Study on the approach to HIV: health management and the healthcare process in Spain.

INTRODUCTION: HIV continues to represent a problem of great relevance for public health in Spain. This study aims to carry out an analysis that will provide in-depth knowledge of the resources, clinical care, and management during the diagnosis, follow-up, and treatment phases of HIV infection in Spain. METHODS: In the first phase, a multidisciplinary Scientific Committee designed an information collection tool in the form of a survey. In the second phase, carried out in the autonomous communities of Andalusia, Catalonia, and La Rioja, a multidisciplinary group of 42 experts, representatives of the public administration, clinical profiles, and representatives of NGOs in the field of HIV answered the survey. RESULTS: The assessment of HIV resources is generally positive. As regards diagnosis, the experts considered that there was good coordination between Primary and Hospital care. Regarding treatment, the evaluations reflected good opinions on therapeutic conciliation and adherence, with a negative opinion in the evaluation of drug interactions with antiretroviral treatment. Regarding follow-up, the perception expressed was disparate concerning the coordination between Hospital and Primary Care as well as the adaptation of care to chronicity, aging, fragility, mental health, and oncological processes. CONCLUSION: There are certain processes that can be improved in the management of HIV infection in people with HIV in Spain, including protocols for follow-up and coordination between primary and hospital care in the treatment and follow-up of the disease.

Consensus statement on the role of health systems in advancing the long-term well-being of people living with HIV.

Health systems have improved their abilities to identify, diagnose, treat and, increasingly, achieve viral suppression among people living with HIV (PLHIV). Despite these advances, a higher burden of multimorbidity and poorer health-related quality of life are reported by many PLHIV in comparison to people without HIV. Stigma and discrimination further exacerbate these poor outcomes. A global multidisciplinary group of HIV experts developed a consensus statement identifying key issues that health systems must address in order to move beyond the HIV field's longtime emphasis on viral suppression to instead deliver integrated, person-centered healthcare for PLHIV throughout their lives.

Impact of Advanced HIV Disease on Quality of Life and Mortality in the Era of Combined Antiretroviral Treatment.

Currently, AIDS or severe immunodeficiency remains as a challenge for people with HIV (PWHIV) and healthcare providers. Our purpose was to analyze the impact of advanced HIV disease (AHD) on mortality, life expectancy and health-related quality of life (HRQoL). We reviewed cohort studies and meta-analyses conducted in middle- and high-income countries. To analyze HRQoL, we selected studies that reported overall health and/or physical/mental health scores on a validated HRQoL instrument. AIDS diagnosis supposes a higher risk of mortality during the first six months, remaining higher for 48 months. It has been reported that cancer and cardiovascular disease persist as frequent causes of mortality in PWHIV, especially those with previous or current AHD. PWHIV who initiate combination antiretroviral therapy (cART) with CD4 < 200 cells/µL have significantly lower estimated life expectancy than those with higher counts. AHD is associated with lower HRQoL, and a worse physical health or mental health status. AIDS and non-AIDS defining events are significant predictors of a lower HRQoL, especially physical health status. AHD survivors are in risk of mortality and serious comorbidities, needing special clinical attention and preventive programs for associated comorbidities. Their specific needs should be reflected in HIV guidelines.

How to cope with disabilities: Development and psychometric properties of the Coping With Disability Difficulties Scale (CDDS).

PURPOSE/OBJECTIVE: The aim of this study was to develop and test the psychometric properties of the Coping With Disability Difficulties Scale (CDDS), a scale to measure the coping strategies used by people with disabilities to face the disability-related difficulties (caused by both disability itself and by stigma) they encounter in their daily lives. METHOD/DESIGN: An initial pool of 110 items was developed based on previous literature and the results of a qualitative study using semistructured interviews. The psychometric characteristics of the CDDS were examined in 3 samples of people with disabilities (each of which included participants with physical, visual, and hearing impairments; total N = 590). RESULTS: A final scale of 17 items was obtained. The factor structure of the CDDS was tested and replicated with an adequate fit (root mean square error of approximation [RMSEA] = 0.056; goodness-of-fit index [GFI] = 0.98; comparative fit index [CFI] = 0.98) using confirmatory factor analysis. The internal consistency of the 4 factors (positive thinking, social sensitization and support, adaptation, and avoidance) was adequate to excellent (with alphas ranging from .68 to .86). CONCLUSIONS/IMPLICATIONS: To the authors' knowledge, this is the first coping scale that is specifically designed for people with disabilities, and it can be highly useful for both research and applied purposes. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Outcome of an HIV education program for primary care providers: Screening and late diagnosis rates.

BACKGROUND: Late HIV diagnosis remains one of the challenges in combating the epidemic. Primary care providers play an important role in screening for HIV infection. Our study aims to evaluate the relationship between knowledge and barriers to HIV testing and screening outcomes. The impact of an education program for primary care providers, towards improving HIV testing and late diagnosis rates, is also assessed. METHODS: A self-administered questionnaire that was developed within the framework of the European project OptTEST was used to examine HIV knowledge and barriers to HIV testing scores before and after being involved in an HIV education program. A quasi-experimental design with pre- and post-intervention measures was performed to investigate its impact. We performed multivariable logistic regression analysis to assess the relationship between variables for the HIV testing offer. RESULTS: A total of 20 primary care centers and 454 primary care staff were included. Baseline OptTEST results showed that more knowledgeable staff offered an HIV test more frequently (OR 1.07; CI 95% 1.01-1.13; p = 0.027) and had lower barrier scores (OR 0.89; CI 95% 0.77-0.95; p = 0.005). Nurses had lower scores in knowledge-related items (OR 0.28; CI 95% 0.17-0.46; p<0.001), but higher scores in barrier-related items than physicians (OR 3.28; CI 95% 2.01-5.46; p<0.001). Specific centers with more knowledgeable staff members had a significant association with a greater level of new HIV diagnosis rates (OR 1.61; CI 95% 1.04-2.49; p = 0.032). After the intervention, we found that 12 out of 14 individual questions showed improved scores. In the 6 months after the training program, we similarly found a higher HIV testing rate (OR 1.19; CI 1.02-1.42; p = 0.036). CONCLUSIONS: This study highlights the association between knowledge and barriers to HIV testing, including HIV testing rates. It shows that it is possible to modify knowledge and reduce perceived barriers through educational programs, subsequently improving HIV screening outcomes.

Health-related quality of life of people living with HIV infection in Spain: a gender perspective.

Studies exploring gender differences in health-related quality of life (HRQOL) of people living with HIV/AIDS (PLWHA) are scarce and contradictory. This study evaluated gender differences in HRQOL of 744 PLWHA with median (IQR) age 44 (37-48) years and HIV infection diagnosed 12 (5-20) years earlier. Results showed important differences between genders (p < .05). Better male physical health was related to being employed, not having economic worries, not receiving psychological support, not having injected drugs in past, low negative mood HIV-related, low HIV illness representation and internalized stigma, and high body image satisfaction and health behavior. For women, variables were fewer years since HIV diagnosis and low enacted stigma-personal experience of rejection. Mentally, variables in men were being employed, not having injected drugs, having a stable partner, high health behavior, use of problem-solving coping, personal autonomy and personal meaning. In women, better mental health was related to high CD4 cells, self-esteem and body image satisfaction, and negative mood HIV-related. Men and women coincided in absence of past opportunistic infections being related to better physical and mental health, and absence of side effects for physical health and low HIV-related stress and HIV illness representation for mental health. Our results highlight the need for detailed study of gender differences that identify the bio-psycho-socio inequalities that affect HRQOL.

Subtle and blatant perceived discrimination and well-being in lesbians and gay men in Spain: The role of social support / Discriminación percibida sutil y manifiesta y bienestar en personas lesbianas y gais en España: el papel del apoyo social

Background: The situation of lesbians and gay men (LGs) in Spain has improved significantly in recent decades. However, Spanish society still exhibits prejudice and discrimination. The current study pursues three main goals: 1) to analyse the extent to which LGs perceive blatant and subtle discrimination, 2) to explore the relationship between perceived discrimination and LGs’ psychological and subjective well-being, and 3) to analyse the possible mediational role of social support in reducing the negative influence of perceived discrimination on well-being. Method: The sample comprised 237 lesbians and 232 gay men. Results: The results show higher perceived subtle than blatant discrimination, and that subtle discrimination affects LGs’ well-being more negatively than blatant discrimination. Results show that social support helps to alleviate the negative effects of discrimination on well-being. Conclusions: These results are important and may contribute to the design of interventions to improve the well-being of lesbians and gay men (AU)

Antecedentes: la situación de las personas lesbianas y gais (LG) en España ha mejorado mucho en las últimas décadas. Sin embargo, el prejuicio y la discriminación todavía están presentes en la sociedad española. El presente estudio persigue tres objetivos principales: 1) analizar hasta qué punto las personas LG perciben la existencia de discriminación manifiesta y sutil; 2) explorar la relación existente entre la discriminación percibida y el bienestar psicológico y subjetivo de las personas LG; y 3) analizar el papel mediador que el apoyo social puede jugar a la hora de reducir la influencia negativa de la discriminación percibida en el bienestar. Método: la muestra incluía 237 mujeres lesbianas y 232 hombres gais. Resultados: los resultados muestran que la discriminación sutil percibida es mayor que la manifiesta y que además dicha discriminación sutil, comparada con la manifiesta, tiene efectos más negativos en el bienestar de las personas LG. Los resultados muestran que el apoyo social contribuye a aliviar los efectos negativos de la discriminación en el bienestar. Conclusiones: estos resultados son relevantes y pueden contribuir a diseñar intervenciones para mejorar el bienestar de las personas LG (AU)

Adaptation of the HIV Stigma Scale in Spaniards with HIV

The primary goal of this study was to adapt Berger, Ferrans, & Lahley (2001) HIV Stigma Scale in Spain, using Bunn, Solomon, Miller, & Forehand (2007) version. A second goal assessed whether the four-factor structure of the adapted scale could be explained by two higher-order dimensions, perceived external stigma and internalized stigma. A first qualitative study (N = 40 people with HIV, aged 28-59) was used to adapt the items and test content validity. A second quantitative study analyzed construct and criterion validity. In this study participants were 557 people with HIV, aged 18-76. The adapted HIV Stigma Scale for use in Spain (HSSS) showed a good internal consistency (α = .88) and good construct validity. Confirmatory Factor Analyses yielded a first-order, four-factor structure and a higher-order, bidimensional structure with the two expected factors (RMSEA = .051, 90% CI [.046, .056]; RMR = .073; GFI = .96; AGFI = .96; CFI = .98). Negative relations were found between stigma and quality of life (r = -.39; p < .01), self-efficacy to cope with stigma (r = -.50; p < .01) and the degree of HIV status disclosure (r = -.35; p < .01). Moreover, the people who had suffered AIDS-related opportunistic infections had a higher score in the Perceived External Stigma dimension than those who had not suffered them, t (493) = 3.02, p = .003, d = 0.26 (AU)

No disponible

Determinants of late diagnosis of HIV infection in Spain / Determinantes del diagnóstico tardío de la infección por VIH en España

El objetivo principal de este estudio fue analizar los determinantes del diagnóstico tardío de la infección por VIH. Asimismo, se estudió el papel que jugaban en ello la percepción de riesgo y la orientación sexual. Se entrevistó a 25 personas con VIH, con las que se estableció contacto a través de hospitales y de organizaciones no gubernamentales (ONG). Para el diseño del guión de la entrevista se partió de una integración de las variables consideradas en los principales modelos de conductas de salud. Se siguió una estrategia mixta de análisis. Primeramente, se realizó análisis temático de las entrevistas. Seguidamente, se realizaron análisis cuantitativos sobre los datos cualitativos. Se halló que los determinantes más relevantes eran la valoración de amenaza del VIH y la baja percepción de riesgo. Se hallaron también oportunidades perdidas de diagnóstico en el sistema sanitario. La baja percepción de riesgo se asociaba con el optimismo irrealista, la poca información sobre el VIH y los estereotipos sobre las personas con VIH. La alta percepción de riesgo se relacionaba con las estrategias de evitación del test. Los discursos de las personas homosexuales mostraron un balance más positivo de los beneficios de conocer el diagnóstico. Los resultados sugieren claves que pueden guiar el diseño de futuras estrategias de promoción del diagnóstico precoz

The main goal of this study was to analyse the determinants of late diagnosis of HIV infection. Secondly, we studied the role of the perception of risk and sexual orientation in HIV testing. Twenty-five people with late HIV diagnosis were interviewed. They were contacted through hospitals and non-governmental organizations (NGOs). To design the interview, we integrated the variables considered in the main models of health-related behaviour. We followed a mixed strategy of analysis. Firstly, we carried out thematic analysis of the interviews, followed by quantitative analysis of the initially qualitative data. The results revealed that the most relevant determinants were the appraisal of the threat of HIV and the low perception of HIV risk. Also, the study found many missed opportunities for diagnosis in health-care setting. Low perception of HIV risk was related to unrealistic optimism, low levels of information about HIV, and the presence of stereotypes about people with HIV. High perception of HIV risk was related to strategies to avoid testing. Homosexuals reported a more positive balance between the benefits of knowing their diagnosis and having the disease. The results provide clues that can guide the design of future strategies to promote early diagnosis