Seventy-nine people were diagnosed with AHI HIV between January 1, 2003 and February 28, 2005 (see ). Of these, 26 people declined to be contacted for an interview and 17 could not be located by study staff. Of the remaining 36 participants, 32 met the eligibility criteria. General demographic characteristics were not statistically significant between those who agreed to participate in the study and those who refused or could not be located. Reasons for declining participation included concerns about confidentiality (n=5), not wanting to talk about their diagnosis (n=2), not interested in study participation (n=6) and no reason given (n=13). All interviews took place within 12 months of AHI diagnosis (Median = 61 days, Range = 10–365 days).
Selection of Study Participants from All People Identified with Acute HIV Infection (AHI) at All Publicly-Funded Testing Sites in NC Diagnosed Between 1/1/03–2/28/05
Demographic features of the study participants are displayed in . Of note, 81% were men, 59% African American, mean age was 29 with a much narrower age range for women (21–28 years) compared with men (19–63 years).
Characteristics of People with Acute HIV Infection in NC Diagnosed Between 1/1/03–2/28/05
Sexual Identity and Gender of Sexual Partners
All women (n=6) identified as heterosexual and reported only male sexual partners (see ). Twenty-two men (85%) reported having male sexual partners, and 42% reported having female sexual partners in their lifetime. Of the six men who identified as heterosexual, all had female sexual partners, and two also reported at least one male sexual partner in his lifetime. Of the seven men who identified as bisexual, all reported having had male sexual partners and five reported having had female sexual partners. None of the 13 men who identified as gay reported having any lifetime female partners.
Number of Sexual Partners and HIV Transmission Risk Behaviors
The median number of lifetime sexual partners of all participants was 20 (range, 1–1,000). Heterosexual men had a median of 20 partners (range, 1–72 partners), bisexual men 12 partners (range, 1–54 partners), and gay men 50 partners (range, 2-1,000 partners) (see ).
The median number of sexual partners in the year prior to diagnosis for all participants was six (range, 1–100 partners) (see ). Among the men, heterosexual men had a median of two partners (range, 1–8 partners), bisexual men had a median of five partners (range, 1–8 partners), and gay men had a median of 22 partners (range, 3–100 partners) in the year prior to being diagnosed with AHI. In the year prior to diagnosis, women had a median of one partner (range, 1–8).
HIV Risk Factors in Year Prior to HIV Diagnosis by Gender and Sexual Orientation of People with Acute HIV Infection in NC Diagnosed Between 1/1/03–2/28/05
In the year before diagnosis, no heterosexually-identified men reported engaging in any acts of insertive anal sex with another man or with a woman, but 2 reported receptive (1 unprotected) anal sex, and 4 reported unprotected vaginal sex. In their pre-diagnosis year, 85% of the gay-identified men reported unprotected receptive anal sex with a steady male partner and 62% reported unprotected insertive anal sex with a steady male partner. Almost half of the gay-identified men (n=6) reported unprotected insertive and unprotected receptive anal sex. None of the women and only 8% of the men reported having protected oral sex. No one reported using injection drugs in the year before AHI diagnosis.
Perception of Risk
When asked to describe what their perceptions had been of their risk of contracting HIV during the year before receiving their AHI diagnosis, 78% of participants reported that they had perceived their risk to have been “unlikely” or “very unlikely”. Six percent had believed, during that year before infection, that their risk of HIV infection was “likely”. A majority of the participants (53% of the total; 83% of women, 57% of MSM, 17% of heterosexual men) thought that they acquired their HIV infection from a steady partner, (defined as someone they had known for more than two months, who they had an emotional bond with, and with whom they had regular sex, such as a boyfriend, spouse, significant other or life partner). More than half (n=17) of the sample reported that before they were diagnosed with HIV, they had thought the chances their steady partner could have been infected with an STI (Sexually Transmitted Infection) or HIV was “unlikely” or “very unlikely”. In contrast, when asked about their thoughts regarding their casual partners before diagnosis, only 30% (n=7) felt their casual partners were “unlikely” or “very unlikely” to have an STI or HIV among individuals (n=23) reporting causal partners.
Lifetime History of Sexually Transmitted Infections
One quarter of the study participants (n = 8) reported a history of Neisseria gonorrhoeae during their lifetime. In the past, five participants (16%) had been diagnosed with Chlamydia trachomatis, five (16%) with hepatitis B, and four (13%) with syphilis.
Lifetime History of HIV Testing () and Reasons for Testing
Overall, more than one third of the study participants (38%) had tested 5 or more times for HIV infection (see ). Only four people (12%) reported that their positive AHI test was their first HIV test. About half (54%) of the gay-identified men reported testing for HIV at least every 6 months, compared to 43% of the bisexual men, 33% of heterosexual men and 17% of women.
Reported Reasons for Voluntarily Seeking an HIV Test of People with Acute HIV Infection in NC Diagnosed Between 1/1/03–2/28/05a
Most individuals (78%) reported multiple reasons for seeking testing at the time of their positive AHI diagnosis (see ), with the majority reporting being tested because they “had unprotected anal sex with a man” (56%), and/or because they “wanted the reassurance that they were HIV negative” (56%). Ten people (31%) had an HIV test because they felt sick at that time. Only six participants (19%) reported ever hearing at all about AHI before their diagnosis.
Number and Pattern of Lifetime HIV Testing by Demographic Characteristics of People with Acute HIV Infection in NC Diagnosed Between 1/1/03–2/28/05
Acute Retroviral Syndrome and Medical Evaluation
Three quarters of participants (n = 24) reported feeling ill some time during the three months before their positive test for AHI. Twenty had sought medical attention for their illness. The reasons that four people did not seek medical attention despite having ARS symptoms included: the cost of medical care or lack of insurance (n=3); the symptoms were not severe enough to warrant seeking medical care (n=3); and/or the symptoms resolved on their own (n=2).
Of the 24 individuals who experienced ARS symptoms, the most commonly reported symptoms were fever (80%), loss of appetite/weight loss (76%), gastrointestinal upset (68%), sore throat (64%). and skin rashes (31%).
Of the 20 people who sought medical care for ARS-like symptoms in the three months prior to their AHI diagnosis, 12 people (60%) sought care in an emergency department or urgent care, six people sought care from a primary care provider, one in a student health clinic and one at an infectious disease clinic.
Ten of those who sought medical care were diagnosed with a viral syndrome (such as an upper respiratory infection, hepatitis, influenza, and gastroenteritis). Five were diagnosed with bacterial infections (such as streptococcal pharyngitis, Rocky Mountain Spotted Fever, and pneumonia), one person was told that he was experiencing a stress reaction and another was evaluated for a myocardial infarction. Three individuals were accurately diagnosed with AHI at their initial sick visit. Seven individuals were prescribed unnecessary antibiotics. Of the 17 misdiagnosed individuals, none were tested for HIV at their initial visit, nine sought later testing at either an HIV counseling and testing site or an STD (Sexually Transmitted Disease) clinic, seven were tested during subsequent medical evaluation at either a hospital, specialty clinic or their primary provider, and one was tested by State Partner Counseling and Referral Officers due to being named as a contact of a HIV positive partner.