Linking clients from hiv antibody counseling and testing to prevention services

The effectiveness of HN antibody counseling and testing as a prevention int ervention is limited: persons testing seronegative do not usually change th eir risk behaviors, some actually increase their risk behaviors, and decrea ses in risk behaviors are usually short-lived. Referrals to additional prev ention and other needed services are therefore recommended, although the ex tent and determinants of referral provision for persons testing seronegativ e are unknown. We assessed the prevalence of referrals and the association between risk behaviors and prevention referrals among seronegatives. We rev iewed HIV testing and referral data on all persons receiving confidential s eronegative test results in San Francisco (SF) in the first 10 months of 19 95 (n = 5,595), and gathered more detailed referral information at the muni cipal STD clinic from November 1995 through May 1996 (n = 747). The overall prevalence of referrals was low: a referral was given to 19.1% of the SF s ample and 10.6% of the STD clinic sample; 15.4% of the SF sample and 5.9% o f the STD clinic sample received a prevention referral. Injection drug user s (IDUs) were the most likely to receive a prevention referral (48.5% of SF IDUs, 36.4% of STD clinic IDUs); men having sex with men and women with hi gh-risk partners were also more likely to get a prevention referral than ot hers. For SF IDUs, unsafe sex and needle sharing were not associated with a n increased likelihood of receiving a prevention referral. Opportunities to link high-risk clients from counseling and testing to HIV prevention servi ces are being missed. The referral component of HIV counseling and testing should be improved.