A recent report by the Institute of Medicine calls for increased efforts to identify and characterize persons with new HIV infections as a method of evaluating the effectiveness of prevention efforts. STD clinics are sites where persons with recent HIV infection are particularly likely to be seen. Such persons can be identified using the serologic testing algorithm for recent HIV seroconversion (STARHS), a newly developed testing strategy that distinguishes persons with recent infections from those with long-standing infections.
The authors prospectively offered STARHS to patients who received voluntary HIV testing at the municipal STD clinic from October 1998 through December 1999 to determine HIV incidence and the demographic, HIV risk, and STD diagnostic correlates of recent HIV infections among STD clinic patients. Participants were clients at the only municipal STD clinic in San Francisco that offers free and low-cost medical examinations and treatment for STDs. During the study period, patients who agreed to HIV testing were asked to consent to participate in a study using STARHS. Patients provided verbal informed consent for STARHS testing in the event that the standard HIV test was positive. HIV and STARHS test results were provided during a face-to-face counseling session one week after specimen collection.
A total of 5,391 STD patients were confidentially tested for HIV at the municipal STD clinic from October 1, 1998, through December 31, 1999. Eighty-nine percent of those tested did not report a prior test during the study period and represent distinct individuals. There were 246 patients who had a prior HIV test during the study period, none of whom reported a prior positive HIV test result. The demographic characteristics of the patients who were tested more than one time during the study period did not differ from those of patients who were only tested once.
The authors found that, of the 5,391 patients tested, 116 (2.1 percent) were HIV-infected and 25 percent of the HIV-infected patients, on average, had seroconverted in the previous 129 days. Consistent with other local studies, the majority of new infections occurred in men who have sex with men. The incidence among men overall was 2 percent/year. African-Americans had the highest incidence rate (2.7 percent/year), followed by Latinos (1.7 percent/year) and white participants (1.4 percent/year). No recent infections were found in Asians, Native Americans, or patients of other race/ethnicity.
Incidence was high among MSM patients (5.3 percent/year), patients who had sex with a partner who was HIV infected (8.6 percent/year) or who was an injection drug user (5.7 percent/year), and patients who had in the past 12 months, sex with 10 or more partners (4.3 percent/year) and unprotected anal sex (5.3 percent/year). Incidence was also high among patients with gonorrhea (6.7 percent/year) and non-gonococcal urethritis (3.4 percent/year). This highlights the need to expand services for diagnoses and treatment of STDs among MSM.
This study provides useful information on persons with recently acquired HIV infection and illustrates the feasibility of tracking the leading edge of the HIV epidemic through the use of STARHS. This study also underlines the importance of developing new methods of HIV prevention for MSM, especially those of color. HIV prevention efforts must be modified to address the current issues that place MSM at risk for HIV infection, including a decrease in concern about acquisition of HIV infection among MSM due to the availability of highly effective antiretroviral treatment. HIV prevention efforts must include messages that are relevant for MSM of color as well as white MSM.
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This article was provided by CDC National Prevention Information Network.
It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.