Why do sub-Saharan Africans present late for HIV care in Switzerland?

Hachfeld, Anna; Darling, K; Calmy, A; Ledergerber, B; Weber, R; Battegay, M; Wissel, K; Di Benedetto, C; Fux, C A; Tarr, P E; Kouyos, R; Ruggia, LS; Furrer, Hansjakob; Wandeler, Gilles (2019). Why do sub-Saharan Africans present late for HIV care in Switzerland? HIV medicine, 20(6), pp. 418-423. Blackwell Science 10.1111/hiv.12727

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Late presentation (LP) to HIV care disproportionally affects individuals from sub-Saharan Africa (SSA). We explored the reasons for late presentation to care among this group of patients in the Swiss HIV Cohort Study.


The prevalence of LP was compared between patients from Western Europe (WE) and those from SSA enrolled between 2009 and 2012. Patients were asked about HIV testing, including access to testing and reasons for deferring it, during face-to-face interviews.


The proportion of LP was 45.8% (435/950) among patients from WE, and 64.6% (126/195) among those from SSA (P < 0.001). Women from WE were slightly more likely to present late than men (52.6% versus 44.5%, respectively; P = 0.06), whereas there was no sex difference in patients from SSA (65.6% versus 63.2%, respectively; P = 0.73). Compared with late presenters from WE, those from SSA were more likely to be diagnosed during pregnancy (9.1% versus 0%, respectively; P < 0.001), but less likely to be tested by general practitioners (25.0% versus 44.6%, respectively; P = 0.001). Late presenters from SSA more frequently reported 'not knowing about anonymous testing possibilities' (46.4% versus 27.3%, respectively; P = 0.04) and 'fear about negative reaction in relatives' (39.3% versus 21.7%, respectively; P = 0.05) as reasons for late testing. Fear of being expelled from Switzerland was reported by 26.1% of late presenters from SSA.


The majority of patients from SSA were late presenters, independent of sex or education level. Difficulties in accessing testing facilities, lack of knowledge about HIV testing and fear-related issues are important drivers for LP in this population.

Item Type:

Journal Article (Original Article)


04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine (ISPM)
04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Hachfeld, Anna, Ruggia, Luciano Silvio, Furrer, Hansjakob, Wandeler, Gilles


600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services




Blackwell Science




Andrea Flükiger-Flückiger

Date Deposited:

21 May 2019 11:53

Last Modified:

05 Dec 2022 15:28

Publisher DOI:


PubMed ID:


Uncontrolled Keywords:

HIV late presentation sub-Saharan Africans





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