DETERMINANTS OF DELAYED DIAGNOSIS OF HIV-INFECTION IN FRANCE, 1993-1995

Objective: To describe the circumstances of the first HIV-positive tes t and to study the determinants of a delayed diagnosis of HIV infectio n. Methods: In a retrospective study among adult AIDS patients diagnos ed between July 1993 and May 1995 in two French districts, data on soc ioeconomic characteristics, circumstances of first HIV-positive test a nd attitudes and behaviours regarding medical care were collected in a confidential interview and analysed for potential association with a late test, defined as a first HIV-positive test within 6 months of AID S diagnosis. Results: Of the 359 AIDS patients studied, 69 (19.2%) had a late test. Late testers were more likely than other patients to hav e had an HIV-positive test because of clinical symptoms (89.7 versus 3 8.9%, P < 0.001) and not to perceive themselves as being at risk of in fection with HIV (53.6 versus 39.3%, P < 0.05). The proportion of late testers was 34.6% among heterosexually infected patients, 12.7% among homo-/bisexual men and 9.6% among injecting drug users. Factors indep endently associated with a late test were male gender [adjusted odds r atio (aOR), 5.6; 95% confidence interval (CI), 1.7-18.9] and absence o f earned income (aOR, 5.2; 95% CI, 1.4-19) among heterosexually infect ed patients; high education (aOR, 3.1; 95% CI, 1.0-9.6) and having con sulted a person practising alternative medicine (aOR, 3.4; 95% CI, 1.2 -10) in homo-/bisexual men. Conclusions: Despite incentives to be test ed for HIV, many individuals in France are still tested too late, even if they are in known high-risk groups. Efforts to test HIV-infected p eople as early as possible should be made by increasing the perception of HIV risk and decreasing the level of missed opportunities for test ing. Current case management approaches make this recommendation criti cally important from both public health and an individual perspective. (C) 1998 Lippincott-Raven Publishers.