title: Access to medical care one year prior to diagnosis in 100 HIV-positive women.
abstract: BACKGROUND
  Anonymous antenatal testing for HIV antibodies suggests that the majority of HIV-positive women in the UK remain undiagnosed. Primary care reaches the majority of the population and women present more often than men. Sexual health matters are frequently raised, so there is an opportunity to discuss concerns with respect to HIV. Women often present with advanced HIV disease and with antiviral treatments proving to be more effective, there is now an even greater incentive to diagnose HIV early.
  
  
  OBJECTIVE
  We aimed to look at access to medical care 1 year prior to HIV diagnosis in 100 HIV-positive women and to establish whether a discussion regarding HIV was recalled.
  
  
  METHODS
  The setting was an established clinic for HIV-positive women in the Royal Free Hospital, London. In a 6-month period a questionnaire was completed by 100 women with their clinic doctor.
  
  
  RESULTS
  Women were young (mean age 31). Most (84%) were infected by heterosexual sex. Forty-six per cent of the women presented with symptomatic HIV or AIDS and 50% were black Africans, hence there is a large ethnic bias in this sample. General practice was accessed by 65% of the women 1 year prior to HIV diagnosis. Few (14%) women recalled a discussion concerning HIV. Secondary care settings such as gynaecology and general outpatients were also frequently attended, but again HIV was apparently rarely discussed. There was no significant difference when variables such as time since diagnosis, health care setting, or ethnic group were concerned with respect to recall of a discussion concerning HIV.
  
  
  CONCLUSIONS
  Despite coming from 'high risk' groups or presenting with symptomatic disease in the year prior to HIV diagnosis, few women recalled discussing HIV in either primary or secondary care settings. As these sites were commonly accessed, we feel that doctors and other health care workers should be encouraged and trained to raise HIV more routinely in their consultations.
authors.affiliation: Department of Thoracic Medicine, Royal Free Hospital, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Madge
authors.forename: A
authors.initials: A
authors.lastname: Olaitan
authors.forename: A
authors.initials: A
authors.lastname: Mocroft
authors.forename: A
authors.initials: A
authors.lastname: Phillips
authors.forename: M
authors.initials: M
authors.lastname: Johnson
mesh_terms: D000328:Adult; D000553:Ambulatory Care / Q000592:standards / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D006679:HIV Seropositivity / Q000175:diagnosis; D006297:Health Services Accessibility; D006801:Humans; D008131:London; D008487:Medical History Taking / Q000592:standards; D012189:Retrospective Studies; D016387:Women's Health