Understanding factors behind the late testing and diagnoses of HIV: a review of the international literature

Stephen J. O’Connor and Sharon Manship
Canterbury Christ Church University

Late diagnosis of HIV results in increased morbidity and mortality and raises the potential for onward transmission to others. It also increases costs to health-service providers and impacts on national health budgets. This is a review of the literature available from an international study investigating barriers to early HIV testing from the perspectives of both patients and healthcare professionals. The literature suggests that reasons for late presentation include demographic factors such as age, sex, ethnicity, fear and stigma associated with an HIV diagnosis, and individual risk appraisal, as well as structural and organisational barriers within the healthcare system. Other key issues highlighted by the available literature include the facts that the number of people living with HIV is increasing year on year and the proportion of people presenting with a late HIV diagnosis is increasing not only in MSM but also in other less recognised groups such as heterosexual women and, in particular, older heterosexual men and women. Reasons for late presentation and diagnosis are multifactorial, however, further research into the issue of late presentation and diagnosis of HIV is required including the exploration of reasons why people continue to present late. The review indicated that further work to raise public awareness of the benefits of early testing, together with improved education and training for healthcare professionals, is vital to improve the uptake and timeliness of HIV testing.