Psychosocial Intervention Psychosocial Intervention
Psychosocial Intervention 23 (2014) 177-85 - Vol. 23 No.3 DOI: 10.1016/j.psi.2014.07.011
Determinants of late diagnosis of HIV infection in Spain
Determinantes del diagnóstico tardío de la infección por VIH en España
María José Fuster-Ruiz de Apodacaa,b,, , Fernando Molerob, Encarnación Nouvilasb, Piedad Arazob, David Dalmaub
a Sociedad Española Interdisciplinaria del Sida (SEISIDA), Spain
b Universidad Nacional de Educación a Distancia (UNED), Spain
Received 07 March 2014, Accepted 22 July 2014

The main goal of this study was to analyse the determinants of late diagnosis of HIV infection. Secondly, we studied the role of the perception of risk and sexual orientation in HIV testing. Twenty-five people with late HIV diagnosis were interviewed. They were contacted through hospitals and non-governmental organizations (NGOs). To design the interview, we integrated the variables considered in the main models of health-related behaviour. We followed a mixed strategy of analysis. Firstly, we carried out thematic analysis of the interviews, followed by quantitative analysis of the initially qualitative data. The results revealed that the most relevant determinants were the appraisal of the threat of HIV and the low perception of HIV risk. Also, the study found many missed opportunities for diagnosis in health-care setting. Low perception of HIV risk was related to unrealistic optimism, low levels of information about HIV, and the presence of stereotypes about people with HIV. High perception of HIV risk was related to strategies to avoid testing. Homosexuals reported a more positive balance between the benefits of knowing their diagnosis and having the disease. The results provide clues that can guide the design of future strategies to promote early diagnosis.


El objetivo principal de este estudio fue analizar los determinantes del diagnóstico tardío de la infección por VIH. Asimismo, se estudió el papel que jugaban en ello la percepción de riesgo y la orientación sexual. Se entrevistó a 25 personas con VIH, con las que se estableció contacto a través de hospitales y de organizaciones no gubernamentales (ONG). Para el diseño del guión de la entrevista se partió de una integración de las variables consideradas en los principales modelos de conductas de salud. Se siguió una estrategia mixta de análisis. Primeramente, se realizó análisis temático de las entrevistas. Seguidamente, se realizaron análisis cuantitativos sobre los datos cualitativos. Se halló que los determinantes más relevantes eran la valoración de amenaza del VIH y la baja percepción de riesgo. Se hallaron también oportunidades perdidas de diagnóstico en el sistema sanitario. La baja percepción de riesgo se asociaba con el optimismo irrealista, la poca información sobre el VIH y los estereotipos sobre las personas con VIH. La alta percepción de riesgo se relacionaba con las estrategias de evitación del test. Los discursos de las personas homosexuales mostraron un balance más positivo de los beneficios de conocer el diagnóstico. Los resultados sugieren claves que pueden guiar el diseño de futuras estrategias de promoción del diagnóstico precoz.

This article is only available in PDF
Adler et al., 2009
A. Adler,S. Mounier-Jack,R.J. Coker
Late diagnosis of HIV in Europe: Definitional and public health challenges
AIDS Care, 21 (2009), pp. 284-293
Ajzen, 1991
I. Ajzen
The theory of planned behavior
Organizational behavior and human decision processes, 50 (1991), pp. 179-211
Ajzen and Fishbein, 1980
I. Ajzen,M. Fishbein
Understanding Attitudes and Predicting Social Behavior
Prentice Hall, (1980)
Becker, 1974
M.H. Becker
The health belief model and sick role behavior
Health Education Monographs, 2 (1974), pp. 409-419
Belza et al., 2014
M.J. Belza,C. Figueroa,M.E. Rosales-Statkus,M. Ruiz,F. Vallejo,L.D.L. Fuente
Low knowledge and anecdotal use of unauthorized online HIV self-test kits among attendees at a street-based HIV rapid testing programme in Spain
International Journal of Infectious Diseases, 25 (2014), pp. 196-200
Boyatzis, 1998
R.E. Boyatzis
Transforming qualitative information: Thematic analysis and code development
Sage Publications, (1998)
Bradley et al., 2011
H. Bradley,A. Tsui,A. Kidanu,D. Gillespie
Client characteristics and HIV risk associated with repeat HIV testing among women in Ethiopia
AIDS and Behavior, 15 (2011), pp. 725-733
Braun and Clarke, 2006
V. Braun,V. Clarke
Using thematic analysis in psychology
Qualitative research in psychology, 3 (2006), pp. 77-101
Brooks et al., 2011
R.A. Brooks,S.J. Lee,G.N. Stover,T.W. Barkley
HIV testing, perceived vulnerability and correlates of HIV sexual risk behaviours of Latino and African American young male gang members
International journal of STD & AIDS, 22 (2011), pp. 19-24
Burns et al., 2008
F.M. Burns,A.M. Johnson,J. Nazroo,J. Ainsworth,J. Anderson,A. Fakoya,K.A. Fenton
Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK
Catania et al., 1990
J.A. Catania,L. Pollack,L.J. McDermott,S.H. Qualls
Help-seeking behaviors of people with sexual problems
Archives of Sexual Behavior, 19 (1990), pp. 235-250
Cohen et al., 2007
M.S. Cohen,C. Gay,A.D. Kashuba,S. Blower,L. Paxton
Narrative review: Antiretroviral therapy to prevent the sexual transmission of HIV-1
Annals of Internal Medicine, 146 (2007), pp. 591-601
Deblonde et al., 2010
J. Deblonde,P. De Koker,F.F. Hamers,J. Fontaine,S. Luchters,M. Temmerman
Barriers to HIV testing in Europe: A systematic review
European Journal of Public Health, 20 (2010), pp. 422-432
Delva et al., 2008
W. Delva,F. Wuillaume,S. Vansteelandt,P. Claeys,H. Verstraelen,D.V. Broeck,M. Temmerman
HIV testing and sexually transmitted infection care among sexually active youth in the Balkans
AIDS Patient Care and STDs, 22 (2008), pp. 817-821
Dorr et al., 1999
N. Dorr,S. Krueckeberg,A. Strathman,M.D. Wood
Psychosocial correlates of voluntary HIV antibody testing in college students
AIDS Education and Prevention, 11 (1999), pp. 14-27
European, 2011
European Centre for Disease Prevention and Control [ECDC]/WHO Regional Office for Europe (2012). HIV/AIDS surveillance in Europe 2011. Stockholm: Author. Retrieved from
Ewart, 1991
C.K. Ewart
Social Action Theory for a Public Health Psychology
American Psychologist, 46 (1991), pp. 931-946
Fernández-Dávila et al., 2012
P. Fernández-Dávila,F. Lupiáñez-Villanueva,K. Zaragoza Lorca
Actitudes hacia los programas de prevención on-line del VIH y las ITS y perfil de los usuarios de Internet en los hombres que tienen sexo con hombres
Gaceta Sanitaria, 26 (2012), pp. 123-130
Forsyth et al., 2008
S.F. Forsyth,E.A. Agogo,L. Lau,E. Jungmann,S. Man,S.G. Edwards,A.J. Robinson
Would offering rapid point-of-care testing or non-invasive methods improve uptake of HIV testing among high-risk genitourinary medicine clinic attendees?. A patient perspective
International Journal of STD & AIDS, 19 (2008), pp. 550-552
Glaser and Strauss, 1967
B. Glaser,A. Strauss
The Discovery of Grounded Theory: Strategies for Qualitative Research
Aldine Publishing Company, (1967)
Goodman and Berecochea, 1994
E. Goodman,J.E. Berecochea
Predictors of HIV testing among runaway and homeless adolescents
Journal of Adolescent Health, 15 (1994), pp. 566-572
Hoyos et al., 2013
J. Hoyos,M.J. Belza,S. Fernández-Balbuena,M.E. Rosales-Statkus,J. Pulido,L. de la Fuente
Preferred HIV testing services and programme characteristics among clients of a rapid HIV testing programme
BMC public health, 13 (2013), pp. 1-9
Kalichman and Hunter, 1993
S.C. Kalichman,T.L. Hunter
HIV-related risk and antibody testing: An urban community survey
AIDS Education and Prevention, 5 (1993), pp. 234-243
Krentz and Gill, 2011
H.B. Krentz,M.J. Gill
The direct medical costs of late presentation (< 350/mm3) of HIV infection over a 15-year period
AIDS Research and Treatment, (2011), pp. 1-8
Kwapong et al., 2014
G.D. Kwapong,D. Boateng,P. Agyei-Baffour,E.A. Addy
Health service barriers to HIV testing and counseling among pregnant women attending ANC; a cross-sectional study
BMC health services research, 14 (2014), pp. 267
Landis and Koch, 1977
J.R. Landis,G.G. Koch
The measurement of observer agreement for categorical data
Biometrics, (1977), pp. 159-174
Lebart and Salem, 1994
L. Lebart,A. Salem
Statistique textuelle
Dunod, (1994)
Liddicoat et al., 2004
R.V. Liddicoat,N.J. Horton,R. Urban,E. Maier,D. Christiansen,J.H. Samet
Assessing missed opportunities for HIV testing in medical settings
Journal of General Internal Medicine, 19 (2004), pp. 349-356
Maguen et al., 2000
S. Maguen,L.P. Armistead,S. Kalichman
Predictors of HIV antibody testing among gay, lesbian, and bisexual youth
Journal of Adolescent Health, 26 (2000), pp. 252-257
Myers et al., 1993
T. Myers,K.W. Orr,D. Locker,E.A. Jackson
Factors affecting gay and bisexual men's decisions and intentions to seek HIV testing
American Journal of Public Health, 83 (1993), pp. 701-704
Ostermann et al., 2007
J. Ostermann,V. Kumar,B.W. Pence,K. Whetten
Trends in HIV testing and differences between planned and actual testing in the United States, 2000-2005
Archives of internal medicine, 167 (2007), pp. 2128-2135
Rodríguez-Marín, 2001
J. Rodríguez-Marín
Psicología social de la salud [Social psychology of health]
Síntesis, (2001)
Rogers, 1983
R.W. Rogers
Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation
Social Psychophysiology, pp. 153-176
Ryan and Bernard, 2000
G.W. Ryan,H.R. Bernard
Data management and analysis methods
Handbook of qualitative research (2nd Edition, pp. 769-802
Sambisa et al., 2010
W. Sambisa,S. Curtis,V. Mishra
AIDS stigma as an obstacle to uptake of HIV testing: Evidence from a Zimbabwean national population-based survey
AIDS Care, 22 (2010), pp. 170-186
Secretaría, 2012
Secretaría del Plan Nacional sobre el Sida/Centro Nacional de Epidemiología. Área de Vigilancia y Conductas de Riesgo (2012). Vigilancia epidemiológica del VIH/Sida en España: Sistema de información sobre nuevos diagnósticos de VIH y registro nacional de casos de Sida [Epidemiologic surveillance of HIV/AIDS in Spain: Information System of new diagnoses of HIV and national registration of AIDS cases]. Madrid: Author. Retrieved from
Sobrino-Vegas et al., 2009
P. Sobrino-Vegas,L.G.S. Miguel,A.M. Caro-Murillo,J.M. Miró,P. Viciana,C. Tural,S. Moreno
Delayed diagnosis of HIV infection in a multicenter cohort: Prevalence, risk factors, response to HAART and impact on mortality
Current HIV Research, 7 (2009), pp. 224-230
Stokes et al., 2007
S.H. Stokes,P. McMaster,K.M. Ismail
Acceptability of perinatal rapid point-of-care HIV testing in an area of low HIV prevalence in the UK
Archives of Disease in Childhood, 92 (2007), pp. 505-508
Stolte et al., 2007
I.G. Stolte,J.B. de Wit,M.E. Kolader,H.S. Fennema,R.A. Coutinho,N.H. Dukers
Low HIV-testing rates among younger high-risk homosexual men in Amsterdam
Sexually Transmitted Infections, 83 (2007), pp. 387-391
Weinstein, 1980
N.D. Weinstein
Unrealistic optimism about future life events
Journal of Personality and Social Psychology, 39 (1980), pp. 806-820

( ! ) Warning: Invalid argument supplied for foreach() in /var/www/html/includes_ws/librerias/html/item.php on line 1196
Call Stack
10.0002243392{main}( ).../index.php:0
20.41913650616include( '/var/www/html/includes_ws/plantilla/template.php' ).../index.php:54
30.42413685664include( '/var/www/html/psyint/contenidos/item.php' ).../template.php:20
40.42673763408getAutorCorrespondenciaHTML( ).../item.php:168
Psychosocial Intervention 23 (2014) 177-85 - Vol. 23 No.3 DOI: 10.1016/j.psi.2014.07.011