Diagnosing HIV in Men Who Have Sex with Men: An Emergency Department's Experience

Abstract

In the United States, men who have sex with men (MSM) constitute the risk group in which the prevalence of new HIV infection is increasing. The percentage of undiagnosed HIV infection and HIV risk behaviors in MSM and non-MSM participating in an emergency department-based rapid HIV screening program were compared. Medical records of all male patients participating in the program from May 2008 to October 2010 were reviewed. MSM were identified as male or male-to-female patients reporting oral and/or anal sex with a male. Males eligible for testing were aged 18 or older, English-speaking, not known to be HIV infected, and able to decline testing. A total of 6672 males were approached for testing; 5610 (84.1%) accepted, 366 (6.5%) were MSM, and 5244 (93.5%) were non-MSM. A total of 90.7% were black. Median age was 41. Fifty-nine MSM (16.1%) were diagnosed with HIV compared to 81 (1.5%) non-MSM. MSM were 10 times more likely than non-MSM to have undiagnosed HIV infection (odds ratio [OR] 10.4, 95% confidence interval [CI] 7.3, 14.0). HIV-infected MSM (median age, 26) were younger than non-MSM (median age, 41). HIV-infected non-MSM were 2 times more likely than MSM to have CD4 counts less than 200 cells per microliter. MSM were more likely to report previous HIV testing (OR 1.9, 95% CI 1.4, 2.5) and risk behaviors, including sex without a condom (OR 2.0, 95% CI 1.5, 2.6), sex with an HIV-infected partner (OR 14.6, 95% CI 8.3, 25.6) and sex with a known injection drug user (OR 4.1, 95% CI 2.0, 8.4). Further investigation of emergency department-based HIV testing and risk reduction programs targeting MSM is warranted.

Qualitative Assessment of Barriers and Facilitators of Access to HIV Testing Among Men Who Have Sex with Men in China

“…Our findings are consistent with those from studies in other countries where HIV stigma, social discrimination, and perceived low HIV risk create barriers to HIV testing uptake; [35][36][37] and recent high risk behaviors (e.g., condomless anal sex), free and rapid testing techniques encourage testing. 36,38,39 Specific to work conducted to date with MSM in China, 3,29,30,[40][41][42] our findings similarly identify stigma and a poor understanding of HIV and transmission dynamics as a major factors in both testing as well as linkage and retention in HIV-care.…”

Global Health and Emergency Care: Defining Clinical Research Priorities

“…In addition vulnerable patients (i.e., persons with substance abuse, homelessness, mental health problems, and victims of violent crime) are 1.4 to 2 times more likely to seek care in the ED compared to primary care settings . Numerous studies have demonstrated that the ED population has a higher prevalence of human immunodeficiency virus (HIV) infection compared to antenatal clinics and other outpatient settings and thus may be an unique high‐impact venue for HIV testing and treatment interventions . It can be hypothesized that globally further research is necessary to define the role of emergency care services in capturing vulnerable populations that are otherwise missed by healthcare system for public health interventions.…”

Racial and sex disparities in HIV screening outcomes within emergency departments of Harris County, Texas

“…Sex and racial disparities in HIV incidence at the national level impact males more than females. African American males are most impacted by the HIV epidemic 27 . This national HIV burden extends to African Americans locally, because this racial group is over‐represented in those tested for HIV in the ED and even more so among those testing positive for HIV.…”