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

To describe the determinants of delayed HIV pre- sentation 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 at- tending a public AIDS program (n = 391) were identified. Immigrants composed 24% of our sample; 78.7% of im- migrants 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. In- terviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all con-