HIV Partner Services for Black Americans, 2016: Reaching Partners Who Don't Know

Summary

• Black Americans are 13% of the U.S. population but received 44% of HIV diagnoses in 2017, and their rate of new diagnoses (41.1 per 100,000) was about eight times that of non-Hispanic white Americans (5.1).
• HIV partner services reach people diagnosed with HIV (index patients) and notify their sex or needle-sharing partners of possible exposure, offering testing and other services.
• In 2016, 76% of Black index patients were interviewed. But fewer than half (47%) of Black partners who were notified got tested — and 17% of those tested had a new HIV diagnosis. Among Black partners who were gay, bisexual or other men who have sex with men (MSM), the figure was 37%, and among transgender partners 38%.

How it was studied

In 2016, CDC funded 61 state and local health departments for HIV prevention programs, including partner services. CDC analyzed data from 59 of them in the National HIV Prevention Program Monitoring and Evaluation system.

• A partner has a new diagnosis if they test positive through partner services with no record of an earlier diagnosis — in surveillance, lab or medical records, or by their own report.
• The index patient and partner databases didn't link race, so a Black partner could have been named by an index patient of any race.

What was found

Interviews of Black index patients were most frequent among 13–19-year-olds (80.6%), women (76.4%), residents of the Northeast (80.5%) and of low-prevalence areas (88.6%). By group, they topped 90% for heterosexual women (92.7%), heterosexual men (91.5%) and MSM (90.3%), and were lowest for people who inject drugs (86.5%) and transgender people (79.6%).

Testing of notified Black partners was highest among 13–19-year-olds (64.9%), women (60.4%), residents of low-prevalence areas (72.7%) and heterosexual men (68.4%). 60.3% of Black MSM partners were tested.

New diagnoses among Black partners tested were highest among those 50 or older (29.0%), in the Midwest (23.4%), in medium and medium-low prevalence areas (28.3% and 28.6%), and among transgender people (37.5%) and MSM (36.8%).

What it means

• Black MSM accounted for 38% of HIV diagnoses among MSM in 2017. They made up 45.6% of partner services interviews of Black index patients, and about 90% of them were interviewed.
• One in six Black partners tested had undiagnosed HIV and one in 11 a previous diagnosis — confirming partner services as an effective, high-yield way to find undiagnosed infections.
• Full implementation, as the National HIV/AIDS Strategy recommends, especially for Black MSM and transgender people, could cut new infections and inequities. Disease intervention specialists need the resources to find partners and link them to care.
• Partner services can also bring back into care people already diagnosed, and connect HIV-negative partners to HIV preexposure prophylaxis and other prevention.
• Barriers include fears about confidentiality and of abuse, stigma, medical mistrust and abandonment — which programs must address.

Limits: health departments carry out partner services differently, depending on local law, systems and resources; new diagnoses may be overestimated where records of earlier diagnoses aren't routinely checked or risk data are often missing; and data collection varies among funded programs.

Sources

Based on Shubha Rao, Wei Song, Mesfin S. Mulatu, Michele Rorie, Kevin O'Connor and Lamont Scales, "HIV Partner Service Delivery Among Blacks or African Americans — United States, 2016," MMWR, Centers for Disease Control and Prevention; a work of the United States government in the public domain. The report's summary box gives 78% of Black index patients as interviewed; its abstract and table give 76%, which this page follows.