National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.
J Int AIDS Soc. 2013 May 9;16(1):18560. doi: 10.7448/IAS.16.1.18560.
Increasing the uptake of HIV testing and decreasing the number of undiagnosed people is a priority for HIV prevention. Understanding the barriers that hinder people from testing is vital, particularly when working with especially vulnerable populations like migrants. Most data available on migrants are based on African migrants in the UK, while barriers to HIV testing in Latin-American migrants living in Europe remain unexplored. Still, they account for a quarter of new diagnosis in Spain and suffer higher rates of delayed diagnosis.
Between May 2008 and March 2011, a mobile unit offered free rapid HIV tests in different Spanish cities. We compared the prevalence of no previous testing, adjusting for potential confounders by two multivariate logistic models, and described differences in perceived barriers to testing in Latin-American migrants living in Spain versus Spaniards. Participants included men who have sex with men (MSM), men who have sex exclusively with women (MSW), and women.
Of the 5920 individuals who got tested and answered a self-administered questionnaire, 36.5% were MSM (20.4% previously untested), 28.9% were MSW (49% previously untested) and 34.6% were women (53% previously untested). Almost one quarter were Latin-American, of whom 30% had never been tested versus 45% of untested Spaniards. After adjusting for potential confounders, Spaniards were more likely to report no previous testing than Latin-Americans among women and MSW all together (Odds Ratio (OR)=2.0; 95% Confidence Interval (CI): 1.7-2.4) and among MSM (OR=1.6; 95% CI: 1.2-2.0). Among the 2455 who had never undergone an HIV test before, main barriers to testing were low perceived risk (54% Spaniards vs. 47% Latin-American) and concerns arising from the loss of anonymity (19.5% vs. 16.9%). Fear of rejection or discrimination and fear of legal problems were a barrier for <2%.
Latin-American migrants living in Spain were more likely to get tested than Spaniards. Regardless of nationality, low perceived risk was the main barrier to testing whereas fear of stigma or discrimination and fear of legal problems were merely incidental. However, new Spanish austerity policies regarding healthcare for migrants in response to the economic crisis may reverse this situation.
提高艾滋病毒检测率，减少未确诊人数，这是艾滋病毒防控的重点。了解阻碍人们进行检测的因素至关重要，尤其是在与移民等弱势群体合作时。目前大多数有关移民的资料都基于在英国的非洲移民，而居住在欧洲的拉丁美洲移民进行艾滋病毒检测的障碍仍有待探索。尽管如此，他们在西班牙占新诊断病例的四分之一，并且延迟诊断的比例更高。
2008 年 5 月至 2011 年 3 月期间，一个流动单位在西班牙不同城市提供免费的快速艾滋病毒检测。我们通过两个多变量逻辑模型，在调整潜在混杂因素后，比较了以前未接受过检测的比例，并描述了居住在西班牙的拉丁美洲移民与西班牙人之间检测障碍的差异。参与者包括男男性接触者（MSM）、仅与女性发生性关系的男性（MSW）和女性。
在接受检测并回答了自我管理问卷的 5920 人中，36.5%为 MSM（20.4%以前未接受过检测），28.9%为 MSW（49%以前未接受过检测），34.6%为女性（53%以前未接受过检测）。近四分之一是拉丁美洲人，其中 30%从未接受过检测，而未接受过检测的西班牙人占 45%。在调整了潜在混杂因素后，与拉丁美洲人相比，西班牙人在女性和所有 MSW 中报告以前未接受过检测的可能性更大（优势比（OR）=2.0；95%置信区间（CI）：1.7-2.4），在 MSM 中（OR=1.6；95%CI：1.2-2.0）。在从未接受过艾滋病毒检测的 2455 人中，检测的主要障碍是低风险认知（54%的西班牙人 vs. 47%的拉丁美洲人）和对匿名性丧失的担忧（19.5% vs. 16.9%）。对拒绝或歧视的恐惧以及对法律问题的恐惧是一个障碍<2%。
居住在西班牙的拉丁美洲移民比西班牙人更有可能接受检测。无论国籍如何，低风险认知是检测的主要障碍，而对耻辱或歧视的恐惧以及对法律问题的恐惧只是偶然因素。然而，西班牙新的医疗保健紧缩政策可能会改变这种情况，以应对经济危机，这些政策针对的是移民。
