International Centre for Reproductive Health, Ghent University, Ghent, Belgium.
Eur J Public Health. 2010 Aug;20(4):422-32. doi: 10.1093/eurpub/ckp231. Epub 2010 Feb 1.
In the European Union (EU) and neighbouring countries, HIV/AIDS, of all infectious diseases, has one of the highest morbidity and mortality rates. An estimated 30% of people living with HIV are unaware of their infection, and may therefore not benefit from timely treatment or may transmit HIV to others, unknowingly. Evidence shows that opportunities are being missed to diagnose HIV infections in EU Member States, particularly in regular health care settings. There is a need to better understand the barriers to HIV testing and counselling with the aim to contribute to the decrease of the number of undiagnosed people.
A systematic review of literature on HIV testing barriers in Europe was conducted, applying a free text strategy with a set of search terms.
A total of 24 studies published in international peer-reviewed journals and meeting the review's eligibility criteria were identified. Fourteen studies report on barriers at the level of the patient; six on barriers at health care provider level and seven on institutional barriers referring to the policy level. The barriers described are centralized around low-risk perception; fear and worries; accessibility of health services, reluctance to address HIV and to offer the test; and scarcity of financial and well trained human resources.
Some barriers to HIV testing and counselling have been illustrated in the literature. Nevertheless, there is lack of structured information on barriers considering (i) legal, administrative and financial factors, (ii) attitudes and practices of health care providers and (iii) perception of patients. Such data is critical to improve effectiveness of HIV testing and counselling.
在欧盟（EU）及其邻国，艾滋病是所有传染病中发病率和死亡率最高的疾病之一。据估计，30%的艾滋病毒感染者并不知道自己已被感染，因此无法及时得到治疗，或者可能在不知情的情况下将艾滋病毒传播给他人。有证据表明，欧盟成员国错过了诊断艾滋病毒感染的机会，特别是在常规医疗保健环境中。因此，有必要更好地了解艾滋病毒检测和咨询的障碍，以减少未确诊的人数。
对欧洲艾滋病毒检测障碍的文献进行了系统评价，采用了一套带有自由文本策略的搜索词。
共确定了 24 项发表在国际同行评议期刊上并符合审查标准的研究。其中 14 项研究报告了患者层面的障碍；6 项研究报告了医疗服务提供者层面的障碍；7 项研究报告了机构障碍，涉及政策层面。描述的障碍主要集中在低风险认知、恐惧和担忧、获得医疗服务的机会、不愿解决艾滋病毒问题和提供检测以及缺乏资金和训练有素的人力资源。
文献中说明了一些艾滋病毒检测和咨询的障碍。然而，缺乏关于障碍的结构化信息，包括（i）法律、行政和财务因素；（ii）医疗服务提供者的态度和做法；（iii）患者的看法。这些数据对于提高艾滋病毒检测和咨询的效果至关重要。
