Factors in the Delayed HIV Presentation of Immigrants in Northern California: Implications for Voluntary Counseling and Testing Programs

Abstract

To describe the determinants of delayed HIV presentation in one Northern California County, the authors identify persons with an opportunistic infection (OI) at HIV diagnosis. From 2000-2002, a sample of HIV patients attending a public AIDS program (n=391) were identified. Immigrants composed 24% of our sample; 78.7% of immigrants were Hispanic. Immigrants, compared to U.S.-born patients, presented with lower initial CD4+ counts at diagnosis than U.S.-born patients (287 cells/mm(3) vs. 333 cells/mm(3), p=0.143), were more likely to have an OI at HIV diagnosis (29.8% vs. 17.2%, p=0.009), and were more likely to be hospitalized at HIV diagnosis (20.2% vs. 12.5%, p=0.064). We found only immigrant status was significantly and independently associated with delayed presentation. Interviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all contribute to delayed clinical presentation. The main precipitants of HIV testing for immigrants were HIV/AIDS related symptoms and sexually transmitted infection (STI)/HIV diagnosis in a sexual partner. These results support augmentation of STI/HIV voluntary clinical testing and partner notification services along the Mexico-California migrant corridor.

Masculinities and Social Contexts of HIV Risk Practices Among Central Asian Male Migrant Workers

“…Consistent with prior research, factors identified as barriers to HIV testing included misperceptions about HIV, lack of knowledge on the importance of knowing one's HIV status, lack of access to testing, and fears of deportation [24][25][26][27]. These factors have been found in other studies among vulnerable groups as barriers to HIV testing [6,[28][29][30].…”

Retraso diagnóstico y enfermedad avanzada en la infección por el virus de la inmunodeficiencia humana en la Comunidad de Madrid (2007-2011)

“…Se conocen diferentes factores que favorecen la ausencia o el retraso de contacto de los inmigrantes con los servicios de salud: barreras lingüísticas, nivel sociocultural, situación administrativa, estigma social, desconocimientos de aspectos relacionados con la infección [28][29] . Hemos encontrado un mayor riesgo de PEA en todas las áreas estudiadas (excluyendo América del Norte, Asia y Oceanía debido al escaso número nuevos diagnósticos) en relación con Europa Occidental.…”

Methamphetamine and Cocaine Use among Mexican Migrants in California: The California-Mexico Epidemiological Surveillance Pilot

“…Moreover, Mexican-born Latinos are more likely than U.S.-born Latinos to present a short HIV-to-AIDS interval, implying delayed testing and inadequate care and treatment (Espinoza, Hall, Selik, & Xiaohong, 2008;Tang, Levy, & Hernandez, 2008). In addition, in two California studies, it was more likely that Latino immigrants were infected with HIV in the U.S. than in their home countries (Harawa et al, 2002;Levy et al, 2007).…”