nurses at anonymous testing clinics are not required to report your name and contact information to Public Health.
If your anonymous HIV test is positive, keep your positive anonymous HIV test code from the anonymous testing clinic. The anonymous testing clinic will refer you for medical treatment. The doctor or registered nurse who will treat you is not required to test you again for HIV, but some doctors and nurses may still require you to take a nominal HIV test to confirm your anonymous positive test. If you have a nominal HIV-positive test, the testing laboratory will tell Public Health, and will give your name and information. See Nominal testing above to find out what happens when you are reported to Public Health.
If you would prefer not to have your name and information reported to Public Health by the testing laboratory, you can ask the treating doctor or nurse to do an anonymous viral load test. The viral load test measures the amount of HIV in your blood and is used to make decisions about your treatment. Your doctor can only do an anonymous viral load test if you have your positive anonymous HIV test code. If your viral load test is done anonymously, the laboratory and your doctor are not required to report your name and contact information to Public Health.
We do not know yet what could happen if you refuse to consent to have a nominal test. It is possible that your doctor or nurse might have a duty to report your name and contact information to Public Health.
If you test HIV positive at an anonymous testing clinic, we encourage you to keep your positive anonymous HIV test code. If you have questions about Public Health reporting requirements, we encourage you to contact us for free legal advice as soon as possible after you receive the positive anonymous HIV test result (ideally before you seek medical treatment).
Public Health might still find out about your HIV
Although the above noted change in reporting requirement has taken place, some others are still required to report HIV to Public Health, including: hospital administrators; and, those in charge of institutions such as prisons, child care centres, long-term care homes, psychiatric facilities and private hospitals.
Also, we are not sure what may happen in some First Nations communities because the federal government (Health Canada) may handle HIV testing and reporting instead of Ontario (Public Health).
Reporting of AIDS is different than it is for HIV. Most health care professionals, including doctors and nurses, are required to report AIDS to Public Health.
There is still so much that is not known. Even if a doctor or nurse does not require you to have a nominal test and orders an anonymous viral load test using your positive anonymous HIV test code, we cannot say with certainty that Public Health will not learn your HIV status and your personal information.
Remember, only an anonymous testing clinic can test you without your name.
How can you get an anonymous HIV test?
Anonymous HIV tests are free in Ontario. You do not need an Ontario Health Insurance Plan (OHIP) card or number to get an anonymous HIV test. To find an anonymous testing clinic in Ontario, you can contact the free, confidential Ontario AIDS & Sexual Health Infoline (you do not have to give your name or information):
- English and a number of other languages: 416-392-2437 or toll-free in Ontario 1-800-668-2437
- French: toll-free in Ontario 1-800-267-7432
- website: https://www.toronto.ca/community-people/health-wellness-care/sexual-health-infoline-ontario/ .
What happens when you go for an anonymous HIV test?
At the anonymous testing clinic, you will be asked for your year of birth and the town or city where you live. If you do not want to give this information, you can just give the year you were born. A counsellor will talk with you about your risk of HIV infection and help you make an informed decision about getting tested (see Informed Consent for Testing above).
Most anonymous testing clinics use the “rapid HIV test”, also known as the “point of care” test (POC test). The rapid test requires a drop of blood from a finger prick, and the test result is available in a few minutes.
If your rapid test is negative, it means HIV is not showing in your blood at the time of the test. It can take up to 3 months for HIV to show in your blood, so a counsellor will talk to you about whether you should have a follow-up test at a later date. The counsellor will also talk to you about protecting yourself from future risks.
If your rapid test is “reactive”, it means you are probably infected with HIV. A second test is needed to confirm that you have HIV.
The counsellor will talk with you about having this second test. The second test is still anonymous but you will be given an anonymous identification (ID) test code. A sample of your blood is taken and sent to the testing laboratory. It takes about 2 weeks for the anonymous testing clinic to get your test result. A counsellor will meet with you again to talk about the result. If this test confirms that you are HIV-positive, then the counsellor will talk with you about things like:
- managing your health and HIV, including medical care
- preventing the spread of HIV
- getting support and more information.
Health care and privacy
Health care professionals, including doctors and registered nurses, owe their patients a duty of confidentiality, there are situations where health care professionals are permitted to release a patient’s health care information without the patient’s consent. This webpage does not address privacy law issues. For privacy-related information, please see the Privacy Law page of our website: www.halco.org/areas-of-law/privacy-law. For privacy law advice, please contact us.
Getting legal help
If you are living with HIV in Ontario, please contact us for free legal advice about HIV testing, privacy and other legal issues.
Other sources of information about HIV testing
The Ontario Ministry of Health and Long-Term Care, and Ontario Public Health websites include information about HIV:
The Public Health Agency of Canada (PHAC) HIV Screening and Testing Guide is available in English and French on the government of Canada website:
- French: www.phac-aspc.gc.ca/aids-sida/guide/hivstg-vihgdd-fra.php