Parisi Christina E, Gracy Abigail, Ranger Sashaun, Chichetto Natalie, Kwara Awewura, Li Zhigang, Cook Robert L, Canidate Shantrel S
Department of Epidemiology, University of Florida, 2004 Mowry Road, FL, 32610, Gainesville, USA.
Division of Infectious Diseases and Global Medicine, University of Florida College of Medicine, Gainesville, FL, USA.
AIDS Behav. 2025 Jun 3. doi: 10.1007/s10461-025-04792-x.
Late HIV diagnosis is an obstacle to ending the HIV epidemic. This study aimed to identify perceived reasons for late HIV diagnoses through semi-structured interviews among people with HIV. Researchers used the social-ecological model (SEM) to examine how factors at the individual, relationship/interpersonal, and community levels affect timely HIV testing and diagnosis. Nineteen participants who had a CD4 count below 350 cells/µL at the time of their diagnosis (mean age 51.3 years, 5 [26%] cisgender female, 9 [47%] non-Hispanic Black, 7 [37%] non-Hispanic White) and who lived throughout Florida were recruited from the Southern HIV and Alcohol Research Consortium (SHARC) contact registry. Interviews were conducted between December 2023 and March 2024. Common individual-level reasons for late diagnosis included lack of HIV knowledge, denial, avoidance, substance use, and health issues that led to testing. At the relationship/interpersonal level, participants were exposed to HIV by trusted sexual partners, while others experienced stigma that prevented them from seeking testing. At the community level, limited access to healthcare and missed testing opportunities with healthcare providers were major factors contributing to late diagnosis. Our findings highlight the need for research and interventions that address multiple levels of the SEM, as well as targeting both community members and healthcare providers. These results can inform strategies to increase HIV testing, reduce late diagnoses, and support efforts to end the HIV epidemic.
晚期艾滋病毒诊断是终结艾滋病毒流行的一个障碍。本研究旨在通过对艾滋病毒感染者进行半结构化访谈，找出晚期艾滋病毒诊断的潜在原因。研究人员使用社会生态模型（SEM）来考察个体、关系/人际以及社区层面的因素如何影响艾滋病毒的及时检测和诊断。从南方艾滋病毒与酒精研究联盟（SHARC）联系人登记处招募了19名参与者，他们在诊断时CD4细胞计数低于350个/微升（平均年龄51.3岁，5名[26%]顺性别女性，9名[47%]非西班牙裔黑人，7名[37%]非西班牙裔白人），且居住在佛罗里达州各地。访谈于2023年12月至2024年3月期间进行。晚期诊断常见的个体层面原因包括缺乏艾滋病毒知识、否认、回避、药物使用以及导致检测的健康问题。在关系/人际层面，参与者通过值得信任的性伴侣接触到艾滋病毒，而其他人则因受到污名化而无法寻求检测。在社区层面，获得医疗保健的机会有限以及错过与医疗保健提供者的检测机会是导致晚期诊断的主要因素。我们的研究结果凸显了开展针对社会生态模型多个层面以及针对社区成员和医疗保健提供者的研究和干预措施的必要性。这些结果可为增加艾滋病毒检测、减少晚期诊断以及支持终结艾滋病毒流行的努力提供策略参考。
