title: Determinants of delayed diagnosis of HIV infection in France, 1993-1995.
abstract: OBJECTIVE
  To describe the circumstances of the first HIV-positive test and to study the determinants of a delayed diagnosis of HIV infection.
  
  
  METHODS
  In a retrospective study among adult AIDS patients diagnosed between July 1993 and May 1995 in two French districts, data on socioeconomic characteristics, circumstances of first HIV-positive test and attitudes and behaviours regarding medical care were collected in a confidential interview and analysed for potential association with a late test, defined as a first HIV-positive test within 6 months of AIDS diagnosis.
  
  
  RESULTS
  Of the 359 AIDS patients studied, 69 (19.2%) had a late test. Late testers were more likely than other patients to have had an HIV-positive test because of clinical symptoms (89.7 versus 38.9%, P < 0.001) and not to perceive themselves as being at risk of infection with HIV (53.6 versus 39.3%, P < 0.05). The proportion of late testers was 34.6% among heterosexually infected patients, 12.7% among homo-/ bisexual men and 9.6% among injecting drug users. Factors independently associated with a late test were male gender [adjusted odds ratio (aOR), 5.6; 95% confidence interval (CI), 1.7-18.9] and absence of earned income (aOR, 5.2; 95% CI, 1.4-19) among heterosexually infected patients; high education (aOR, 3.1; 95% CI, 1.0-9.6) and having consulted a person practising alternative medicine (aOR, 3.4; 95% CI, 1.2-10) in homo-/bisexual men.
  
  
  CONCLUSIONS
  Despite incentives to be tested for HIV, many individuals in France are still tested too late, even if they are in known high-risk groups. Efforts to test HIV-infected people as early as possible should be made by increasing the perception of HIV risk and decreasing the level of missed opportunities for testing. Current case management approaches make this recommendation critically important from both public health and an individual perspective.
authors.affiliation: European Centre for the Epidemiological Monitoring of AIDS, Hôpital National de Saint-Maurice, France.
authors.forename: E
authors.initials: E
authors.lastname: Couturier
authors.forename: V
authors.initials: V
authors.lastname: Schwoebel
authors.forename: C
authors.initials: C
authors.lastname: Michon
authors.forename: J B
authors.initials: JB
authors.lastname: Hubert
authors.forename: M C
authors.initials: MC
authors.lastname: Delmas
authors.forename: P
authors.initials: P
authors.lastname: Morlat
authors.forename: F
authors.initials: F
authors.lastname: Boué
authors.forename: A M
authors.initials: AM
authors.lastname: Simonpoli
authors.forename: F
authors.initials: F
authors.lastname: Dabis
authors.forename: J B
authors.initials: JB
authors.lastname: Brunet
mesh_terms: D000328:Adult; D005260:Female; D005602:France / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors