A recent CDC Morbidity and Mortality Weekly Report highlighted the need for “identifying persons with human immunodeficiency virus (HIV) infection who are unaware of their infection status, linking them to HIV care, and reducing racial/ethnic disparities” as important national HIV prevention goals. They further discussed the importance of effective implementation of partner services, linking these patients to care or re-engaging them in care, and providing services to reduce HIV transmission.
The report recognized that blacks are disproportionately affected by HIV infection in the United States. Data from 2017 revealed that while representing only 13% of the US population, 44% of new HIV infections diagnosed occurred in the black population and the rate of new diagnoses was approximately 8 times higher than that in non-Hispanic whites. The report analyzed data regarding HIV partner services from the 2016 National HIV Prevention Program Monitoring and Evaluation, such as services offered by health officials to individuals with diagnosed HIV infection (index patients) and their sex- or needle-sharing partners notified of their potential HIV exposure and offered HIV testing and related services.
In a population of 49,266 index patients identified as candidates for partner services, 43% were black and the percentage of black index patients interviewed for partner services (76%) was higher than all index patients combined (73%). Identified index patients cumulatively identified 11,088 black partners and 78% were notified of their possible HIV exposure. However, only 43% of the partners notified were subsequently tested. One in six of individuals (17%) who were tested received a new HIV diagnosis. The prevalence of new infections was particularly high in black partners who were gay, bisexual, and other men who have sex with men (MSM) (37%), and transgender individuals (38%).
The report also listed several limitations to this study. The first is that while the Centers for Disease Control and Prevention (CDC) provides recommendations outlining the basic elements of partner services, the implementation of these varies greatly by health department. In addition, the rates of new infections may have been overestimated in jurisdictions with large amounts of missing data on behavioral risks and those that do not routinely check existing laboratory or surveillance records to identify previously diagnosed individuals. The report also noted considerable variation in data collection approaches and systems in CDC-funded recipients.
Recommendations put forth in the report included, “full and effective implementation of partner services programs to reach all index patients and partners, particularly black MSM and transgender persons, as recommended by the National HIV/ Acquired Immunodeficiency Syndrome Strategy., which is important for identifying individuals who are unaware of their HIV status.
It is also recommended that partner service program managers ensure, “that disease intervention specialists have access to all the resources needed to identify and locate partners named by index patients during partner services interviews and to link newly diagnosed partners to HIV medical care.” Partner services can also offer both index and previously diagnosed patients the opportunity to re-engage with care and facilitate linkage to pre-exposure prophylaxis and other prevention services for high-risk partners who do not have HIV.
Rao S, Song W, Mulatu MS, Rorie M, O’Connor K, Scales L. HIV partner service delivery among blacks or African Americans – United States, 2016. MMWR Morb Mortal Wkly Rep. 2019;68:81-86.