Background:  A 2005 health report on homeless New York City (NYC) adults showed increased rates of HIV-related morbidity and mortality when comparing homeless adults using city shelters to the general NYC adult population. The NYC Department of Health and Mental Hygiene and the NYC Department of Homeless Services (DHS) collaborated to offer a rapid HIV test to everyone who presented to medical clinics in homeless assessment shelters for single adults. We sought to characterize the test results for those offered an HIV test at DHS assessment shelters for single adults from September 2006 to June 2007.

Methods: Adults entering the DHS single adult shelter system are referred to assessment shelters for medical screenings. All adults receiving medical screenings were to be offered an HIV test. Shelters reported on number and demographics of people offered testing, number tested, number testing positive (preliminary and confirmed), number linked to care, number and demographics of people refusing testing, and reasons for refusal.

Results: Preliminary data for 6 of 7 assessment shelters showed that 3089 (74%) of people who received a physical exam were offered an HIV test. Of those offered, 1769 persons (52%) accepted and were tested for HIV, with 32 (1.81%) identified as preliminary positive. Half of clients with preliminary positive diagnoses were confirmed positive; 13% declined a confirmatory test because they were known positive. The remaining 37% refused confirmatory testing, had missing data, or were lost to care. One person received a false positive result; 75% of clients with a positive confirmatory test were linked to care. Males accounted for 995 (56%) of people tested. The majority of people tested were non-Hispanic black (65%) or Hispanic (26%). Of clients tested, 1381 (78%) were aged 18 to 49 years. Those who refused testing had similar demographics to those who accepted testing. However, of clients offered an HIV test, 55% of men and 26% of women refused the offer. The majority of people who refused testing, 1170 (79%), reported they had been tested previously.

Conclusions:  The majority of adults in NYC single adult assessment shelters accepted an HIV test when routinely offered. Obtaining confirmatory test results and linking the positive client to care remain a challenge in this population. More research is needed to lower refusal rates among homeless adults offered an HIV test, especially homeless men.