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- Missed Opportunities
- Avoiding Missed Opportunities
- Gynecological Indicators
HCET Home > On-line Training > HIV Risk Assessment in Women > 4. Importance of Early HIV Diagnosis
4. Importance of Early HIV Diagnosis
- Early diagnosis allows people to take full advantage of antiretroviral therapies and opportunistic infections
prophylaxis.
- Considering that women of childbearing age comprise the largest portion of women living with HIV, early diagnosis also allows the client to make informed reproductive choices. (14)
- Women are less likely than men to receive early diagnosis and treatment, which leads to shorter survival times. However, women whose HIV infections are detected early and who receive appropriate treatment survive as long as HIV-infected men.
- Several studies have demonstrated that women with HIV infection are less likely to receive health care services and antiretroviral therapy than men. While the reasons for this are unclear, it appears that barriers to early diagnosis exist for many women, including:
- Poor access to health care,
- Other more immediate priorities such as children and family,
- Domestic violence,
- Homelessness,
- Lack of social supports, and
- Women may not perceive themselves at risk for HIV infection. (24)
Missed Opportunities Among Women in Health Care
In 1998, McDonald et al. conducted a study to determine the factors prompting HIV testing in women as well as missed opportunities for testing. (29)
- Within the context of this study, a missed opportunity is defined as an encounter with a health care provider for any reproductive health issue regardless of risk factors or any contact with any other health care provider by a patient engaging in high-risk behavior where testing was not performed.
Methods
- 81 women living with HIV were interviewed and asked questions regarding:
- Health care information
- Demographic information
- Sexual/pregnancy history
- Number and types of health encounters in the year before diagnosis
Study Findings
- 73 of the 81 women had a total of 116 health care encounters
- 75% of these encounters were missed opportunities
- 80% of the women had at least one missed opportunity in 12 months before diagnosis
- 78% of the women had a missed opportunity at reproductive health encounters
- Of 25 pregnant women, 12 were not diagnosed during pregnancy
| Who Initiated Testing?
|
|---|
| Health care providers diagnosing HIV infection |
|---|
 |
| Conclusion: Despite visits to reproductive health care providers, the presence of symptoms suspicious of HIV disease, high-risk behaviors and even specific requests for testing by many of the women, numerous opportunities for the earlier diagnosis of HIV infection were missed. |
Gynecological Indicators
- To increase the possibility for early diagnosis, health care providers need to be alert to gynecological problems that may be indicators of HIV infection, including
- Persistent or recurrent vaginal candidiasis (unresponsive to standard therapy)
- Other vaginal infections such as BV, GC, Chlamydia or Trich (recurrent or more severe)
- Severe herpes simplex virus ulcerations (unresponsive to standard therapy)
- Recurrent cervical neoplasia/HPV (despite treatment)
- Idiopathic genital ulcers (no evidence of infectious organism or cancerous cells)
- Recurrent or particularly severe pelvic inflammatory disease
- Persistent urinary tract infections (unresponsive to standard therapy)
- Menstrual irregularities (25)
Avoiding Missed Opportunities
- Offer HIV testing to all women using clinic services
- Perform risk reduction counseling with all clients regardless of testing
- Encourage retesting as needed, as a positive step in managing one’s health
- Encourage testing of current or any new sexual partners
For more information, go to:
- HIV/AIDS Bureau - A Guide to the Clinical Care of Women With HIV/AIDS
