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

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Abstract

To describe the determinants of delayed HIV presentation 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 attending a public AIDS program (n=391) were identified. Immigrants composed 24% of our sample; 78.7% of immigrants were Hispanic. Immigrants, compared to U.S.-born patients, presented with lower initial CD4+ counts at diagnosis than U.S.-born patients (287 cells/mm3 vs. 333 cells/mm3, 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. Interviews with 20 newly HIV diagnosed Hispanic patients suggest lack of knowledge regarding HIV risk, social stigma, secrecy and symptom driven health seeking behavior all contribute to delayed clinical presentation. The main precipitants of HIV testing for immigrants were HIV/AIDS related symptoms and sexually transmitted infection (STI)/HIV diagnosis in a sexual partner. These results support augmentation of STI/HIV voluntary clinical testing and partner notification services along the Mexico-California migrant corridor.

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Acknowledgments

Funding for Dr. Levy provided by the University wide AIDS research program of the University of California, Grant number CF02-SMCHC-300. We acknowledge the following for their contributions and invaluable assistance in this research. Sarah Cottrell (San Mateo Department of Public Health), the staffs of the San Mateo County AIDS Program and the Department of Medical Records at the San Mateo Medical Center. We thank David Bangsberg and Dave Huebner for their comments on earlier versions of this work. Lastly, we thank all the patients whose participation and feedback made this research possible.

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Authors and Affiliations

  1. Stanford University School of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford, California, USA

    Vivian Levy, Dennis Israelski & David Katzenstein

  2. San Mateo County- San Francisco Peninsula AIDS Research Center, 222 West 39th Avenue, San Mateo, CA 94103, California, USA

    Vivian Levy, Diane Prentiss, Gladys Balmas, Dennis Israelski & David Katzenstein

  3. San Francisco Department of Public Health, San Francisco, California, USA

    Sanny Chen

  4. Department of Medicine, Center for AIDS Prevention Studies, University of California San Francisco, San Francisco, California, USA

    Kimberly Page-Shafer

Authors
  1. Vivian Levy
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  2. Diane Prentiss
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  3. Gladys Balmas
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  4. Sanny Chen
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  5. Dennis Israelski
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  6. David Katzenstein
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  7. Kimberly Page-Shafer
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Correspondence to Vivian Levy.

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Levy, V., Prentiss, D., Balmas, G. et al. Factors in the Delayed HIV Presentation of Immigrants in Northern California: Implications for Voluntary Counseling and Testing Programs. J Immigrant Health 9, 49–54 (2007). https://doi.org/10.1007/s10903-006-9015-9

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  • DOI: https://doi.org/10.1007/s10903-006-9015-9

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