Determinants of late disease-stage presentation at diagnosis of HIV infection in Venezuela: A case-case comparison

Maeva A Bonjour¹^,2 , Morelba Montagne³ , Martha Zambrano³ , Gloria Molina³ , Catherine Lippuner¹^,4 , Francis G Wadskier⁵ , Milvida Castrillo³ , Renzo N Incani⁵ and Adriana Tami¹^,5^,6

¹Department of Biomedical Research, Royal Tropical Institute, Amsterdam, The Netherlands

²Department of Epidemiology and Biostatistics, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

³Centre for Integral Attention for Sexually Transmitted Diseases and HIV/AIDS, National Program of HIV/AIDS, Ministry of Health and Social Development, Valencia, Venezuela

⁴Department of Biology and Society, Faculty of Earth and Life Sciences, Free University of Amsterdam, Amsterdam, The Netherlands

⁵Department of Parasitology, Faculty of Health Sciences, University of Carabobo, Valencia, Venezuela

⁶Centre of Information Technology, Communication and Assisted Education, Faculty of Health Sciences, University of Carabobo, Valencia, Venezuela

author email corresponding author email

AIDS Research and Therapy 2008, 5:6doi:10.1186/1742-6405-5-6


Published:	16 April 2008

Abstract

Background

Although Venezuela has a National Human Immunodeficiency Virus (HIV) Program offering free diagnosis and treatment, 41% of patients present for diagnosis at a later disease-stage, indicating that access to care may still be limited. Our study aimed to identify factors influencing delay in presenting for HIV-diagnosis using a case-case comparison. A cross-sectional survey was performed at the Regional HIV Reference Centre (CAI), Carabobo Region, Venezuela. Between May 2005 and October 2006 225 patients diagnosed with HIV at CAI were included and demographic, behavioural and medical characteristics collected from medical files. Socio-economic and behavioural factors were obtained from 129 eligible subjects through interviews. "Late presentation" at diagnosis was defined as patients classified with disease-stage B or C according to the 1993 Centers for Disease Control and Prevention (Atlanta, USA) classification, and "early presentation" defined as diagnosis in disease-stage A.

Results

Of 225 subjects, 91 (40%) were defined as late presenters. A similar proportion (51/129) was obtained in the interviewed sub-sample. Older age (>30 years), male heterosexuality, lower socio-economic status, perceiving ones partner to be faithful and living ≥ 25 km from the CAI were positively associated with late diagnosis in a multivariate model. Females were less likely to present late than heterosexual males (odds ratio = 0.23, P = 0.06). The main barriers to HIV testing were low knowledge of HIV/AIDS, lack of awareness of the free HIV program, lack of perceived risk of HIV-infection, fear for HIV-related stigma, fear for lack of confidentiality at testing site and logistic barriers.

Conclusion

Despite the free Venezuelan HIV Program, poverty and barriers related to lack of knowledge and awareness of both HIV and the Program itself were important determinants in late presentation at HIV diagnosis. This study also indicates that women; heterosexual, bisexual and homosexual men might have different pathways to testing and different factors related to late presentation in each subgroup. Efforts must be directed to i) increase awareness of HIV/AIDS and the Program and ii) the identification of specific factors associated with delay in HIV diagnosis per subgroup, to help develop targeted public health interventions improving early diagnosis and prognosis of people living with HIV/AIDS in Venezuela and elsewhere.