The association between HIV-related stigma, HIV knowledge, and HIV late presenters among people living with HIV (PLHIV) attending public primary care clinic settings in Selangor / Mohd Zulfikry Ahmad

Introduction: Early diagnosis and treatment of HIV have proven beneficial for people living with HIV (PLHIV), reducing the burden on healthcare systems, and contributing to ending the HIV/AIDS epidemic. However, in Malaysia, over 50% of newly diagnosed HIV patients present late, leading to increased morbidity and premature mortality. This study aims to determine the prevalence of late HIV presenters and its association with HIV-related stigma and HIV knowledge among PLHIV attending public primary care clinics in Selangor.
Methods: A cross-sectional study was conducted at selected public health clinics in Selangor, involving PLHIV aged 18 years and older, who were diagnosed since 2019. In this study, late presenters were defined as individuals presenting with a CD4 count below 350 cells/µL or with an AIDS-defining event, according to the European Late Presenter Consensus working group. HIV-related stigma was measured using the Malay version of Berger's HIV Stigma Scale, and HIV knowledge was assessed using the Malay version of Brief HIV-KQ-18. Univariate and multivariate logistic regression analyses were performed to identify factors associated with late HIV presentation.
Results: A total of 400 participants were included in the study, with 60.0% (n=240, 95% CI: 55.0-65.0) classified as late presenters. The participants had a mean age of 30.29 (±7.77) years. The risk factors for late presenters were high levels of HIV-related stigma (aOR=1.049, 95% CI: 1.034-1.063, p-value <0.001), low levels of HIV knowledge (aOR=0.709, 95% CI: 0.6460.778, p-value <0.001), tertiary education background (aOR=15.962, 95% CI: 1.898-134.235, p-value =0.011), and being single (aOR=3.582, 95% CI: 1.393-9.208, p-value=0.008).
Conclusion: This study highlights the association between high levels of HIV-related stigma, low levels of HIV knowledge, and late HIV presentation. Effective intervention programs targeting early HIV diagnosis, improved HIV care, and treatment are necessary to address this issue.