Background:  The Bellevue/NYU Langone Medical Center’s M*SHP is an HIV and Sexually Transmitted Infection (STI) testing program servicing MSM attending commercial sex venues, events, and parties (CSVEP) in New York City (NYC). Clients are offered standard HIV serology, as well as other testing to identify acute and recent HIV infection.

Methods:  This program offers field-based screening for HIV using rapid serology and pooled plasma HIV viral load (VL) to allow detection of established and acute HIV infection (AHI). Men who are found to be Western blot positive are assessed for recent infection using the Serologic Testing Algorithm for Recent HIV Seroconversion (STARHS). Demographic and behavioral data are collected from participants.

Results:  Between February 2006 and August 2009, 1902 visits have occurred among 1386 unique clients at M*SHP venues. Of these clients, 955 (69%) provided venous blood for HIV serologic and VL testing; 2.7% of those tested were newly diagnosed with HIV, of these, 30% were acutely or recently infected. Of these newly HIV-diagnosed men, 7 demonstrated evidence of recent infection using STARHS (0.5% of all men tested, and 19% of newly diagnosed men). Four men were diagnosed with AHI through M*SHP based on a negative serology and positive HIV VL and one additional AHI was identified through partner referral to an affiliated program (0.36% of all men tested for HIV, 0.05% of those agreeing to phlebotomy, and 13.5% of clients newly diagnosed with HIV infection). The majority (73%) of the men diagnosed with acute or recent HIV infection categorized themselves as racial or ethnic minorities; 90% were exclusively MSM and described their sexual orientation as “gay.” Participants reported a median of 10 sex partners in the 90 days before their testing visit. Many reported using drugs, most commonly inhalants, erectile dysfunction drugs, and alcohol; 90% of men diagnosed with HIV have been connected to care.

Conclusions:  Targeted testing for AHI has a high diagnostic yield. The rate of AHI detected by M*SHP is 2 to 3-fold higher than the rate reported by NYC in pooled plasma VL testing at Department of Health Sexually Transmitted Infection clinics. Although experience in CSVEP is limited, the “point of risk” testing approach utilized by M*SHP has identified a significant burden of long-standing, recent, and acute HIV infection. Implementation of field/community-based VL testing as screening for AHI should be explored as a supplement to standard serologic testing approaches.