Rapid HIV Testing

Of the estimated 1 million persons living with HIV infection in the United States, approximately 25% do not know their HIV status. In 2003, the CDC initiative Advancing HIV Prevention: New Strategies for a Changing Epidemic called for implementation of new models for diagnosing HIV infections.

As part of an initiative to reduce racial/ethnic disparities in HIV infection, the U.S. Conference of Mayors, through a cooperative agreement with CDC, provided funding to CBOs and health departments to conduct behavioral assessments at gay pride events attended primarily by men who have sex with other men from racial/ethnic minority groups. CDC provided on-site technical assistance to the CBO and health department staff, including developing assessment questionnaires, training interviewers, and coordinating HIV testing and questionnaire administration. During 2004--2006, CBOs and health departments were funded to conduct assessments and HIV testing at 1) black gay pride events in Detroit, Michigan (2004 and 2005), Baltimore, Maryland (2004), Jackson, Mississippi (2005), Charlotte, North Carolina (2006), St. Louis, Missouri (2006), and the District of Columbia (2005); 2) Hispanic gay pride events in Oakland (2004) and San Francisco, California (2005); and 3) gay pride events in Oakland, California (2004), and Chicago, Illinois (2006). Their report indicated that rapid HIV testing was successful.

Rapid HIV testing can increase the number of persons who are willing to be tested and the proportion of persons tested who receive their results. The findings in this report suggest that rapid HIV testing of MSM in racial/ethnic minority groups at gay pride events is a useful way to enable HIV-infected persons to learn their HIV status.

Overall, of the persons who reported that they were HIV negative or who did not know their HIV status during the assessment and who were tested at gay pride events, 6% had positive HIV test results. This result is comparable to the 7% of minority MSM with a positive HIV test result in 2004 at CDC-supported testing sites, which included hospitals, public health and STD clinics, prisons and jails, drug treatment centers, and outreach settings. Four of the eight men who were newly identified as infected with HIV had received negative HIV test results during the preceding year. Men who mistakenly believe that they are HIV negative, even those who have this belief based on a recent negative HIV test, represent an important risk group for HIV transmission. For example, 47 (7%) of the 723 MSM in the Young Men's Survey who had received negative HIV test results during the preceding year and disclosed that they were HIV negative to their sex partners were unaware that they were HIV positive. Knowledge of being infected with HIV has been associated with reduction of high-risk behaviors.

CBOs and health departments face several challenges when conducting rapid HIV testing at gay pride events. The effectiveness of testing depends, in part, on the amount of resources that CBOs and health departments can dedicate to such events. The demand for rapid HIV testing at several of the events described in this report exceeded the capacity of CBO and health department staff to provide testing. Persons who could not be tested during the event were referred for testing at a later date. Effectiveness also depends on proper follow up of persons with newly diagnosed HIV. Two of the eight MSM with newly diagnosed and confirmed HIV infection were not referred to medical care because they could not be located after the event. HIV testing at gay pride events is only one part of a greater strategy to encourage HIV testing among MSM.

HIV testing provided by CBOs and health departments outside of the health-care setting, such as at gay pride events, is an important strategy to reach MSM who might not regularly access health care. Among persons for whom health-care--seeking behavior information was available, 74% had visited a health-care provider during the preceding year; however, only 41% had been offered HIV testing by a provider during the preceding year. To decrease the number of missed opportunities for HIV testing, in 2006, CDC recommended that HIV testing for patients aged 13--64 years become a routine part of medical services using a voluntary, opt-out approach. CDC further recommended that persons likely to be at high risk for HIV infection, including sexually active MSM, be tested at least annually.

Future analyses of outreach activities such as the ones described in this report can be used to understand barriers to HIV testing among MSM and help determine the cost-effectiveness of such activities for health departments and CBOs. Expansion of HIV testing opportunities for racial/ethnic minorities outside of health-care settings, combined with culturally appropriate behavioral interventions, are important components of ongoing CDC activities to reduce HIV transmission and eliminate disparities in the rates of HIV infection by race and ethnicity.