Barriers to health care services for migrants living with HIV in Spain.

Background: In Spain, migrants are disproportionately affected by HIV and experience high rates of late diagnosis. We investigated barriers to health care access among migrants living with HIV (MLWH) in Spain. Methods: Cross sectional electronic survey of 765 adult HIV-positive migrants recruited within 18 health care settings between July 2013 and July 2015. We collected epidemiological, demographic, behavioral and clinical data. We estimated the prevalence and risk factors of self-reported barriers to health care using multivariable logistic regression. Results: Of those surveyed, 672 (88%) had information on health care access barriers: 23% were women, 63% from Latin America and Caribbean, 14% from Sub-Saharan Africa and 15% had an irregular immigration status. Men were more likely to report barriers than women (24% vs. 14%, P = 0.009). The main barriers were: lengthy waiting times for an appointment (9%) or in the clinic (7%) and lack of a health card (7%). Having an irregular immigration status was a risk factor for experiencing barriers for both men (OR: (4.0 [95%CI: 2.2-7.2]) and women (OR: 10.5 [95%CI: 3.1-34.8]). Men who experienced racial stigma (OR: 3.1 [95%CI: 1.9-5.1]) or food insecurity (OR: 2.1 [95%CI: 1.2-3.4]) were more likely to report barriers. Women who delayed treatment due to medication costs (6.3 [95%CI: 1.3-30.8]) or had a university degree (OR: 5.8 [95%CI: 1.3-25.1]) were more likely to report barriers. Conclusion: Health care barriers were present in one in five5 MLWH, were more common in men and were associated to legal entitlement to access care, perceived stigma and financial constraints.

[Relationship between the distance to hospital emergency services and their utilization]. / Relación entre la distancia a los servicios de urgencias hospitalarias y su utilización.

The relationship between the distance to the Elche County Hospital, grouping the towns in its area of influence into four categories (over 29 km, 20 to 19 Km, under 20 Km and Elche proper), and the rates regarding the use of this hospital's emergency room services are studied based on a sample of 3,546 emergency cases treated in said hospital in 1985. The relative standardized risks by age (RelR) are significantly greater than 1 in all categories regarding that of 29 Km, concerning both men (1.36, 2.64, 3.86) and women (1.52, 2.02, 3.87). This is an association which follows a statistically significant upward trend concerning men (X ext-Mantel = 21.63 p less than 0.01) and women (X ext-Mantel = -18.85 p less than 0.01) as the distance decreases. We point out the limitations of the study, and some implications of the inverse association found (b = -0.38 for men and -0.29 for women p less than 0.05) are discussed with regard to refocusing health care services.

[Opinion of asymptomatic HIV-positive patients about their primary care physicians]. / Opinión de los pacientes VIH positivos asintomáticos sobre sus médicos de atención primaria.

OBJECTIVE: To find the opinion of asymptomatic HIV+patients about their Primary Care doctors. DESIGN: A descriptive, crossover study with an 11-item questionnaire, filled in by the patient him/herself anonymously and analysing: communication of being seropositive, frequency of attendance, confidence in the doctor and their competence in dealing with the patient. SETTING: AIDS Information and Prevention Centre, Alicante. PATIENTS: Consecutive sampling of the first 100 HIV+patients who attended voluntarily during the first 5 months of 1993 (from January 3 to May 18 inclusive). MEASUREMENTS: 60.2% (C.I. 95%, 69.9%--50.5%) said they communicated their being seropositive to the doctor. Intravenous drug users communicated this fact more (72.9%), against 41% of the rest of the groups (p = 0.0016). 25% had little or no confidence in their doctor and 44% considered him/her incompetent or barely competent, with these two variables being related (r = 0.42; p = 0.0001). Communicating their condition to the doctor is only related to more frequent attendance at the clinic (p = 0.0001). The reasons for not doing so are due mainly to lack of confidence (30.8%) and "didn't think of it" (46.2%). The doctor's competence obtained the lowest points average, 2.6, with its Confidence limits sharing no value with frequency of attendance or confidence. CONCLUSIONS: An important percentage of patients do not communicate their condition, due basically to problems of confidentiality and rejection. There are doubts among HIV+patients interviewed about their doctor's competence, at the same time as they have little confidence in him/her.