Background:  Surveillance for HIV has been limited to monitoring HIV seroprevalence populations. This method has limited ability to detect increasing incidence or clustering within specific risk groups or geographic areas. Beginning in November 2002, North Carolina’s Screening and Tracing Active Transmission (STAT) Program added HIV RNA screening to all public voluntary counseling and testing for detection of HIV antibody-negative acute HIV infections.  Of 5 acute infections detected in less than 3 months, 2 were in male students attending different colleges in the same city.

Methods:  To investigate HIV infection among college attendees in North Carolina we reviewed state HIV surveillance records for all new diagnoses of HIV infection in males younger than 30 years old living in 34 counties throughout North Carolina. Information was characterized about all patients diagnosed with HIV infection between January 1, 2001 and May 1, 2003 and their contacts. A cross sectional comparison of risk behavior and demographic information of newly diagnosed HIV-infected male college enrollees (college males) to newly diagnosed HIV-infected males who were not currently enrolled in college (non-college males) was conducted.

Results:  Of 423 newly reported HIV⁺ men in North Carolina, 56 (13%) attended 28 colleges. Of the 56 newly reported HIV⁺ students (17 with documented seroconversion while in college), 88% were African American and 91% were men who have sex with men (MSM) or men or who have sex with men and women (MSM/W). Compared with other newly reported HIV⁺ individuals, college men  were more likely to be actively bisexual (OR 3.00; 95%CI: 1.52 to 5.92), to meet sex partners at gay clubs (OR 1.97; 95%CI: 1.00 to 3.90) or over the Internet (OR 4.03; 95%CI:  1.69 to 9.48) or to use ecstasy/club drugs (OR 5.90; 95%CI:  1.36 to 23.98). Compared with other newly reported HIV⁺ individuals, college men were less likely to report only women as sex partners (OR 0.09; 95%CI:  0.01 to 0.37) or to have exchanged sex for drugs or money (OR 0.21; 95%CI:  0.02 to 0.86).

Conclusions:  By linking North Carolina’s enhanced HIV-screening program with focused epidemiologic investigation, we detected and rapidly described an epidemic in college students primarily involving African American MSM and MSM/W. Active monitoring of HIV transmission, based on real-time identification of incidence of HIV infection, can illuminate emerging sexual networks with active HIV transmission providing focus for limited prevention resources.

Keywords: Acute/Primary HIV; Outbreak; Epidemiology