Background Although Venezuela has a National Human Immunodeficiency Virus (HIV) Program offering free diagnosis and treatment, 41% of patients present for diagnosis at a later disease-stage, indicating that access to care may still be limited. Our study aimed to identify factors influencing delay in presenting for HIV-diagnosis using a case-case comparison. A cross-sectional survey was performed at the Regional HIV Reference Centre (CAI), Carabobo Region, Venezuela. Between May 2005 and October 2006 225 patients diagnosed with HIV at CAI were included and demographic, behavioural and medical characteristics collected from medical files. Socio-economic and behavioural factors were obtained from 129 eligible subjects through interviews. "Late presentation" at diagnosis was defined as patients classified with disease-stage B or C according to the 1993 Centers for Disease Control and Prevention (Atlanta, USA) classification, and "early presentation" defined as diagnosis in disease-stage A. Results Of 225 subjects, 91 (40%) were defined as late presenters. A similar proportion (51/129) was obtained in the interviewed sub-sample. Older age (>30 years), male heterosexuality, lower socio-economic status, perceiving ones partner to be faithful and living ≥ 25 km from the CAI were positively associated with late diagnosis in a multivariate model. Females were less likely to present late than heterosexual males (odds ratio = 0.23, P = 0.06). The main barriers to HIV testing were low knowledge of HIV/AIDS, lack of awareness of the free HIV program, lack of perceived risk of HIV-infection, fear for HIV-related stigma, fear for lack of confidentiality at testing site and logistic barriers. Conclusion Despite the free Venezuelan HIV Program, poverty and barriers related to lack of knowledge and awareness of both HIV and the Program itself were important determinants in late presentation at HIV diagnosis. This study also indicates that women; heterosexual, bisexual and homosexual men might have different pathways to testing and different factors related to late presentation in each subgroup. Efforts must be directed to i) increase awareness of HIV/AIDS and the Program and ii) the identification of specific factors associated with delay in HIV diagnosis per subgroup, to help develop targeted public health interventions improving early diagnosis and prognosis of people living with HIV/AIDS in Venezuela and elsewhere.

Objective: The purpose of this study was to determine the validity of maternal self reports of obstetrical complications, which are commonly used in estimating the prevalence of complications. These estimates vary greatly between countries and could either reflect true differences or reporting bias. Methods: A cross‐sectional study was conducted among 1027 women in two Bolivian maternity hospitals. A questionnaire recorded mothers' perceptions of obstetrical complications while hospital medical records and physical examinations established their clinical condition. Sensitivity, specificity, predictive values, and percent agreement were obtained for obstetrical conditions. Results: In general, women's reports of obstetrical complications did not match medical diagnoses. The highest agreement was obtained for reporting eclampsia, with less agreement for labor disorders, postpartum hemorrhage and malpresentation. Conclusions: Maternal self reports in this study did not provide a valid estimate of the prevalence of obstetrical complications. Health surveys based on maternal self reports must be interpreted with consideration of this limitation.