HIV partner services are associated with timely linkage to HIV medical care.

The Centers for Disease Control and Prevention (CDC) recommends that persons diagnosed with HIV receive partner services with health department involvement. CDC describes partner services as not only including partner notification, but also linkage to medical care for HIV-infected persons. The New York City Health Department formed a unit in 2006 to expedite partner services. We examined the contribution of our HIV partner services program in improving timely linkage and retention in HIV medical care.

Identifying the correlates of membership in HIV-serodiscordant partnerships in New York City.

BACKGROUND: Identification and characterization of patients in HIV-serodiscordant partnerships can inform strategies to improve HIV prevention efforts for this group. METHODS: We conducted a case-control analysis using New York City Department of Health and Mental Hygiene HIV surveillance and partner services (PS) data from July 2006 to July 2010. HIV-infected index patients reported and interviewed for PS who named 1 or more sex and/or syringe-sharing partner (n = 1309) and their sex partners notified by New York City Department of Health and Mental Hygiene with confirmed HIV serostatus (n = 1564) were selected for analysis. Index patients were classified into either serodiscordant or seroconcordant-positive partnerships based on the HIV serostatus of their partner(s). Multivariable regression analysis was conducted to examine the likelihood of membership in a serodiscordant partnership by a range of individual- and partnership-level variables. RESULTS: Of the 1309 index patients, 624 (48%) were in HIV-serodiscordant partnerships. In multivariable analysis, the likelihood of serodiscordant partnership membership was slightly higher among women, individuals with unknown HIV transmission risk, and those with 2 to 3 named partners versus 1. Index patients claimed more partners than they named; for example, index patients who named 1 partner claimed an average of 2.3 partners in the past 12 months. CONCLUSIONS: Many HIV-infected patients who received PS were in HIV-serodiscordant partnerships, with characteristics indicating potential for HIV transmission. Our findings suggest several potential programmatic and policy needs, including enhanced linkage-to-care efforts for this population, especially HIV-infected individuals with uncontrolled viremia; ongoing PS for individuals with evidence of continuing exposure of others; and participation by patients and their serodiscordant, steady partners in local prevention interventions.

Do sexual risk behaviors differ between heterosexual youth infected with HIV perinatally versus sexually?

PURPOSE: To determine if sexually active heterosexual HIV-infected 15- to 24-year-old youth have different sexual or other risk behaviors depending on whether they were infected perinatally or heterosexually. METHODS: We compared youth aged 15 to 24 years who acquired HIV perinatally or sexually and were interviewed in-person or by phone for partner services by the New York City Department of Health and Mental Hygiene. We included heterosexually active youth with at least one sexual partner of the opposite sex in the past 12 months, and excluded men who have sex with men and injection drug users. We used χ(2) tests and t tests to compare demographics, sexual risk behaviors, partner services outcomes, and viral loads. RESULTS: Both groups reported few partners (median 1, mean 2), and only 12% of partners of perinatally infected youth were previously diagnosed (18% of sexually infected youths' partners). A minority reported always using condoms. Both groups had similar rates of sexually transmitted infections and median HIV plasma RNA (perinatally infected: 5,140 copies/mL; sexually infected: 6,835 copies/mL). Despite these similarities, among tested partners not previously HIV diagnosed, none of 17 named by perinatally infected youth was newly HIV diagnosed, whereas 21% (8/39, p = .09) of those named by sexually infected youth were newly diagnosed. CONCLUSIONS: Though perinatally infected youth did not transmit HIV infection to previously undiagnosed partners, they had similar HIV-related risk behaviors to youth infected sexually who reported on risks that led to their infection. HIV prevention among HIV-infected youth remains a critical challenge.

Differences in risk behaviors and partnership patterns between younger and older men who have sex with men in New York City.

BACKGROUND: Men who have sex with men (MSM) account for a higher proportion of HIV diagnoses than any other risk group in the United States. Given that in NYC MSM younger than 30 years represent a growing proportion of new diagnoses among MSM, we examined differences between MSM by age. METHODS: We analyzed NYC surveillance and partner services (PS) data for MSM newly diagnosed with HIV from January 2007 to December 2008. We compared demographics, HIV-related risk behaviors, and sexual partner characteristics between younger MSM (<30 years old) (YMSM) and MSM ≥30 years old. RESULTS: Three hundred and thirty-six MSM were interviewed for PS (180 YMSM and 156 older MSM). MSM were mostly black or Hispanic (91%). YMSM were more likely than older MSM to report gay sexual identity (70% vs. 58%, P < 0.01), and a recent sexually transmitted infection (29% vs. 15%, P < 0.01). More YMSM named ≥1 male partner for HIV notification (66% vs. 36%, P < 0.01). YMSM were more likely than older MSM to name partners who were 5 or more years older (42% vs. 25%, P < 0.01). More YMSM tested for HIV at least once in the past 2 years than older MSM (66% vs. 40%, P < 0.01). DISCUSSION: Our study has identified important differences in HIV risk behaviors and sexual partnerships between YMSM and older MSM newly diagnosed with HIV. YMSM were more willing to provide the names of male sex partners for the purposes of partner notification than were older MSM, suggesting that PS may be particularly effective at identifying new cases of HIV.

The effect of HIV field-based testing on the proportion of notified partners who test for HIV in New York City.

HIV partner services can effectively reach populations with high HIV prevalence. However, located and notified sex and needle-sharing partners of persons infected with HIV often fail to test. Field testing may increase the proportion of notified partners who test for HIV. In 2008, New York City's health department incorporated field testing into partner services. After the introduction of field testing, the proportion of notified partners who tested for HIV rose from 52% to 76% (P<.001). HIV prevalence fell slightly among notified partners who accepted testing (12% to 9%, P=.82), but we identified more than double the number of new positives (11 vs 25). All positive and 97% of negative results were received by the person tested.

Comparing HIV partner notification effectiveness between blacks and Hispanics in New York City.

Between July 2006 and November 2007, a total of 894 blacks and 491 Hispanics were interviewed to assess partner notification services. Fewer Hispanics needed to be interviewed to identify 1 newly diagnosed partner as compared with blacks (24 vs. 60, P < 0.01), but number needed to be interviewed was similar for identifying partners with any HIV infection.

The free condom initiative: promoting condom availability and use in New York City.

In 2005, the New York City Department of Health and Mental Hygiene (DOHMH) made free condoms available to organizations through a Web-based ordering system. In 2006, we interviewed managers and patrons about free condom availability, acquisition, and use in venues where people at high risk for human immunodeficiency virus congregate. DOHMH condom distribution increased from 5.8 million in 2004 to 17.3 million in 2006. Overall, managers reported making condoms available at 76% (309/409) of high-priority venues, but only at 40% of gay bars. Among patrons who saw free condoms, 80% (280/351) reported taking them; 73% (205/280) of those who reported taking them also reported using them. A simple, Web-based ordering system dramatically increased condom distribution. In the venues we sampled, the majority of patrons acquired and used free condoms when available and visible, suggesting that increasing free condom availability may increase use. Special efforts are needed to ensure availability at gay bars.