In Australia, people who have engaged in an identifiable risk behaviour comprise the majority of those diagnosed with HIV, such as men who have sex with men (MSM). However, as noted above, significant numbers of infections are diagnosed in women, people from culturally and linguistically diverse (CALD) backgrounds and people in older age groups (13, 14) Personal and health-care provider ignorance about risk, social isolation, poor access to health care, language and cultural barriers, HIV-related stigma and fear of discrimination are some factors which prevent people from having timely HIV testing (13).  A recent study in Europe highlights similar barriers, especially for migrant women (15). 

Late presenters may have had limited contact with health services before their HIV diagnosis, but in some cases, a person may have attended primary health services with HIV-related indicator conditions e.g. seborrhoeic dermatitis, oral candidiasis (thrush) or unexplained weight loss, but the health care provider has not considered HIV.  Healthcare workers may not have the knowledge to consider HIV or may not identify risk factors for HIV infection, resulting in missed or delayed diagnoses (16).