In the US, black men who have sex with men (MSM, in the parlance of researchers) are more than twice as likely as similar men of other races to be HIV-positive, according to a review of studies on the topic.

And almost half of HIV-positive MSM are unaware of their infection, reinforcing the recommendation from the Centers for Disease Control and Prevention that MSM be tested for HIV at least annually, according to an article in the CDC’s Morbidity and Mortality Weekly Report.

One way to achieve this goal is with peer outreach through social networks, which appears to be an effective means of persuading people at high risk for HIV infection to get tested, according to authors of a second paper in the publication.

Dr. F. Sifakis, from Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues with the National HIV Behavioral Surveillance system tested 1767 MSMs at venues where they normally congregated, such as bars, clubs and social organizations, in five different cities.

Overall, 25 percent tested positive for HIV.

However, the infection rate differed by race - 46 percent among blacks, 21 percent among whites, and 17 percent among Hispanics.

Nearly half of those who tested positive were unaware of their HIV infection. Of those with unrecognized HIV infections, 64 percent were black, 18 percent were Hispanic, and 11 percent were white. Although most had undergone testing in the past, the researchers found that 58 percent with unrecognized infections had not been tested during the previous year.

“We know that persons who are aware of their HIV status take measures to seek treatment and reduce risk behaviors, which underscores the importance of annual testing, particularly among African-American MSM,” said Dr. Stephanie Behel, from the CDC in Atlanta.

Compared with MSM who were HIV-negative, those with unrecognized infections avoided testing because they were more afraid of learning they had HIV and were worried that others would find out about the test results.

One important way to overcome such barriers is to let people know about advances in testing that allow individuals to learn their test results in 20 minutes instead of waiting for 2 weeks, Behel noted.

Also, “We have to increase our prevention messages to help people understand about the benefits of treatment and that people are living longer and healthier lives even with HIV infection,” she added.

In the second article, Dr. C. Emerson of the Tenderloin AIDS Resource Center in San Francisco, and associates report on a social network strategy to identify persons at risk of HIV infection and to direct them to counseling, testing and referral. The data came from nine community-based organizations involved in a 2-year demonstration project in seven cities.

The networking approach was to enlist HIV-positive recruiters who would contact high-risk individuals in their social, sexual, or drug-using network and accompany them or refer them to sites where counseling, testing and referral are conducted.

During October 2003 to September 2004, a total of 133 recruiters were enlisted, and their efforts led to testing of 814 network associates. The results showed that 46 of these contacts were newly diagnosed with HIV, and 669 were HIV negative but at high risk.

“This strategy appears to make efficient use of community-based organization staff members,” the authors write, “enabling them to focus on in-depth network interviews with recruiters, establishing rapport and trust, and coaching recruiters on how to effectively refer network associates for counseling, testing and referral.”

According to the CDC’s Dr. Lisa Kimbrough, organizations best suited for this type of program are those that provide comprehensive services for HIV-positive individuals so they will have a base from which to enlist recruiters, and to whom the recruiters can refer their network associates.

Recruiters “go through an orientation process that includes information about the project and about what their role would be as a recruiter,” Kimbrough said, as well as “specific information on the persons they should identify to be referred for counseling and testing.”

Ideally, the recruiter would be someone with access to a network of individuals at high risk and who has some prominence in that network, she added.

“This strategy works well because about 82 percent of the people who were identified for testing were at high risk,” Kimbrough commented, “as opposed to the ‘worried well’ people who just walk in off the street.”

SOURCE: Morbidity and Mortality Weekly Report, June 24, 2005.