• Christopher S Krawczyk, Ellen Funkhouser, J Michael Kilby, Richard A Kaslow, Amita K Bey, and Sten H Vermund.
• University of Alabama, Birmingham Schools of Public Health and Medicine, Birmingham, AL, USA. CKrawczy@dhs.ca.gov
• South. Med. J. 2006 May 1; 99 (5): 472481472-81.

BackgroundDespite the proven benefits conferred by early human immunodeficiency virus (HIV) diagnosis and presentation to care, delays in HIV medical care are common; these delays are not fully understood, especially in the southern United States.MethodsWe evaluated the extent of, and characteristics associated with, delayed presentation to HIV care among 1,209 patients at an HIV/AIDS Outpatient Clinic in Birmingham, Alabama between 1996 and 2005.ResultsTwo out of five (41.2%) patients first engaged care only after they had progressed to CDC-defined AIDS. Among these, 53.6% were diagnosed with HIV in the year preceding entry to care. Recent presentation (2002 - 2005), male sex, age > or = 25, Medicare or Medicaid insurance coverage, and presentation within six months of HIV diagnosis were independently associated with initiating care after progression to AIDS.ConclusionsA high proportion of patients entered clinical care after experiencing substantial disease progression. Interventions that effectively improve the timing of HIV diagnosis and presentation to care are needed.

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