title: Delay between first HIV-related symptoms and diagnosis of HIV infection in patients attending the internal medicine department of the Fondation Jeanne Ebori (FJE), Libreville, Gabon.
abstract: BACKGROUND
  HIV-infected patients (pts) in Africa are often diagnosed at very advanced stages of disease. They seek relief using traditional medicine or religious beliefs. General practitioners (GPs) are often consulted first. Once the HIV diagnosis has been made, concomitant use of alternative and allopathic medicine is also frequent.
  
  
  OBJECTIVE
  To describe the delay between presentation of HIV-related symptoms and diagnosis, the first physician consulted, and the use of traditional medicine or religion as an alternative or complement to allopathic medicine in HIV-infected patients.
  
  
  METHODS
  Patients followed for HIV infection at Fondation Jeanne Ebori were retrospectively interviewed to trace their therapeutic itinerary.
  
  
  RESULTS
  150 pts were interviewed. There were 63% females, mean age was 39 years, median CD4 count was 242 cells/microL (102-394), CDC stage A/B/C was 32%/40%/28%, and 57% had very low income. Religious affiliations were Catholic (52%), Protestant (21%), Muslim (3%), "progressive" Church (16%), and none (7%). The median time elapsed between their first symptoms and HIV diagnosis was 124 (20-292) days. The first person consulted was a traditional healer (5%), GP (61%), or private clinics (23%). Traditional healers were consulted for initiation rites in 23%, cure of disease in 90%, or sorcery in 20%. Once allopathic medicine was started, concomitant alternative therapy occurred in 25 (17%) for traditional medicine and 4 (3%) for faith healing. Resort to traditional healer (odds ratio [OR] 2.6, p = .02) and to faith healing (OR 3.1, p = .048) were risk factors for diagnosis delay.
  
  
  CONCLUSIONS
  Many factors related to patients, the health system, and culture or society are detrimental to an early diagnosis of HIV infection in Gabon. Increasing awareness of the risk of HIV infection throughout the general population and hope and trust in western medicine in patients and non-HIV-specialist physicians, as well as suppression of social stigma, could shorten the delay before diagnosis. Better communication between allopathic physicians and traditional or faith healers could also improve the care of HIV-infected patients.
authors.affiliation: Infectious Diseases Unit, Fondation Jeanne Ebori, Libreville, Gabon.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Okome-Nkoumou
authors.forename: Fleur
authors.initials: F
authors.lastname: Okome-Miame
authors.forename: Eric
authors.initials: E
authors.lastname: Kendjo
authors.forename: Guy-Patrick
authors.initials: GP
authors.lastname: Obiang
authors.forename: Philomène
authors.initials: P
authors.lastname: Kouna
authors.forename: Olivia
authors.initials: O
authors.lastname: Essola-Biba
authors.forename: Jean
authors.initials: J
authors.lastname: Bruno Boguikouma
authors.forename: Michel
authors.initials: M
authors.lastname: Mboussou
authors.forename: Philippe
authors.initials: P
authors.lastname: Clevenbergh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003466:Cultural Characteristics; D005260:Female; D005681:Gabon / Q000453:epidemiology; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology; D006801:Humans; D008297:Male; D008499:Medical Records; D016488:Medicine, African Traditional; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012067:Religion; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors