title: Understanding delay to medical care for HIV infection: the long-term non-presenter.
abstract: OBJECTIVE
  To examine delayed presentation for HIV testing and primary care in the second decade of the AIDS epidemic.
  
  
  METHODS
  Cohort study in two urban hospitals in the USA between February 1994 and April 1996.
  
  
  METHODS
  A total of 203 consecutive outpatients on initial HIV primary care presentation were interviewed about sociodemographic characteristics, alcohol and drug use, social support, sexual practices, HIV testing, awareness of possible HIV infection, and CD4 cell count.
  
  
  METHODS
  Duration of delay to medical presentation in years based on CD4 cell count, factors independently associated with low CD4 cell counts, frequency of awareness of HIV risk before testing.
  
  
  RESULTS
  The estimated mean duration between acquiring HIV infection and initial presentation to primary care was 8.1 years (95% CI 7.5, 8.6) based on our cohort's median initial CD4 cell count of 280/microl. Male sex, older age, and no jail time were associated with lower CD4 cell counts; 34% reported not being aware that they were at risk of HIV before testing. Heterosexual intercourse as a risk behavior for HIV was the most statistically significant factor for personal unawareness of HIV risk. Of those who acknowledged awareness, the mean time between awareness of HIV risk and testing was 2.5 years (median 1.0 year).
  
  
  CONCLUSIONS
  In the pre-highly active antiretroviral therapy era, HIV-infected patients frequently initiated primary medical care years after initial infection, at a time of advanced immunosuppression. Over one-third of HIV-infected patients were not cognisant of their HIV risk before testing, a condition significantly associated with heterosexual intercourse as the only HIV risk behavior.
authors.affiliation: Department of Medicine, Boston University School of Medicine and Public Health, MA, USA. jsamet@bu.edu
authors.forename: J H
authors.initials: JH
authors.lastname: Samet
authors.forename: K A
authors.initials: KA
authors.lastname: Freedberg
authors.forename: J B
authors.initials: JB
authors.lastname: Savetsky
authors.forename: L M
authors.initials: LM
authors.lastname: Sullivan
authors.forename: M D
authors.initials: MD
authors.lastname: Stein
mesh_terms: D000328:Adult; D018791:CD4 Lymphocyte Count; D015331:Cohort Studies; D004196:Disease Outbreaks; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000276:immunology / Q000523:psychology / Q000628:therapy; D020276:HIV Long-Term Survivors; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology; D013997:Time Factors; D014481:United States / Q000453:epidemiology