Late presentation to HIV/AIDS care in Brazil among men who self-identify as heterosexual

MacCarthy, Sarah; Brignol, Sandra; Reddy, Manasa; Nunn, Amy; Dourado, Inês

doi:10.1590/S1518-8787.2016050006352

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Sumário

Artigos Originais • Rev. Saúde Pública 50 • 2016 • https://doi.org/10.1590/S1518-8787.2016050006352 copy

Late presentation to HIV/AIDS care in Brazil among men who self-identify as heterosexual

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

OBJECTIVE

To analyze the factors associated with late presentation to HIV/AIDS services among heterosexual men.

METHODS

Men infected by HIV who self-identified as heterosexual (n = 543) were included in the study. Descriptive, biivariate and logistic regression analyses were performed to evaluate the factors associated with late presentation (defined as individuals whose first CD4 count was <350 cells/mm³) in the study population.

RESULTS

The prevalence of late presentation was 69.8%. The multivariate logistic analysis showed testing initiated by the provider (OR_adjusted 3.75; 95%CI 2.45–5.63) increased the odds of late presentation. History of drug use (OR_adjusted 0.59; 95%CI 0.38–0.91), history of having sexually transmitted infections (OR_adjusted 0.64; 95%CI 0.42–0.97), and having less education (OR_adjusted 0.63; 95%CI 0.41–0.97) were associated with a decreased odds of LP.

CONCLUSIONS

Provider initiated testing was the only variable to increase the odds of late presentation. Since the patients in this sample all self-identified as heterosexual, it appears that providers are not requesting they be tested for HIV until the patients are already presenting symptoms of AIDS. The high prevalence of late presentation provides additional evidence to shift towards routine testing and linkage to care, rather than risk-based strategies that may not effectively or efficiently engage individuals infected with HIV.

Men’s Health; Heterosexual; Acquired Immunodeficiency Syndrome; Cross-Sectional Studies; Late Presentation; HIV/AIDS

Variable	Men who self-identify as heterosexual
	(n = 543)

	n	%
CD4 cell count at presentation to care
< 350 cells/mm³	379	69.8
≥ 350 cells/mm³	164	30.2
Reported sexual practice
Reported sex with women only	285	52.5
Reported sex with women and men	258	47.5
Age (years)
18-44	309	56.9
45-86	234	43.1
Skin color
Brown	253	46.7
Black	177	32.7
White, Yellow, Indigenous, or other	112	20.6
Individual income*
> Minimum wage	415	76.4
≤ Minimum wage	118	23.6
Employment
Employed	270	49.8
Unemployed	272	50.2
Years of schooling
> 8 years	237	43.7
≤ 8 years	306	56.3
Reason for taking an HIV test
Patient requested the HIV test/Other	203	37.4
Provider requested the HIV test	340	62.6
Perceived HIV risk
No	411	76.0
Yes	130	24.0
History of drug use
No	373	68.7
Yes	170	31.3
Number of sexual partners in the last 12 months
≤ One	329	63.8
> One	187	36.2
History of STI
Never	322	59.9
At least once	216	40.1

Variable	Late presentation among men who self-identify as heterosexual

	n	%	OR	95%CI
Reported sexual practice
Reported sex with women only	200	70.2	1.00
Reported sex with women and men	179	69.4	0.96	0.67–1.39
Age (years)
18-44	214	69.3	1.00
45-86	165	56.6	1.06	0.73–1.54
Skin color
Brown	171	67.6	1.00
Black	126	71.2	1.18	0.78–1.80
White, Yellow, Indigenous, or other	81	72.3	1.25	0.77–2.05
Individual Income*
> Minimum wage	290	70.0	1.00
≤ Minimum wage	89	69.5	0.98	0.64–1.51
Employment
Employed	175	64.8	1.00
Unemployed	203	74.6	1.60	1.10–2.32
Years of schooling
> 8 years	172	72.6	1.00
≤ 8 years	207	67.7	0.79	0.41–0.89
Reason for taking an HIV test
Patient requested the HIV test/Other	104	51.2	1.00
Provider requested the HIV test	275	80.9	4.02	2.68–6.05
Perceived HIV risk
No	123	64.1	1.00
Yes	254	73.0	1.52	1.04–2.22
History of drug use
No	273	73.2	1.00
Yes	106	62.4	0.61	0.41–0.89
Number sexual partners in the last 12 months
≤ One	234	71.1	1.00
> One	126	67.4	0.84	0.57–1.24
History of STI
Never	235	73.0	1.00
At least once	140	64.8	0.68	0.57–1.23

Variable	Late presentation among men who self-identify as heterosexual

	n	%	OR	95%CI
Reported sexual practice
Reported sex with women only	200	70.2	1.00
Reported sex with women and men	179	69.4	1.51	0.85–2.69
Age (years)
18-44	214	69.3	1.00
45-86	165	70.5	0.93	0.60–1.42
Skin color
Brown	171	67.6	1.00
Black	126	71.2	1.58	0.98–2.53
White, Yellow, Indigenous, or other	81	72.3	1.23	0.71–2.13
Employment
Employed	175	64.8	1.00
Unemployed	203	74.6	1.52	0.99–2.31
Years of schooling
> 8	172	72.6	1.00
≤ 8	207	67.7	0.63	0.41–0.97
Reason for taking an HIV test
Patient requested the HIV test/Other	104	51.2	1.00
Provider requested the HIV test	275	80.9	3.82	2.49–5.85
Perceived HIV risk
No	298	72.5	1.00
Yes	80	61.5	0.87	0.54–1.41
History of drug use
No	273	73.2	1.00
Yes	106	62.4	0.58	0.37–0.91
Number sexual partners in the last 12 months
≤ One	234	71.1	1.00
> One	126	67.4	0.67	0.37–1.20
History of sexually transmitted infection
Never	235	73.0	1.00
At least once	140	64.8	0.62	0.40–0.95

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E-mail: revsp@usp.br

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[1] Correspondence: Sarah MacCarthy RAND Corporation 1776 Main Street Santa Monica, 90403 California, USA E-mail: sarahm@rand.org