Rapid HIV Testing at Gay Pride Events

In the United States, human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) disproportionately affect men from racial/ethnic minority groups (1). Approximately half of the HIV/AIDS cases among non Hispanic black and Hispanic males reported by 33 states using name based HIV surveillance during 2002 to 2005 were among men who have sex with men (MSM) (1).

Each year, approximately 100 gay pride events are held in cities across the United States to celebrate diversity, demonstrate solidarity of the gay community, and heighten awareness of topics of importance to the gay community. These events are attended by several hundred to several hundred thousand MSM. Certain gay pride events are focused on celebrating solidarity in the minority gay community and are attended primarily by MSM from racial/ethnic minority groups.

These events offer an opportunity for community based organizations (CBOs) and health departments to provide HIV prevention education and outreach. In 2004, CBOs and health departments, with technical assistance from CDC, began conducting rapid behavioral assessments at gay pride events and at minority gay pride events (2).

This report describes the results of assessments and rapid HIV testing conducted at 11 events in nine U.S. cities during 2004 to 2006; most of these events were attended primarily by MSM from racial/ethnic minority groups. A total of 543 attendees who participated in the assessments reported at the time of the event that they had not had HIV infection diagnosed previously. Of these, 133 (24%) were tested for HIV during the event, and eight (6%) of those tested during the event had a positive rapid test result. All eight were subsequently confirmed to be HIV positive by Western blot testing. Testing at gay pride events provides an opportunity to identify new HIV infections among MSM outside of health care settings, particularly those from racial/ethnic minority groups.

As part of an initiative to reduce racial/ethnic disparities in HIV infection, the U.S. Conference of Mayors, through a cooperative agreement with CDC, provided funding to CBOs and health departments to conduct behavioral assessments at gay pride events attended primarily by MSM from racial/ethnic minority groups. CDC provided on site technical assistance to the CBO and health department staff, including developing assessment questionnaires, training interviewers, and coordinating HIV testing and questionnaire administration. During 2004--2006, CBOs and health departments were funded to conduct assessments and HIV testing at 1) black gay pride events in Detroit, Michigan (2004 and 2005), Baltimore, Maryland (2004), Jackson, Mississippi (2005), Charlotte, North Carolina (2006), St. Louis, Missouri (2006), and the District of Columbia (2005); 2) Hispanic gay pride events in Oakland (2004) and San Francisco, California (2005); and 3) gay pride events in Oakland, California (2004), and Chicago, Illinois (2006).

Both volunteer and paid interviewers were stationed in multiple places at event sites. Interviewers approached and invited adult attendees to participate in a behavioral assessment. At some events, attendees were offered nonmonetary incentives (typically valued at <$10) to increase participation. Assessments were conducted using a two-page, self-administered questionnaire in 2004 and a more comprehensive questionnaire administered by local staff using hand-held personal computers during 2005--2006. The assessment questionnaires included questions about demographic characteristics, sexual behavior, illicit drug use, HIV status, history of testing for HIV and other sexually transmitted diseases (STDs), and access to HIV and STD prevention services. After completing the questionnaire, respondents who said they were HIV negative or did not know their HIV status were offered rapid HIV testing using the OraQuick® Advance(tm) Rapid HIV 1/2 Antibody Test (OraSure Technologies, Inc., Bethlehem, Pennsylvania).

Because a positive rapid HIV test is considered to be a preliminary result, persons with preliminary positive results were asked to provide an oral fluid or blood specimen for confirmatory Western blot testing. Rapid HIV testing at the 11 events was performed in diverse settings, including tents, mobile testing units, community centers, churches, bars, and hotel rooms.

Of 627 male respondents aged >18 years who self identified as being from a racial/ethnic minority group and as being either gay or bisexual, 543 reported that they were HIV negative or did not know their HIV status. Of these, 133 (24%) were tested for HIV at an event (Table). Of the 133 respondents who were tested, eight (6%) had preliminary positive test results.

All eight were subsequently confirmed to be HIV positive by Western blot testing. The median age of the eight HIV positive respondents was 36 years (range: 21 to 43 years), and seven were non Hispanic blacks. Four of the eight newly identified HIV positive respondents reported having had a negative HIV test result during the preceding year, one had never been tested for HIV, and the testing histories of three were unknown.

Of the 169 persons who were willing to be tested at a 2005 or 2006 event, 105 (62%) were tested; data for 2004 were unavailable. Although the reasons willing respondents were not tested were not collected systematically, anecdotal reports from staff at events suggest that the primary reasons were that respondents did not report to testing locations after completing the behavioral assessment or, if they did report to testing locations, they chose not to wait until staff were available to administer a test.

Data on health care seeking behaviors were available from the 2005 assessments only. Of the 229 respondents in 2005 who reported that they were HIV negative or did not know their HIV status, 23 (10%) had received a referral for HIV testing from a health care provider or outreach worker during the preceding year, and 169 (74%) respondents had visited a health care provider during the preceding year. Of these 169 respondents, 70 (41%) had been offered an HIV test by their health care provider.