Understanding factors behind the late testing and diagnoses of HIV: a review of the international literature

Late diagnosis of HIV results in increased morbidity and mortality and raises the potential for onward transmission to others. It also increases costs to health service providers and impacts on national health budgets. This paper reports results from a literature review conducted to inform the conduct of an international study investigating barriers to early HIV testing from the perspectives of both patients and healthcare professionals. The literature suggests that reasons for late presentation include demographic factors such as age, sex and ethnicity; fear and stigma associated with an HIV diagnosis; and individual risk appraisal, as well as structural and organisational barriers within the healthcare system. Other key issues highlighted by the literature review include the fact that: the number of people living with HIV is increasing year on year, the proportion of people presenting with a late HIV diagnosis is increasing not only in MSMs but also in other less recognised groups such as heterosexual women and in particular, older heterosexual men and women. Reasons for late presentation and diagnosis are multifactorial, but further research into the issue of late presentation and diagnosis of HIV is required, including the exploration of reasons why people continue to present late. The review indicated that further work to raise public awareness of the benefits of early testing, together with improved education and training for healthcare professionals is vital to improve the uptake and timeliness of HIV testing.