Why do sub-Saharan Africans present late for HIV care in Switzerland? HIV Medicine
Late presentation (LP) to care of HIV-1 infected individuals remains a problem, although for many years now it is clear that early initiation of antiretroviral therapy is highly beneficial for the individual but also on the population level.
Hachfeld et al. , explored reasons for LP to HIV care in individuals from sub-Saharan Africa (SSA) in the Swiss HIV Cohort study because this group is disproportionally affected. They compared the prevalence of LP between patients from Western Europe (WE) and those from SSA, enrolled between 2009 and 2012. Patients were asked about HIV testing, including access to testing and reasons for deferring it, during face-to-face interviews.
The proportion of LP was 45.8% (435/950) among patients from WE, and 64.6% (126/195) among those from SSA (P<0.001). Women from WE were slightly more likely to present late than men (52.6% versus 44.5%, respectively; P=0.06), whereas there was no sex difference in patients from SSA (65.6% versus 63.2%, respectively; P=0.73).
Compared with late presenters from WE, those from SSA were more likely to be diagnosed during pregnancy (9.1% versus 0%, respectively; P<0.001), but less likely to be tested by general practitioners (25.0% versus 44.6%, respectively; P=0.001).
Late presenters from SSA more frequently reported ‘not knowing about anonymous testing possibilities’ (46.4% versus 27.3%, respectively; P=0.04) and ‘fear about negative reaction in relatives’ (39.3% versus 21.7%, respectively; P=0.05) as reasons for late testing. Fear of being expelled from Switzerland was reported by 26.1% of late presenters from SSA.
In conclusion, the majority of patients from SSA were late presenters, independent of sex or education level. Difficulties in accessing testing facilities, lack of knowledge about HIV testing and fear-related issues are important drivers for LP in this population.