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HIV Partner Service Delivery Among Blacks or African Americans-- United States, 2016.

Identifying persons with human immunodeficiency virus (HIV) infection who are unaware of their infection status, linking them to HIV care, and reducing racial/ethnic disparities are important national HIV prevention goals (1). Blacks/African Americans (blacks)* are disproportionately affected by HIV infection in the United States. Although blacks represent 13% of the U.S. population (2), in 2017, 44% of diagnoses of HIV infection were in blacks, and the rate of new diagnoses in blacks (41.1 per 100,000 persons) was approximately eight times that of non-Hispanic whites (5.1) (3). HIV partner services are offered by health officials to persons with diagnosed HIV infection (index patients) and their sex- or needle-sharing partners, who are notified of their potential HIV exposure and offered HIV testing and related services (4). CDC analyzed 2016 data from the National HIV Prevention Program Monitoring and Evaluation system submitted by 59 health departments. ([dagger]) Among 49,266 index patients identified as potential candidates for partner services, 21,191 (43%) were black. The percentage of black index patients interviewed for partner services (76%) was higher than that for all index patients combined (73%). Among the 11,088 black partners named by index patients, 78% were notified of their potential HIV exposure. Fewer than half (47%) of those notified were tested for HIV infection. Among those tested, one in six (17%) received a new HIV diagnosis. The prevalence of newly diagnosed HIV infection was particularly high among black partners who were gay, bisexual, and other men who have sex with men (MSM) (37%) and transgender persons (38%). Effective implementation of partner services is important to identify HIV infection, link patients to care or reengage them in care, and provide prevention services to reduce HIV transmission.

In 2016, CDC funded 61 state and local health departments to implement comprehensive HIV prevention programs, including partner services. CDC analyzed HIV partner services client-level data in the National HIV Prevention Program Monitoring and Evaluation system submitted by 59 health departments. Data were stratified by age group, gender, U.S. Census region, ([section]) HIV prevalence, ([paragraph]) and priority population (i.e., MSM, transgender persons, persons who inject drugs, heterosexual males, and heterosexual females).** An index patient is eligible for partner services if he or she is living within the jurisdiction at the time of report. Named partners are eligible for partner services if there is enough information to potentially locate and notify them of their exposure to HIV. Partners with newly diagnosed HIV infection are defined as those who test positive for HIV through partner services-initiated HIV testing and have no evidence of a previous HIV diagnosis reported to the health department surveillance system; recorded in a laboratory report, medical record, or other available data source (e.g., partner services database or records of previous treatment for HIV infection); or recorded in a patient self-report. Partners with a previous diagnosis of HIV infection are those who test positive and have evidence of a previous HIV diagnosis. Data on index patients and partners were extracted from two databases that did not link the race/ethnicity of index patients and partners. Thus, black partners included in this analysis could have been named by index patients of any race/ethnicity. Data on behavioral risk factors used to define the priority population were required for HIV-positive persons and optional for HIV-negative persons. The key outcomes for this analysis include the percentage of black index patients who were interviewed for partner services, HIV status, and the HIV positivity rate among black partners named during the partner services interviews.

Overall, 49,266 index patients were identified as potential candidates for partner services in 2016, including 21,191 (43.0%) who were black (Table 1). The percentage of interviews of black index patients by partner services were higher among those aged 13-19 years (80.6%); females (76.4%); persons residing in the Northeast (80.5%) (excluding U.S. dependent areas); persons residing in low HIV prevalence areas (88.6%), and heterosexual women (92.7%). Among priority populations, percentages of interviews among black index patients by partner services exceeded 90% among heterosexual women (92.7%), heterosexual men (91.5%), and MSM (90.3%); the lowest percentages of interviews among black index patients occurred among those who inject drugs (86.5%) and transgender patients (79.6%).

Among 27,779 partners named by index patients in 2016, a total of 11,088 (39.9%) were black (Table 2). Among named partners who were black, 77.7% (8,616) were notified of their potential HIV exposure. Among partners who were notified, 4,080 (47.4%) were tested for HIV infection. The highest percentages of testing occurred among black partners aged 13-19 years (64.9%); females (60.4%); residents of the Northeast (50.4%); residents of low HIV prevalence areas (72.7%); and heterosexual men (68.4%).

Among black partners tested in 2016, 16.9% received a new diagnosis of HIV infection. Newly diagnosed HIV positivity among black partners was higher among persons aged [greater than or equal to]50 years (29.0%); males (17.0%); those residing in the Midwest (23.4%) (excluding U.S. dependent areas); persons residing in medium and medium-low prevalence areas (28.3% and 28.6%, respectively); transgender persons (37.5%); and MSM (36.8%). Among black partners tested, the percentage with previously diagnosed HIV infection was 8.8%. The prevalence of previously diagnosed HIV infection among black partners tested was higher among persons aged 20-29 years (10.0%); males (9.0%); persons residing in the South (10.3%); persons residing in low prevalence areas (18.8%); and heterosexual men (21.4%). Among black MSM partners, 60.3% were tested for HIV.

Discussion

Among MSM, blacks accounted for 38% of HIV diagnoses in 2017 (3). The present analysis found that partner services implemented by CDC-funded health departments interviewed approximately three of four black index patients. Index patients who were black MSM accounted for 45.6% (7,362 of 16,153) of partner services interviews among all black index patients, and approximately 90% of those in this group were interviewed. Fewer than half of all black partners notified of their potential HIV exposure were tested. Among those tested, one in six received a new diagnosis of HIV infection, and one in 11 had a previous diagnosis. The rate of newly diagnosed HIV infection was particularly high among black partners who were MSM (37%) and transgender persons (38%). The high HIV positivity rates among black partners and black MSM partners who were tested are consistent with previous findings that indicate partner services is an effective, high-yield strategy for identifying undiagnosed HIV infections (5,6). Prevention efforts that promote HIV testing and consistently include partner services might increase early diagnosis and improve HIV-related health outcomes among blacks, particularly among black MSM and transgender persons.

The findings in this report are subject to at least three limitations. First, although CDC provides recommendations outlining the basic elements of partner services (4), health department implementation varies considerably. Health departments employ different methods and models for partner services that depend on local legislation and regulations, local service delivery systems, and available resources, including trained disease intervention specialists. Second, the rate of newly diagnosed HIV infection might have been overestimated in those jurisdictions that do not routinely check their laboratory or surveillance records to identify persons with previously diagnosed HIV infection and those jurisdictions with a large proportion of missing data on behavioral risk information. Finally, even though partner services evaluation data requirements are standardized, data collection approaches and systems vary among CDC-funded recipients.

Full and effective implementation of partner services programs to reach all index patients and partners, particularly black MSM and transgender persons, as recommended by the National HIV/ Acquired Immunodeficiency Syndrome (AIDS) Strategy, is important to identifying persons who are unaware of their HIV status (1). Further, partner services program managers need to ensure that disease intervention specialists have access to all the resources needed to identify and locate partners named by index patients during partner services interviews and to link newly diagnosed partners to HIV medical care. In addition, partner services offer the opportunity to reengage both index patients and previously diagnosed partners who are not in care (4). Partner services can also facilitate linkage to HIV preexposure prophylaxis and other prevention services, especially for high risk HIV-negative partners of HIV-positive persons, to reduce their risk of HIV acquisition (7). Barriers to effective implementation of partner services and HIV testing include client concerns about compromised confidentiality and fear of negative impacts (e.g., abuse, stigmatization, medical mistrust, and abandonment) (8-10). Therefore, HIV prevention programs, such as partner services that focus on increasing testing, enhancing linkage to HIV care, reengaging patients with previously diagnosed HIV infection in care, providing prophylactic treatment, and increasing access to support services for blacks, would help to address barriers to service and so reduce onward HIV transmission and HIV-related health disparities.

Summary

What is already known about this topic?

In 2017, the rate of diagnosis of new human immunodeficiency virus (HIV) infection among blacks/African Americans (blacks) was approximately eight times that of non-Hispanic whites.

What is added by this report?

In 2016, 78% of black index patients were interviewed for partner services. However, among black partners, fewer than half were tested for HIV infection, 17% received a new diagnosis of HIV infection, and 9% were previously infected. The prevalence of newly diagnosed HIV infection was particularly high among black partners who were gay, bisexual, and other men who have sex with men (MSM) (37%) and transgender persons (38%).

What are the implications for public health practice?

Focusing effective implementation of partner services for blacks, especially for MSM and transgender persons, could lead to reductions in HIV incidence and HIV-related inequities.

Acknowledgments

Hui Zhang, Lisa Kimbrough, Janet Heitgerd, Program Evaluation Branch, Division of HIV/AIDS Prevention, National Center for HIV/ AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; Prevention Program Branch, Quantitative Sciences and Data Management Branch, Division of HIV AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

Corresponding author: Shubha Rao, SRao1@cdc.gov, 404-639-8521.

References

(1.) Office of National AIDS Policy. National HIV/AIDS strategy for the United States: updated to 2020. Washington, DC: The White House, Office of National AIDS Policy; 2015. https://files.hiv.gov/s3fs-public/ nhas-update.pdf

(2.) US Census Bureau. Population and housing unit estimates datasets. Suitland, MD: U.S. Department of Commerce; US Census Bureau; 2018. https://www.census.gov/programs-surveys/popest/data/data-sets.html

(3.) CDC. Diagnoses of HIV infection in the United States and dependent areas, 2017. HIV surveillance report, vol. 29. Atlanta, GA: US Department of Health and Human Services, CDC; 2018. https://www. cdc.gov/hiv/pdf/library/reports/surveillance/cdc-hiv-surveillance-report 2017-vol-29.pdf

(4.) CDC. Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. Atlanta, GA: US Department of Health and Human Services, CDC; 2008. https:// www.cdc.gov/mmwr/preview/mmwrhtml/rr57e1030a1.htm

(5.) Hogben M, McNally T, McPheeters M, Hutchinson AB. The effectiveness of HIV partner counseling and referral services in increasing identification of HIV-positive individuals a systematic review. Am J Prev Med 2007;33(Suppl):S89-100. https://doi.org/10.1016/j. amepre.2007.04.015

(6.) Varghese B, Peterman TA, Holtgrave DR. Cost-effectiveness of counseling and testing and partner notification: a decision analysis. AIDS 1999; 13:1745-51. https://doi.org/10.1097/00002030-199909100-00019

(7.) Song W, Mulatu MS, Rorie M, Zhang H, Gilford JW. HIV testing and positivity patterns of partners of HIV-diagnosed people in partner services programs, United States, 2013-2014. Public Health Rep 2017;132:455-62. https://doi.org/10.1177/0033354917710943

(8.) Passin WF, Kim AS, Hutchinson AB, Crepaz N, Herbst JH, Lyles CM; HIV/AIDS Prevention Research Synthesis Project Team. A systematic review of HIV partner counseling and referral services: client and provider attitudes, preferences, practices, and experiences. Sex Transm Dis 2006;33:320-8. https://doi.org/10.1097/01.olq.0000194597.16236.48

(9.) Eaton LA, Driffin DD, Kegler C, et al. The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. Am J Public Health 2015;105:e75-82. https://doi. org/10.2105/AJPH.2014.302322

(10.) Levy ME, Wilton L, Phillips G 2nd, et al. Understanding structural barriers to accessing HIV testing and prevention services among black men who have sex with men (BMSM) in the United States. AIDS Behav 2014;18:972-96. https://doi.org/10.1007/s10461-014-0719-x

Shubha Rao, MPH [1]; Wei Song, PhD [1]; Mesfin S. Mulatu PhD [1]; Michele Rorie, DrPH [1]; Kevin O'Connor, MA [1]; Lamont Scales, MA [2]

* Persons categorized as blacks/African Americans were not Hispanic or Latino.

[1] Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC; [2] Office of Health Equity, Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC.

All authors have completed and submitted the ICMJE form for disclosure of potential conflicts of interest. No potential conflicts of interest were disclosed.

([dagger]) Fifty states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and eight metropolitan statistical areas (MSAs) or specified metropolitan divisions (Baltimore, Chicago, Fulton County (Atlanta), Houston, Los Angeles County, New York City, Philadelphia, and San Francisco). In 2016, two health departments did not submit partner services data and were excluded from the analysis.

([section]) U.S. Census regions (includes MSAs): Northeast: Connecticut, Maine, Massachusetts, New Hampshire, New Jersey, New York, New York City (New York), Pennsylvania, Philadelphia (Pennsylvania), and Rhode Island. Midwest: Chicago (Illinois), Indiana, Iowa, Kansas, Michigan, Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota, and Wisconsin; South: Alabama, Arkansas, Atlanta (Georgia), Baltimore (Maryland), Delaware, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Virginia, District of Columbia, and West Virginia. West: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Los Angeles (California), Montana, Nevada, New Mexico, Oregon, San Francisco, Utah, Washington, and Wyoming; U.S. dependent areas: Puerto Rico and U.S. Virgin Islands.

([paragraph]) HIV prevalence is defined based on the number of persons with diagnosed HIV infection in 2010. The jurisdictions are classified based on HIV prevalence as high: >20,000; medium: 4,000-19,999; medium-low: 10003,999; low: <1,000. https://www.cdc.gov/hiv/pdf/policies/progressreports/ cdc-hiv-stateprogressreport.pdf.

** MSM includes males who reported male-to-male sexual contact and those who reported both male-to-male sexual contact and injection drug use in the past 12 months. Persons who inject drugs include persons who reported injection drug use in the past 12 months. Heterosexual males include males who only reported heterosexual contact with a female in the past 12 months. Heterosexual female includes females who only reported heterosexual contact with a male in the past 12 months.
TABLE 1. Number and percentage of all index patients and black
index patients offered services through human immunodeficiency
virus (HIV) partner services, by demographic characteristics
and priority populations--United States, * 2016

Characteristic                        All index patients
                                      No.            No. (%)
                                  (% of total)      interviewed

Total                            49,266 (100.0)    36,037 (73.1)

Age group (yrs)
[(dagger)]

13-19                               1,002 (2.0)      800 (79.8)
20-29                             15,577 (31.6)    12,086 (77.6)
30-39                             12,941 (26.3)    9,462 (73.1)
40-49                              8,569 (17.4)    5,956 (69.5)
[greater than or equal to] 50     10,635 (21.6)    7,545 (70.9)

Gender ([section])

Male                              40,148 (81.5)    29,167 (72.6)
Female                             7,076 (14.4)    5,308 (75.0)

U.S. Census region
([paragraph])

Northeast                          5,884 (11.9)    4,696 (79.8)
Midwest                             4,263 (8.7)    2,586 (60.7)
South                             28,002 (56.8)    22,387 (79.9)
West                              10,772 (21.9)    6,031 (56.0)
U.S. dependent areas                  345 (0.7)      337 (97.7)

HIV prevalence **

High                              32,920 (66.8)    24,486 (74.4)
Medium                            14,876 (30.2)    10,466 (70.4)
Medium-low                          1,128 (2.3)      812 (72.0)
Low                                   342 (0.7)      273 (79.8)

Priority population ([dagger])
([dagger])

MSM                               22,780 (46.2)    19,200 (84.3)
Transgender persons                   507 (1.0)      374 (73.8)
Persons who inject drugs              768 (1.6)      640 (83.3)
Heterosexual men                    4,125 (8.4)    3,705 (89.8)
Heterosexual women                  3,914 (7.9)    3,568 (91.2)

Characteristic                   Black index patients
                                 No. (% of total     No. (%)
                                 index patients)    interviewed

Total                             21,191 (43.0)    16,153 (76.2)

Age group (yrs)
[(dagger)]

13-19                                654 (65.3)      527 (80.6)
20-29                              8,167 (52.4)    6,460 (79.1)
30-39                              5,223 (40.4)    3,962 (75.9)
40-49                              2,853 (33.3)    2,075 (72.7)
[greater than or equal to] 50      4,163 (39.1)    3,112 (74.8)

Gender ([section])

Male                              15,853 (39.5)    12,007 (75.7)
Female                             4,352 (61.5)    3,323 (76.4)

U.S. Census region
([paragraph])

Northeast                          2,760 (46.9)    2,222 (80.5)
Midwest                            2,026 (47.5)    1,279 (63.1)
South                             14,516 (51.8)    11,538 (79.5)
West                               1,882 (17.5)    1,108 (58.9)
U.S. dependent areas                    7 (2.0)        6 (85.7)

HIV prevalence **

High                              1,4084 (42.8)    11,207 (79.6)
Medium                             6,763 (45.5)    4,685 (69.3)
Medium-low                           274 (24.3)      199 (72.6)
Low                                   70 (20.5)       62 (88.6)

Priority population ([dagger])
([dagger])

MSM                                8,155 (35.8)    7,362 (90.3)
Transgender persons                  284 (56.0)      226 (79.6)
Persons who inject drugs             192 (25.0)      166 (86.5)
Heterosexual men                   2,395 (58.1)    2,192 (91.5)
Heterosexual women                 2,523 (64.5)    2,340 (92.7)

Abbreviation: MSM = gay, bisexual, and other men who have sex with
men.

* Includes U.S. dependent areas of Puerto Rico and the U.S. Virgin
Islands.

([dagger]) Because of missing/invalid data, records were excluded
in the column "All index patients" for number of index patients
(542; 1.1%) and number interviewed (188; 0.5%) and in the column
"Black index patients" for number of black index patients (131;
0.6%) and number interviewed (17; 0.1%).

([section]) Records for transgender persons and other
missing/invalid genders were excluded in the column "All index
patients" for number of index patients (2,042; 4.1%) and number
interviewed (1,562; 4.3%) and in the column "Black Index Patients"
for number of black index patients (986; 4.7%) and number
interviewed patients (823; 5.1%).

([paragraph]) Northeast: Connecticut, Maine, Massachusetts, New
Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and
Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan,
Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota,
and Wisconsin; South: Alabama, Arkansas, Delaware, District of
Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland,
Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee,
Texas, Virginia, and West Virginia; West: Alaska, Arizona,
California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico,
Oregon, Utah, Washington, and Wyoming; U.S. dependent areas: Puerto
Rico and U.S. Virgin Islands. Two states did not submit data.

** Jurisdictions are grouped according to HIV prevalence and based on
the number of persons with diagnosed HIV infection in 2010 (high:
>20,000; medium: 4,000-19,999; medium-low: 1,000-3,999; and low:
<1,000).

([dagger])([dagger]) Because of missing risk information,
records were excluded in the column "All index patients" for number
of index patients (17,172; 34.9%) and number interviewed (8,550;
20.7%) and in the column "Black index patients" for number of black
index patients (7,642; 36.1%) and number interviewed (3,867;
23.9%). MSM include males who reported male-to-male sexual contact
as well as males who reported both male-to-male sexual contact and
injection drug use in the past 12 months. Persons who inject drugs
include persons who reported injection drug use in the past 12
months. Heterosexual males include males who only reported
heterosexual contact with a female in the past 12 months.
Heterosexual females include females who only reported heterosexual
contact with a male in the past 12 months. Data on behavioral risk
factors used to define the priority population were required for
HIV-positive persons and optional for HIV-negative persons.

TABLE 2. Number and percentage of black partners named, notified,
and tested, and new and previous diagnoses of human immunodeficiency
virus (HIV) infection through HIV partner services programs, by
characteristic--United States, * 2016

                                                         Named
                                 Named partners,     partners
Characteristic                             no.      notified,
                                   (% by group)        no. (%)

Total                            11,088 (100.0)    8,616 (77.7)

Age groups (yrs)
([dagger])

13-19                                 248 (2.2)     194 (78.2)
20-29                              4,136 (37.3)    3,260 (78.8)
30-39                              2,484 (22.4)    1,909 (76.9)
40-49                              1,170 (10.6)     914 (78.1)
[greater than or equal to] 50      2,113 (19.1)    1,792 (84.8)

Gender ([section])

Male                               8,563 (77.2)    6,555 (76.6)
Female                             1,736 (15.7)    1,389 (80.0)

U.S. Census region
([paragraph])

Northeast                          1,406 (12.7)     704 (50.1)
Midwest                            1,130 (10.2)     650 (57.5)
South                              7,848 (70.8)    6,872 (87.6)
West                                  700 (6.3)     388 (55.4)
U.S. dependent areas                    4 (0.0)       2 (50.0)

HIV prevalence **

High                               7,407 (66.8)    6,353 (85.8)
Medium                             3,388 (30.6)    2,078 (61.3)
Medium-low                            265 (2.4)     163 (61.5)
Low                                    28 (0.3)      22 (78.6)

Priority population ([dagger])
([dagger])

MSM                                1,731 (15.6)    1,392 (80.4)
Transgender persons                    58 (0.5)      40 (69.0)
Persons who inject drugs               17 (0.2)      15 (88.2)
Heterosexual men                      542 (4.9)     452 (83.4)
Heterosexual women                    467 (4.2)     398 (85.2)

                                                       Tested
                                    Notified    partners with
                                   partners             newly
Characteristic                       tested,    diagnosed HIV
                                     no. (%)    infection, no.
                                                          (%)

Total                            4,080 (47.4)      690 (16.9)

Age groups (yrs)
([dagger])

13-19                             126 (64.9)        15 (11.9)
20-29                            1,837 (56.3)      275 (15.0)
30-39                            1,032 (54.1)      173 (16.8)
40-49                             504 (55.1)        78 (15.5)
[greater than or equal to] 50     483 (27.0)       140 (29.0)

Gender ([section])

Male                             3,168 (48.3)      540 (17.0)
Female                            839 (60.4)        98 (11.7)

U.S. Census region
([paragraph])

Northeast                         355 (50.4)        72 (20.3)
Midwest                           273 (42.0)        64 (23.4)
South                            3,268 (47.6)      539 (16.5)
West                              183 (47.2)         14 (7.7)
U.S. dependent areas                1 (50.0)        1 (100.0)

HIV prevalence **

High                             2,964 (46.7)      376 (12.7)
Medium                           1,030 (49.6)      292 (28.3)
Medium-low                         70 (42.9)        20 (28.6)
Low                                16 (72.7)         2 (12.5)

Priority population ([dagger])
([dagger])

MSM                               839 (60.3)       309 (36.8)
Transgender persons                16 (40.0)         6 (37.5)
Persons who inject drugs            8 (53.3)         2 (25.0)
Heterosexual men                  309 (68.4)        69 (22.3)
Heterosexual women                270 (67.8)        65 (24.1)

                                        Tested
                                 partners with
                                    previously
Characteristic                   diagnosed HIV
                                 infection, no.
                                           (%)

Total                                361 (8.8)

Age groups (yrs)
([dagger])

13-19                                  7 (5.6)
20-29                               183 (10.0)
30-39                                 89 (8.6)
40-49                                 36 (7.1)
[greater than or equal to] 50         44 (9.1)

Gender ([section])

Male                                 285 (9.0)
Female                                74 (8.8)

U.S. Census region
([paragraph])

Northeast                              8 (2.3)
Midwest                                7 (2.6)
South                               335 (10.3)
West                                  11 (6.0)
U.S. dependent areas                     0 (-)

HIV prevalence **

High                                 270 (9.1)
Medium                                85 (8.3)
Medium-low                             3 (4.3)
Low                                   3 (18.8)

Priority population ([dagger])
([dagger])

MSM                                 170 (20.3)
Transgender persons                    1 (6.3)
Persons who inject drugs              1 (12.5)
Heterosexual men                     66 (21.4)
Heterosexual women                   55 (20.4)

Abbreviation: MSM = gay, bisexual, and other men who have sex with
men.

* Includes U.S. dependent areas of Puerto Rico and the U.S. Virgin
Islands.

([dagger]) Because of missing/invalid data, records were excluded
in the columns for named partners (937; 8.5%); notified partners
(547; 6.3%); tested partners (98; 2.4%); newly diagnosed
HIV-positive partners (9; 1.3%); and previously diagnosed
HIV-positive partners (2; 0.2%).

([section]) Because of missing/invalid data, records for
transgender persons and other missing/invalid genders were excluded
in the columns for named partners (789; 7.1%); notified partners
(672; 7.8%); tested partners (73; 1.8%); newly diagnosed
HIV-positive partners (52; 7.5%); and previously diagnosed
HIV-positive partners (2; 0.6%).

([paragraph]) Northeast: Connecticut, Maine, Massachusetts, New
Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, and
Vermont; Midwest: Illinois, Indiana, Iowa, Kansas, Michigan,
Minnesota, Missouri, Nebraska, North Dakota, Ohio, South Dakota,
and Wisconsin; South: Alabama, Arkansas, Delaware, District of
Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland,
Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee,
Texas, Virginia, and West Virginia; West: Alaska, Arizona,
California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico,
Oregon, Utah, Washington, and Wyoming; U.S. dependent areas: Puerto
Rico and U.S. Virgin Islands. Two states did not submit data.

** Jurisdictions are grouped according to HIV prevalence and based on
the number of persons with diagnosed HIV infection in 2010 (high:
>20,000; medium: 4,000-19,999; medium-low: 1,000-3,999; and low:
<1,000).

([dagger])([dagger]) Because of missing risk information,
records were excluded in the columns for named partners (8,273;
74.6%); notified partners (6,319; 73.3%); tested partners (2,638;
64.7%); newly diagnosed HIV-positive partners (239; 34.6%); and
previously diagnosed HIV-positive partners (68; 18.8%). MSM include
males who reported male-to-male sexual contact as well as males who
reported both male-to-male sexual contact and injection drug use in
the past 12 months. Persons who inject drugs include persons who
reported injection drug use in the past 12 months. Heterosexual
males include males who only reported heterosexual contact with a
female in the past 12 months. Heterosexual females include females
who only reported heterosexual contact with a male in the past 12
months. Data on behavioral risk factors used to define the priority
population were required for HIV-positive persons and optional for
HIV-negative persons.
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Author:Rao, Shubha; Song, Wei; Mulatu, Mesfin S.; Rorie, Michele; O'Connor, Kevin; Scales, Lamont
Publication:Morbidity and Mortality Weekly Report
Date:Feb 1, 2019
Words:4335
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