Barriers preventing early testing and diagnosis of HIV: results of a five-year retrospective review of clinical data for those diagnosed HIV positive in two European regions

Stephen J O’Connor1, Sharon Manship1, Momar Diouf2, Jean-Luc Schmit2 and Stephen Clift1
1Canterbury Christ Church University, UK 2Centre Hospitalier Universitaire d’Amiens, France

Background: Late diagnosis of HIV is detrimental to patients, resulting in increased morbidity, mortality, and increased potential for onward transmission. The prevalence of HIV in both the UK and France continues to rise, particularly in non-traditional groups such as heterosexuals and older people, yet at least 20% of those infected with HIV do not know their status and are capable of transmitting the virus to others according to the European Centre for Disease Control/WHO data. Methods: A five-year retrospective review of demographic and clinical data was conducted for every patient diagnosed with HIV (n=406) in two European regions, Kent and Medway in the UK, and Amiens and Creil in France to identify common barriers preventing people from seeking an early HIV test. Results: Findings showed similarities between the two countries in relation to those most likely to present late. Heterosexuals formed the largest group of patients and were more likely to present late, as were migrants or other minority ethnic community members. Gay and bisexual men were likely to seek testing more frequently and had higher rates of early diagnosis than other groups. The two French regions performed better than the UK in respect of early diagnosis in all groups, though still not matching the performance of other French regions. Conclusion: In spite of recent improvements in HIV treatment, it is necessary to educate more white and minority ethnic heterosexuals about the benefits of early HIV testing so that the number of late diagnoses and complications associated with these can be reduced. The study suggests that there is a need to develop specific health promotion and education interventions targeted at these groups, as well as healthcare professionals who continue to attribute signs and symptoms of HIV infection to non-HIV causes.
Keywords: HIV testing, late presentation, late diagnosis, health education, public health