Earlier Diagnosis of HIV Infection Among Men Who Have Sex with Men (MSM) and HIV/STD-Focused Healthcare Services

Background:The creation and maintenance of clinics and medical provider networks that specialize in sexual health care for MSM may be one means to promote more frequent HIV testing and earlier HIV diagnosis.  

Methods:We examined the relationship between provider type and time from last negative HIV test to first positive test (intertest interval, ITI) among MSM newly diagnosed with HIV infection.  Public health staff routinely collected testing histories through partner services interviews and medical record reviews.  We used median regression to compare ITIs.

Results: From 1/1/2010-6/30/2013, 730 MSM were diagnosed with HIV infection in King County, WA. Among 671 (92%) MSM with testing history data, 252 (38%) were diagnosed at publicly funded HIV/STD testing programs, 174 (26%) by MSM or HIV specialty providers, and 245 (37%) by other providers.  MSM diagnosed at HIV/STD testing programs had the shortest median ITI (8.2 months, IQR=3.9-21), followed by those diagnosed by MSM/HIV providers (10.5 months, IQR=4.8-28) and men diagnosed by other providers (13.7 months, IQR=5.4-28) (p<0.001).  Adjusting for race/ethnicity, nativity, age, homelessness, gender of partners, unprotected sex, methamphetamine use, and meeting partners in bathhouses, ITIs among MSM diagnosed by HIV/STD testing programs and MSM/HIV providers were similar, whereas the median ITI among MSM diagnosed by other providers remained 3.7 months longer. MSM diagnosed by other providers were most likely to have no prior negative test (12% vs. 8% and 3% for HIV/STD testing programs and MSM/HIV providers, respectively; p=0.004).

Conclusions: Although the differences we observed in ITI by diagnosing provider type may reflect unmeasured differences in the populations tested by different provider types, our findings suggest that venues providing specialized MSM HIV testing services may reduce the amount of time infected MSM spend unaware of their status.  Because some MSM only seek care in non-specialized clinical settings, however, efforts to routinize testing remain critical.