Factors related to delayed diagnosis of HIV infection in southeastern France

We aimed to identify risk factors associated with delayed diagnosis of HIV infection in a French region highly affected by AIDS. Data were collected i n southeastern France through the HIV-surveillance system based upon anonym ous declarations by laboratories and physicians prescribing HIV testing. Fr om January 1996 to December 1997, 825 persons were diagnosed for the first time as HIV infected (female: 32%; >40 years: 28%); 46% had been infected t hrough heterosexual intercourse, 26% through homosexual intercourse, and 19 % through intravenous drug use. The semestrial (6 monthly) incidence rate d ecreased from 122.7 to 69.7 per million inhabitants (P<0.001). County of re sidence, age, sex, country of birth, and transmission category did not chan ge significantly during the observation period. Twenty-seven per cent had a delayed diagnosis of HIV infection. This proportion did not differ signifi cantly according to sex or country of birth, or during the observation peri od. However, after controlling for the other factors, delay was more freque nt among injecting drug users (IDUs) (35%, P<10(-2)) than other transmissio n categories; it was also positively associated with age (47% above 50 year s vs 13% under 30 years, P<10(-2)). This study highlights that, in spite of the current AIDS prevention policy and wide access to HIV screening, the proportion of delayed diagnosis of HI V infection remains high. Physicians should concern themselves with this pu blic health issue, and campaigns should target people insufficiently aware, especially IDUs and older people. Further research is needed to understand better the causes of delayed diagnoses and of inequalities in access to HI V screening.