Immigrant women living with HIV in Spain: a qualitative approach to encourage medical follow-up.

BACKGROUND: Immigrant women living with HIV generally have worse adherence to medical treatment and follow-up when compared to native women and immigrant or native men. The general aim of this study was to improve healthcare services for HIV-positive women and to better understand why some of them discontinue treatment. The specific objectives were: (1) to explore the barriers and facilitators to medical follow-up among women and (2) to use the findings to create a guide for healthcare professionals with strategies and tools to encourage the immigrant women to continue with their healthcare treatment. METHODS: We conducted a qualitative, patient-centred research based on semi-structured interviews in order to understand the drivers and barriers for HIV positive immigrant women to adhere to medical follow-up. A total of 26 women in active or discontinued treatment (from sub-Saharan Africa (10), Latin America (8) and Spain (8)) were interviewed in 2012 using a purposive sampling methodology. The semi-structured interviews were transcribed and analysed based on the grounded theory approach and the framework method. Three researchers took part in the triangulation of results.The study was approved by the Ethical Committee of the Hospital Universitario Ramón y Cajal. RESULTS: The study revealed eight categories that impacted adherence to treatment and medical follow-up: doctor-patient relationship, relationship between body and HIV, employment, gender roles, representations of AIDS, emotional support received, trust in biomedical system, and psychological condition. Specific barriers and facilitators related to these categories were identified. In immigrant women, the influence of these barriers was greater than in Spanish women.Recommendations for healthcare professionals based on this study have been compiled in an informative brochure. CONCLUSIONS: Social, cultural, and psychological aspects as well as self-perception of body changes, gender roles, and the relationship with the healthcare system, are key elements that may affect the adherence to medical treatment of immigrant women living with HIV.Qualitative research focused on the comprehensive experience of living with HIV can be useful for creating tools that pave the way to detect barriers and facilitators to medical follow-up in specific populations.

Targeted rapid HIV testing in public primary care services in Madrid. Are we reaching the vulnerable populations?

OBJECTIVES: To describe the population targeted for the rapid HIV testing program delivered via socio-culturally adapted services in primary care centers and to assess factors associated with uptake of first-time testing. METHODS: This was a descriptive cross-sectional study. We analyzed consultations between April 29, 2010 and May 31, 2012. We assessed the differences in age, origin, education, and sexual history between men who have sex with men (MSM), heterosexual men (HM), and women, using a two-sided independent t-test and Chi-square statistics. Factors associated with first-time testing were analyzed by logistic regression. RESULTS: Of 1940 consultations, 45.1% were HM, 25.4% MSM, and 29.5% women; 35.4% were immigrants, 2.5% were or had been sex workers, and 15.4% had visited one. The test was reactive in 2.1%. Up to 44.2% had never been tested. The probability of being tested for the first time increased in HM, women, populations from the Indian Subcontinent, those with no casual sexual partners, those whose partner's serostatus was unknown, and those with no history of other sexually transmitted infections. CONCLUSIONS: This program managed to reach a high proportion of vulnerable people. First time HIV testing rates were high.

A multidisciplinary approach to engage VFR migrants in Madrid, Spain.

VFRs are at a greater risk of contracting travel-related illnesses such as malaria, and their knowledge about travel health tends to be poor. Since 2009, community-based activities targeting potential and impending VFRs were performed by a multidisciplinary team in Madrid, Spain. The design and distribution of multilingual and culturally-sensitive material following a qualitative research, and intercultural mediators were key tools of the health education programme.

Reluctance to do blood testing limits HIV diagnosis and appropriate health care of sub-Saharan African migrants living in Spain.

This study investigates the reasons why sub-Saharan African migrants (SSAM) living in Spain may be unwilling to have their blood tested. A qualitative study was developed for 3 years (2006-2009) with the participation of 1338 SSAM. Cultural differences along with lack of information about Spanish health care system and health-related rights produced a feeling of mistrust towards medical staff. Reluctance to do blood testing may prevent SSAM from having a prompt HIV diagnosis and an appropriate health care. Linguistically and culturally adapted information is essential to overcome these barriers and achieve an equal access to health care services and HIV testing.