Background:  Identification of incident cases of HIV infection in a timely manner can interrupt the network of transmission and can allow for geographic and behavioral targeted prevention activities. These acutely infected individuals represent an important resource for understanding and characterizing at-risk populations and sexual behaviors that are occurring at the time of HIV transmission.

Methods:  North Carolina recently implemented the Screening and Tracing Active Transmission (STAT) program, a novel statewide system for identification, management, and surveillance of incident HIV infections. STAT includes HIV RNA testing to detect acute infections among HIV antibody-negative specimens. We conducted qualitative interviews about risk behaviors and sexual identity in patients identified either through the STAT program or community providers as having acute HIV infection from January 1, 2003 to October 15, 2004.

Results:  To date, we have conducted 20 interviews (16 men and 4 women) with acutely infected individuals:  10 of the men (63%) were black, 4 (25%) were white, and 2 (12%) Hispanic; of the 4 women, 2 were black and 2 white. The mean age of the men and woman was 27.2 years (SD 12.4) and 30.2 years (SD 5.6), respectively. In the year before diagnosis, the subjects reported a mean of 16.3 sex partners (range 1 to 100, SD 25.3), 5.9 steady sex partners (range 1 to 25, SD 7.6), 10.4 casual sex partners (range 0 to 75, SD 19.2); 50% had a history of a previous STD. At the time of diagnosis, 6 (38%) of the men were attending college and 9 (56%) had sex partners who were college students. In the year prior to diagnosis, 56% of the men met their sex partners over the Internet, 56% at gay bars or clubs and 69% at house or sex parties. Half of the men identified as gay, and 38% as bisexual. All 6 men who identified as bisexual were black and 4 were college students. Half of the gay or bisexual men were open about their sexuality to friends, family, and sex partners.

Conclusions:  Acutely infected individuals offer significant insight on hidden populations driving the spread of HIV in concentrated epidemics. In North Carolina, HIV transmission is associated with gay and bisexual men meeting sex partner at bars or clubs, over the Internet, and at sex parties. The majority of identified acute infections were in college students or individuals with college student sex partners. College students are a high-risk population that may represent a bridge for the transmission of infection.

Keywords: Acute HIV Infection; Sexual behavior; College Students