Case 2: HIV Testing as the Gateway to Care: A 24-Year-Old Man With A New Diagnosis of HIV Infection

A 24-year-old Latino man comes to the New York City Riverside STI Clinic located in upper Manhattan. He is undocumented and uninsured. He is married to a woman in the Dominican Republic, but since coming to New York City, he has been sexually active with men only. His only contact with the health care system was a visit to the emergency room in the Bronx 2 years ago after he suffered a minor injury at work. During that visit, he was offered a rapid HIV test and he accepted after it was framed as a matter of routine care. The test result was negative. He has not been tested for HIV infection or any other STI since then. The patient recently saw a social marketing campaign promoting the services of STI clinics for all New York City without regard for insurance or immigration status. The patient has been engaging in condomless insertive and occasionally receptive anal sex with multiple male partners that he met at social functions and online. He does not recall the names or Internet handles of most of his sex partners. The patient consents to HIV and syphilis testing and is willing to provide specimens for STI testing including urine, a self-collected rectal swab, and a throat swab. He does not report any symptoms of acute HIV infection or STIs. The patient’s HIV testing includes a fourth-generation rapid HIV test supplemented with pooled NAAT for acute HIV infection if the rapid HIV test result is nonreactive. The point-of-care test result is negative for HIV antigen and positive for HIV antibody.