We were pleased to learn of your examination of a distinct population-based sample of HIV-infected patients in southern Alberta, Canada, with regard to the possible delay between notification of HIV-positive status and presentation for HIV-related primary medical care. The finding that this delay in your region affected less than half the percentage of people who were affected at our 2 urban hospitals is of great interest (39% of our group delayed ≥ 12 months). Your results suggest that a portion of the delay may relate to the medical system in which the HIV-infected person seeks care. Our findings mainly focused on individual factors that may in part account for the delay in seeking care after learning of one's positive serostatus. We agree that it is likely that system issues are important factors in the delay phenomenon; however, sorting this out is complex. In fact, in both Massachusetts and Rhode Island, HIV-related care that includes medications and laboratory testing is readily available, irrespective of the individual's insurance coverage or ability to pay, as is the case in Canada. It may well be that to the infected individual the perception is different.
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