title: Frequent failed early HIV detection in a high prevalence area: implications for prevention.
abstract: To identify the frequency of and factors associated with early detection of HIV infection in Los Angeles County, data were evaluated from interviews of a population-based sample of adult persons with AIDS. Early detection was defined as greater than 5 years between the first reported positive HIV test and an AIDS diagnosis. The associations between early detection and sociodemographic and behavioral factors were assessed for the period January 1997 through June 2002. Over the study period, only 20% (253/1268) of persons interviewed met the criterion for early detection. Early HIV detection was less likely for women (adjusted odds ratio [AOR] = 0.6, 95% confidence interval [CI]: 0.4, 0.9), blacks (AOR = 0.5, 95% CI: 0.4, 0.8), foreign-born Latinos (AOR = 0.2, 95% CI: 0.1, 0.3), U.S.-born Latinos (AOR = 0.3, 95% CI: 0.2, 0.6, and heterosexuals (AOR = 0.5, 95% CI: 0.3, 0.7). Trends of increasing early detection with older age groups (p < 0.001) and higher educational levels (p < 0.001) were also observed. Our findings indicate an overall low level of early HIV detection and suggest that major sociodemographic and risk group disparities exist in the likelihood of early detection among HIV-infected persons in Los Angeles. These differences have important implications for reducing the level of community HIV transmission and for improving individual health outcomes among people with HIV. Aggressive efforts are needed to expand HIV testing and early detection for women, minorities, heterosexuals, younger age groups, and persons of lower education. Links to treatment and behavioral intervention programs should accompany such expanded testing efforts.
authors.affiliation: Epidemiology Program, Los Angeles County Department of Health Services, Los Angeles, California 90005, USA. denjohnson@dhs.co.la.ca.us
authors.forename: Denise F
authors.initials: DF
authors.lastname: Johnson
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Sorvillo
authors.forename: Amy R
authors.initials: AR
authors.lastname: Wohl
authors.forename: Gordon
authors.initials: G
authors.lastname: Bunch
authors.forename: Nina T
authors.initials: NT
authors.lastname: Harawa
authors.forename: Alexander
authors.initials: A
authors.lastname: Carruth
authors.forename: Maribel
authors.initials: M
authors.lastname: Castillon
authors.forename: Breska
authors.initials: B
authors.lastname: Jimenez
mesh_terms: D000328:Adult; D017677:Age Distribution; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006801:Humans; D007182:Income; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D017678:Sex Distribution; D012725:Sexual Behavior; D013997:Time Factors