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Objectives Teach HIV-negative men who have sex with men (MSM) symptoms of acute HIV infection (AHI) and direct them to nucleic acid amplification testing (NAAT) though Public Health—Seattle & King County (PHSKC). Design Cross-sectional surveys, retrospective database analysis and chart review. Methods Beginning in June 2009, the ru2hot? campaign described AHI symptoms and NAAT. Two preintervention and two postintervention surveys assessed campaign visibility, symptom knowledge, and healthcare-seeking behaviour. Regression analyses evaluated secular trends in case-finding. Results 366 MSM completed surveys. In survey 4, 23% of 100 men reported seeing the campaign, and 25% knew ‘ru2hot?’ referred to AHI. From survey 1 to survey 4, the proportion of subjects who knew ≥2 symptoms or that AHI was a ‘flu-like’ illness was unchanged (61% vs 57%, p=0.6). However, in survey 4, 13 (72%) of 18 subjects who saw the campaign named fever as a symptom of AHI compared with 19 (35%) of 55 subjects who had not seen the campaign (p=0.005). From 9/2003 to 12/2010, 622 (2.2%) of 27 661 MSM tested HIV-positive, and 111 (18%) were identified by the Public Health—Seattle & King County NAAT programme. In terms of the impact of the campaign on case-finding, diagnosis of EIA-negative/NAAT-positive and OraQuick-negative/EIA-positive cases increased from six in 2004 to 20 in 2010 (p=0.01), but postcampaign numbers were unchanged. 23 (51%) of 45 cases identified before and 8 (44%) of 18 cases identified after the campaign reported symptoms at initial testing (p=0.6). Conclusions Although a quarter of MSM surveyed saw the campaign and knowledge of fever (the symptom of emphasis) was high, case-finding was unchanged. Increasing campaign visibility could have had greater impact.

In 2006, the US Centers for Disease Control and Prevention recommended expanding HIV testing in healthcare settings1 in order to identify the estimated 25% of HIV-infected persons who are unaware of their status and who may be responsible for up to 50% of HIV transmission.2 These recommendations partly attribute the failure of risk-based testing to issues related to access to care and the inability to target testing if individuals do not admit to potentially stigmatising risk behaviours or are unaware of their risk. However, in this issue of Sexually Transmitted Infections , Brown and colleagues3 ( see page 4 ) present data that suggest that the failure of targeted testing may be partly due to missed opportunities for HIV testing in readily identified high-risk populations. Studying men who have sex with men (MSM) attending 15 genitourinary medicine (GUM) clinics in the UK between 1999 and 2002, the authors detected anti-HIV antibodies in 737 (6.7%) of 10 935 specimens obtained during visits when blood was obtained for syphilis testing but HIV testing did not occur (fig 1). These results are consistent with other published studies, including an anonymous serosurvey conducted at 28 US sexually transmitted disease (STD) clinics in 1997. In nearly all clinics HIV prevalence was 1.4 to 18 times higher …

Background Few US health departments provide partner service (PS) to persons with gonorrhoea (GC) or chlamydia (CT). We sought to define the potential utility of providing PS to MSM with GC or CT as an HIV prevention intervention. Methods We analysed public health reporting and PS data from WA State, USA, 2007–2010 to evaluate whether provider initiated case reports could identify MSM with GC or CT, to assess engagement in HIV care among MSM with STIs previously diagnosed with HIV, and to determine how often MSM HIV test when diagnosed with GC or CT. Estimates of previously diagnosed HIV, engagement with care, and HIV testing were derived from a random sample of cases weighted to reflect cases9 residence and receipt of care in the King County STD clinic. We linked STI and HIV reporting data to estimate the risk of subsequent HIV diagnoses among MSM reported with GC or CT. Results Medical providers recorded the gender of cases9 sex partners on 19 000 (68%) of 27 762 case reports on men with GC or CT, 4281 (22%) of which indicated that the case had sex with men. Case report and PS interview data on cases9 sexual orientation agreed in 6711 (96%) of 6999 cases for which both data sources were available (κ=0.90). Agreement was higher for STD clinic cases (κ=0.98) than for other King County cases (κ=0.86) or among men outside of King County (κ=0.68). Among a random sample of 1103 cases identified as MSM in both case report and PS data, 25% were previously diagnosed with HIV, of whom 87% were in care and 63% were on antiretrovirals. Among MSM without a prior HIV diagnosis, 55% reported that they HIV tested when diagnosed with GC or CT. The proportion of MSM who HIV tested was higher STD clinic cases (82%) than among other King County MSM (57%) or MSM outside of King County (41%) (p Conclusions MSM with GC and CT are an identifiable and accessible population at high risk for HIV acquisition and transmission who might benefit from efforts to increase HIV testing frequency and linkage to HIV care. Expanding PS for bacterial STI should be evaluated as a means to achieve these goals.

Background HIV testing remains one of the most effective HIV prevention interventions because most persons newly diagnosed with HIV alter their behaviours to reduce the risk of transmission to others. We examined temporal trends and correlates of the frequency of HIV testing among men who have sex with men (MSM) in King County, WA. Methods We evaluated electronic medical records of MSM testing for HIV at the Public Health—Seattle & King County (PHSKC) STD Clinic. The intertest interval (ITI) was defined as the number of days between the last reported HIV test and the current visit. ITIs ≤30 days were not considered to be new tests. Correlates of the ITI were determined using Wilcoxon rank-sum tests, Spearman9s correlation coefficients, and median regression. Results Between 1 January 2003 and 7 December 2010, there were 13 637 HIV testing visits among MSM who reported a prior negative HIV test or did not know their status. These men reported a median ITI of 215 days (range: 31–8536; IQR: 124–409); 10 567 (77%) reported an ITI consistent with at least annual testing ( Conclusions From 2003 to 2010, the median ITI among MSM attending the PHSKC STD Clinic was 215 days, and this has decreased over time. Encouragingly, MSM at highest risk for HIV acquisition have even shorter ITIs, although those newly diagnosed with HIV continue to have longer ITIs. Further efforts are needed to reduce the time that HIV-infected persons are unaware of their status.