Oregon patients with HIV infection who experience delayed diagnosis

Abstract

This project sought to understand factors contributing to the delayed diagnosis of HIV in the state of Oregon, USA in order to increase timely testing and diagnosis. People unaware of their positive HIV status account for a disproportionate number of transmissions of HIV, making delayed diagnosis a profound public health concern. We interviewed a sample of 17 adults, diverse in age, reported risk behaviors and sexual orientation, who were identified as being diagnosed late, about their experiences with testing and diagnosis. We defined delayed diagnosis as a diagnosis of AIDS within 12 months of the first positive HIV test. We conducted thematic analysis using NVivo® software for data management. Three overarching themes emerged: risk perception, missed opportunities for diagnosis, routine testing and the role of the medical community. Definitions of these themes, corresponding sub-themes, and illustrious quotations provide an informative description of characteristics of late testers, factors contributing to delayed diagnosis, and potential points of intervention to increase regular and timely testing. We conclude that routine HIV screening as part of regular medical care might significantly reduce the number of delayed diagnoses and minimize the stigma of testing by normalizing it as part of routine medical care. Earlier diagnosis of HIV will result in better outcomes for individual patients and lower rates of HIV transmission by unknowing individuals.

Keywords:

• delayed diagnosis
• risk perception
• testing barriers

Acknowledgments

We would like to thank Katrina Hedberg for editing and revising the manuscript; Julie Castle for participant recruitment; Kim Toevs for study concept and assistance with participant recruitment; Doris Cordova for interview design, interviews, and participant recruitment; Lea Bush for interview design, interviews, development of sample, and participant recruitment.