A study presented at the International AIDS conference in Durban last week showed that Africans are still more likely to present at a later stage of disease progression than non-Africans.
A total of 165 Africans and 260 non-Africans diagnosed HIV positive at one of three specialist HIV clinics in North and East London between January 1998 and December 1999 were studied.
Those from African communities had significantly lower CD4 counts (the median being 220) when compared to non-Africans (in whom the median was 380) at time of diagnosis, though there was no significant difference in viral load among the two groups. 33% of African patients had an AIDS-defining illness within one month of their HIV diagnosis, compared to only 18% of non-Africans.
Researchers found that reasons for testing differed significantly among the two groups. Africans were more likely to test because of the development of AIDS, an HIV positive child, or in the antenatal setting. Whereas non-Africans were more likely to test because of patient request or known contact with an infected person.
The non-African group consisted largely of white gay men. Researachers identified a higher likelihood of a prior sexually transmitted infection among the non-African group before being diagnosed HIV-positive and the fact that they were more likely to have previously tested for HIV was attributed to marked differences in health-seeking behaviour between the two groups, as well as the existence of different patterns of access to health services for Africans. Africans were more likely to be in touch with a GP at the time of diagnosis.
The need for early diagnosis
The introduction of antiretroviral therapy has led to a marked decline in HIV/AIDS associated morbidity and mortality in the UK and the rest of the developed world where such therapies are widely available.
However, individuals are only able to benefit from these advances if they are aware of their HIV status. Pre-HAART retrospective studies found that Africans (those ethnically black and born in sub-Saharan Africa) were more likely to present with HIV at a later stage of disease than their non-African counterparts.
Improved survival after an AIDS diagnosis has been linked to a longer awareness of HIV status prior to AIDS diagnosis. In recent years promotional campaigns have encouraged gay men to test for HIV, in order to take full advantage of both clinical services and therapeutic advances.
The researchers suggested a range of strategies to reach African communities. These included:
- A pro testing campaign similar to those used within the gay community
- Expanding HIV testing sites outside of the GUM setting to include community based outreach clinics, family planning services and General Practictioners.
The researchers concluded that there is an urgent need for more innovative models of health delivery to increase awareness of and early access to HIV services among African Communities.
Reference
Burns F et al. Africans with HIV continue to present with advanced disease in the era of HAART. XIII International AIDS Conference, Durban, 2000 (unlisted abstract).