Late diagnosis of HIV infection in women seeking counseling and testing services in Sao Paulo, Brazil

We investigated whether women positive for human immunodeficiency virus (HI V) infection were late in seeking an anonymous HIV counseling and testing s ervice, and the factors associated with a low CD4 count, in Sao Paulo, Braz il. Seventy-one consecutive HIV-1-seropositive women were interviewed by me ans of a structured questionnaire. Blood samples were collected for CD4(+) T-lymphocytes count and determination of HIV-1 subtypes. Hepatitis C, syphi lis, human T-cell lymphotrophic virus type I (HTLV-I), and HTLV-11 infectio ns were assessed by serologic tests. More than 70% of the women had less th an 500 CD4(+) cells/mm(3) (20% below 200). Low CD4 count was significantly associated with sex work history, condom use in the last 6 months, and sero positivity to HTLV-I and syphilis. There was no relation between low CD4 co unt and HIV-1 subtypes. These results indicate that in Sao Paulo many women are seeking an anonymous testing service late in the course of HIV infecti on. The main purposes of anonymous HIV testing services-early diagnosis of infection, and counseling to prevent infection-are not being achieved. Anot her strategy for reducing the interval between infection and diagnosis in w omen must be addressed.