Human immunodeficiency virus infection and women: A survey of missed opportunities for testing and diagnosis

Objective: Our purpose was to describe factors that prompted testing of women infected with the human immunodeficiency virus and health encounters in which missed opportunities for diagnosis occurred. Study Design: An observational investigation of 81 human immunodeficiency virus–infected women in the Chicago area was performed by means of an interviewer-administered survey. Patient demographic data, health history, and health care contacts were elicited. Results: Sixty-five women (80%) had at least one documented missed opportunity during the 12 months before their diagnosis. Seventy-eight percent of those women with missed opportunities had them occur at reproductive health encounters. Of 25 pregnant women pregnant in the year before their eventual diagnosis, 12 failed to be diagnosed during that pregnancy. Conclusion: Despite visits to reproductive health care providers, the presence of symptoms suspicious for human immunodeficiency virus disease, high-risk behaviors, and even specific requests for testing by many of the women, numerous opportunities for the earlier diagnosis of human immunodeficiency virus infection were missed. (Am J Obstet Gynecol 1998;178:1264-71.)