HIV risk behaviors, HIV testing, and entry into Medical Care in Utah

Early diagnosis of HIV infection is beneficial for improved health outcomes on the individual level and for HIV prevention on the community level. Using data from a survey of men who have sex with men (MSM) and from the electronic HIV/AIDS reporting system (eHARS) at the Utah Department of Health, I explored high-risk behaviors and HIV testing among men MSM in Utah and entry into medical care for newly diagnosed individuals in Utah. Using a survey of 986 MSM, the associations between high-risk behaviors, HIV testing, and having a regular medical care provider were examined. Sixty percent of the MSM had a regular provider and 53% had been tested for HIV in the last year. For the three sexual risk behaviors (number of partners, type of partner, and use of condoms during anal sex) there was no association with having a medical provider. However MSM who inject drugs were less likely to have a medical provider. Having an HIV test in the last year was only associated with having a regular medical care provider if the patient disclosed his sexual orientation to the provider. Based on these findings, I recommend that interventions to improve communication between a patient and his provider be developed, and if a provider is uncomfortable asking about sexual history, then the provider should universally screen for HIV. Survival analysis was used to evaluate the time from initial HIV diagnosis to entry into medical care for 522 newly diagnosed individuals. Of these individuals, 65% iv had entered medical care within the first 90 days while for 14% there was no evidence of ever entering care. The only characteristic associated with delayed entry to care was having no risk identified (NRI) for transmission. This finding suggests that individuals with NRI may benefit from more extensive post-HIV counseling.