title: Effects of region of birth, educational level and age on late presentation among men who have sex with men newly diagnosed with HIV in a network of STI/HIV counselling and testing clinics in Spain.
abstract: This paper analyses late presentation (LP) of HIV infection, and its determinants, among men who have sex with men (MSM) in Spain, newly diagnosed with HIV (2003-2011) in 15 sexually transmitted infection/HIV counselling and testing clinics. LP was defined as <350 CD4 cells/µL or AIDS. In total, 3,081 MSM were included (2,499 having CD4/AIDS); overall LP was 25.3%. LP was higher in men older than 34 years, those not previously HIV-tested (adjusted odds ratio (aOR):3.1; 95% confidence intervals (CI):2.3-4.2) , and those tested > 12 months before diagnosis (12-24 months (aOR:1.4; 95% CI:1.0-2.0); > 24 months (aOR:2.2; 95% CI:1.7-3.0)). LP was less likely in MSM reporting a known HIV-infected partner as infection source or symptoms compatible with acute retroviral syndrome. 'Region of birth' interacted with 'educational level' and 'steady partner as infection source': only African and Latin-American MSM with low educational level were more likely to present late; Latin-American men attributing their infection to steady partner, but no other MSM, had LP more frequently. In Spain, HIV testing among MSM should be promoted, especially those > 34 years old and migrants with low educational level. The current recommendation that MSM be tested at least once a year is appropriate.
authors.affiliation: area de Vigilancia del VIH y comportamientos de riesgo, Centro Nacional de Epidemiologia, Instituto de Salud Carlos III, Madrid, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Diaz
authors.forename: J
authors.initials: J
authors.lastname: del Romero
authors.forename: C
authors.initials: C
authors.lastname: Rodriguez
authors.forename: I
authors.initials: I
authors.lastname: Alastrue
authors.forename: J
authors.initials: J
authors.lastname: Belda
authors.forename: F J
authors.initials: FJ
authors.lastname: Bru
authors.forename: M M
authors.initials: MM
authors.lastname: Cámara
authors.forename: M L
authors.initials: ML
authors.lastname: Junquera
authors.forename: I
authors.initials: I
authors.lastname: Sanz
authors.forename: L J
authors.initials: LJ
authors.lastname: Viloria
authors.forename: L
authors.initials: L
authors.lastname: Gil
authors.forename: E
authors.initials: E
authors.lastname: Martínez
authors.forename: F
authors.initials: F
authors.lastname: Gual
authors.forename: M C
authors.initials: MC
authors.lastname: Landa
authors.forename: I
authors.initials: I
authors.lastname: Pueyo
authors.forename: J M
authors.initials: JM
authors.lastname: Ureña
authors.forename: B
authors.initials: B
authors.lastname: Martínez
authors.forename: J A
authors.initials: JA
authors.lastname: Varela
authors.forename: A
authors.initials: A
authors.lastname: Polo
authors.forename: M A
authors.initials: MA
authors.lastname: Azpiri
authors.forename: M
authors.initials: M
authors.lastname: Diez
mesh_terms: D000328:Adult; D000349:Africa / Q000208:ethnology; D017668:Age of Onset; D003151:Community Health Centers; D003376:Counseling; D057210:Delayed Diagnosis; D004522:Educational Status; D015658:HIV Infections / Q000175:diagnosis* / Q000208:ethnology / Q000635:transmission; D018451:Homosexuality, Male; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis; D013030:Spain / Q000453:epidemiology