Delayed HIV diagnosis is shown to be associated with increased mortality, morbidity and at least twofold short-term costs [4–7]. Furthermore, the consequences and costs of late HIV diagnosis are probably multiplied at the epidemiological level: individuals who are not aware of their HIV infection for years may be a major source of new infections, and thus could
represent the driving force of the epidemic [8–10]. To facilitate early HIV diagnosis, new HIV-testing policies have been promoted. In 2006, the Centre for Disease Prevention and Control (CDC) recommended routine HIV screening in all health care settings for patients Forskolin clinical trial aged 13–64 years, unless the local HIV prevalence is known to be <0.1% . The European Centre for Disease Prevention and Control (ECDC) is evaluating current testing policies in the European Union. The value of universal testing in low-prevalence countries is controversial. However, low HIV prevalence may influence HIV testing by raising the threshold for HIV testing. In some
studies, living in a region with a low prevalence of HIV has been a risk factor for late diagnosis [4,12,13]. Finland is a low-HIV-prevalence country (adult HIV prevalence <0.1%) where HIV was introduced among men who have sex with Bleomycin nmr men (MSM) in the early 1980s and into the heterosexual population some years later . In contrast to many other Western
European countries, HIV infection among injecting drug users (IDUs) was rare until 1998 . However, the incidence of HIV in Finland has gradually risen to a level close to that of other Nordic countries . There is universal access to public health care see more in Finland for legal residents, and the role of municipal primary health care is strong. HIV testing is only compulsory for blood and organ donations. The participation in HIV testing in public maternal care is over 99% after introducing opt-out testing in 1997. Throughout the country, voluntary and free-of-charge HIV testing is available in municipal primary health care. In addition, HIV testing is offered in some cities at sexually transmitted disease (STD) clinics, non-governmental organizations (NGO) AIDS support and counselling centres and within low threshold health service centres (LTHSC) offering needle exchange and other health and social services for IDUs. The aim of the present study was to assess trends in late HIV diagnosis to provide information for improving HIV prevention and testing policies in Finland. We describe 20-year trends in, and determinants of, late HIV diagnosis, determine facilities where HIV testing was performed, and examine delays between HIV diagnosis and entry into clinical care. The Helsinki University Central Hospital (HUCH) serves a population of 1.4 million inhabitants.