Department of Psychology, University of Washington, Box 351525, Seattle, WA 98195-1525, USA.
J Urban Health. 2010 Jul;87(4):642-55. doi: 10.1007/s11524-010-9434-8.
We sought to identify factors associated with delayed diagnosis of human immunodeficiency virus (HIV; testing HIV-seropositive 6 months or more after HIV seroconversion), by comparing delayed testers to non-delayed testers (persons who were diagnosed within 6 months of HIV seroconversion), in King County, Washington among men who have sex with men (MSM). Participants were recruited from HIV testing sites in the Seattle area. Delayed testing status was determined by the Serologic Testing Algorithm for Recent HIV Seroconversion or a self-reported previous HIV-negative test. Quantitative data on sociodemographic characteristics, health history, and drug-use and sexual behaviors were collected via computer-assisted self-interviews. Qualitative semi-structured interviews regarding testing and risk behaviors were also conducted. Multivariate analysis was used to identify factors associated with delayed diagnosis. Content analysis was used to establish themes in the qualitative data. Out of the 77 HIV-seropositive MSM in this sample, 39 (51%) had evidence of delayed diagnosis. Factors associated with delayed testing included being African-American, homeless, "out" to 50% or less people about male-male sex, and having only one sex partner in the past 6 months. Delayed testers often cited HIV-related sickness as their reason for testing and fear and wanting to be in denial of their HIV status as reasons for not testing. Delayed testers frequently did not identify as part of the MSM community, did not recognize that they were at risk for HIV acquisition, and did not feel a responsibility to themselves or others to disclose their HIV status. This study illustrates the need to further explore circumstances around delayed diagnosis in MSM and develop outreach methods and prevention messages targeted specifically to this potentially highly marginalized population in order to detect HIV infections earlier, provide HIV care, and prevent new infections.
我们旨在通过比较延迟检测者和非延迟检测者（在 HIV 血清转化后 6 个月内被诊断出 HIV 阳性的人），来确定与人类免疫缺陷病毒（HIV；在 HIV 血清转化后 6 个月或更长时间后进行 HIV 检测呈阳性）诊断延迟相关的因素，该研究在华盛顿州金县（King County）的男男性行为者（MSM）中进行。参与者是从西雅图地区的 HIV 检测点招募的。通过最近 HIV 血清转化的血清学检测算法或自我报告的以前 HIV 阴性检测来确定延迟检测状态。通过计算机辅助的自我访谈收集了社会人口统计学特征、健康史、药物使用和性行为的定量数据。还进行了关于检测和风险行为的定性半结构化访谈。多变量分析用于确定与延迟诊断相关的因素。内容分析用于确定定性数据中的主题。在本样本中，77 名 HIV 血清阳性的 MSM 中有 39 名（51%）有证据表明诊断延迟。与延迟检测相关的因素包括非裔美国人、无家可归、向 50%或更少的人公开自己的男男性行为、以及在过去 6 个月内只有一个性伴侣。延迟检测者经常将与 HIV 相关的疾病作为他们检测的原因，而恐惧和否认自己的 HIV 状况是他们不检测的原因。延迟检测者通常不认为自己是 MSM 群体的一部分，不认为自己有感染 HIV 的风险，也不认为自己有责任向自己或他人披露自己的 HIV 状况。本研究说明了需要进一步探讨 MSM 中延迟诊断的情况，并制定专门针对这一潜在高度边缘化人群的外展方法和预防信息，以便更早地发现 HIV 感染，提供 HIV 护理，并预防新的感染。
