What drives patients to delay HIV care? Preliminary results from a cross-sectional study of a multiracial/ethnic population of HIV-positive persons in California who have never received HIV care

Background: Communities of color are disproportionately represented among persons living with HIV who delay entry into HIV medical care. Understanding ethnic/racial differences in care initiation can inform targeted interventions to improve treatment entry.

Methods: HIV-infected patients who knew their status ≥ 3 months and had never received HIV care were recruited by outreach workers from 11 Bridge Project sites throughout California for an interview (English/Spanish) on their demographics, sexual behaviors, drug use and barriers to HIV care. Results represent data collected between 09/2006-01/2009.

Results: Sixty-five participants completed the survey with 71% male; 42% Latino, 28% Black, 23% White, and 6% other ethnicity/race; and a median age of 32 years (range 19-64 years). Reasons for not initiating HIV medical care included: "Didn't want to think about being HIV-positive" (72%); "Didn't want to tell anyone I was HIV positive" (57%); "Too embarrassed/ashamed to go" (39%); and "Believed that the HIV positive test was wrong (35%)". Latinos were significantly more likely than non-Latinos to report that they believe the HIV test result was wrong, HIV doesn't exist, and natural remedies are safer than HIV medications. Non-Latinos were significantly more likely than Latinos to cite drinking and/or using drugs and missing appointments as barriers to care.

Conclusions: Reasons for delaying HIV care differ by ethnicity/race. In this study, barriers for Latinos were related to patient denial about illness while non-Latinos were more likely to cite substance abuse and missed appointments. Our findings may inform culturally-tailored efforts to better link HIV testing and care.