Abstract

Circumstances that led to a diagnostic HIV test in a Caribbean Island. Medical Research Foundation, Trinidad and Tobago

S. Soyer-Labastide, C. Bartholomew

Medical Research Foundation, Port of Spain, Trinidad and Tobago

Background: Almost 30 years after AIDS was first recognized, with the advent of rapid testing, antiretrovirals, voluntary counseling and testing (VCT) and educational programmes, it is hoped that having an HIV test would be proactive and not reactive. This study identified the reasons for patients having an HIV test before attending our treatment centre.
Methods: From April 2002 to December 2009, of 5310 patients, 2464 (46%) were asked to identify the circumstances that led to their positive HIV test, at first entry into the clinic.
Results: Of the 2464 patients, 1189 (48%) were males, 1275 (52%) females; heterosexuals 2229 (90%), bisexuals 128 (5%) and homosexuals 107 (5%). Patients were classified into two groups based on their CD4 counts at entry. Of these, 978 (40%) had CD4 counts ≤200 cells/mm³ and 1486 (60%) had CD4 counts > 200cells/mm³.

Reason for HIV test	CD4 ≤ 200cells/mm³	CD4 > 200cells/mm³	Total
Illness	668 (68%)	383 (26%)	1051 (42%)
Pregnancy	48 (5%)	287 (19%)	335 (14%)
VCT	91 (9%)	331 (22%)	422 (7%)
Partner´s HIV status	129 (13%)	377 (25%)	506 (21%)
Other	43 (5%)	107 (8%)	150 (6%)

[Reason for HIV test]


The other reasons for HIV testing were seeking visas 15 (0.6%), employment 28 (1%), and insurance 38 (1.5%).Additional reasons were drug rehabilitation 19 (0.7%), rape 9 (0.3%), imprisonment 7 (0.2%), blood donor 16 (0.6%), HIV+ child 18 (0.7%).
Conclusions: As many as 978 (40%) were late presenters (CD4 count ≤200 cells/mm³) and because only 7% of these patients became aware of their HIV status as a result of attending a VCT centre, the Ministry of Health has been advised to establish more centers throughout the island and to embark on a more intensive programme to encourage sexually active people to be tested.