Recent Federal Guidance about Services for Persons with HIV: Implications for Access to STD Prevention and Care

Background: Improving STD services for persons with HIV is important because HIV-STD co-infection is common, STDs have serious health consequences, and some STDs facilitate HIV transmission.

Methods: We analyzed the content of recent federal government guidance on HIV testing, care, and reporting that might influence access to STD services for persons with HIV.

Results: Updated guidance on “prevention with HIV-positives” recommends prompt linkage to HIV care where providers can screen for STDs that facilitate HIV transmission; offer risk-reduction interventions (RR) that can reduce STD exposure; and offer partner services (PS) that can address both HIV and STDs. Recent guidance also recommends linking persons with initial positive HIV tests to HIV care before supplemental test results are available and allows reporting of initial-positive HIV tests to surveillance programs before diagnosis is confirmed. This can speed clinician or health department support for linking persons with positive tests to HIV services that, in turn, may provide opportunities for STD services even if HIV infection is ruled out. New guidance also addresses the benefits of routine diagnosis and reporting of acute HIV infection cases that are frequently identified in STD clinics. Acute HIV infection is the most infectious stage and commonly occurs among MSM co-infected with STDs.  Routine notification and reporting of acutely infected case-patients can help clinicians and health departments quickly identify individuals who urgently need services for HIV and recently acquired, highly infectious STDs.  Implementing this recent guidance can reduce gaps in HIV and STD care: currently, about 20% of HIV-infected persons do not receive outpatient care within three months of diagnosis and less than half receive RR, PS, or gonorrhea or chlamydia screening shortly after diagnosis.

Conclusions: Implementing this recent HIV guidance may improve access to several STD services and improve synergies between HIV and STD control programs.