Marcus Ulrich, Hickson Ford, Weatherburn Peter, Furegato Martina, Breveglieri Michele, Berg Rigmor C, Schmidt Axel J
Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
Sigma Research, London School of Hygiene & Tropical Medicine, London, United Kingdom.
PLoS One. 2015 Mar 20;10(3):e0121047. doi: 10.1371/journal.pone.0121047. eCollection 2015.
The preventive effects of antiretroviral treatment (ART) on onward transmission of HIV are a major reason for broadening eligibility for ART. In the WHO European Region, surveillance reveals substantial differences in access to ART across regions and sub-populations. We analysed self-reported data on ART and reasons for not taking ART from EMIS, a large Pan-European Internet survey among men-who-have-sex-with-men (MSM).
Respondents from 38 European countries reported their last HIV test result and, if diagnosed with HIV, their treatment status, and reasons for not taking or having stopped ART from a 7 item multiple choice list and/ or answered an open-ended question to give other reasons. Responses were classified as fear of consequences, perceived lack of need, and ART inaccessibility based on factor analysis. Associations between not taking ART because of fear of consequences, and demographic, behavioural and contextual indicators were identified in a multivariable regression model.
13,353 (7.7%) of 174,209 respondents had been diagnosed with HIV. Among them 3,391 (25.4%) had never received ART, and 278 (2.1%) had stopped taking ART. Perceived lack of need was by far the most common reason for not taking or stopping ART (mentioned by 3259 (88.8%) respondents), followed by fear of consequences (428 (11.7%)), and ART inaccessibility (86 (2.3%)). For all reasons, an East-West gradient could be seen, with larger proportions of men living in Central and Eastern Europe reporting reasons other than medical advice for not taking ART. A minority of men were reluctant to start ART independent of medical advice and this was associated with experiences of discrimination in health care systems.
ART is widely available for MSM diagnosed with HIV across Europe. Not being on treatment is predominantly due to treatment not being recommended by their physician and/or not perceived to be needed by the respondent.
抗逆转录病毒治疗（ART）对HIV进一步传播的预防作用是扩大ART资格范围的主要原因。在世卫组织欧洲区域，监测显示不同地区和亚人群在获得ART方面存在显著差异。我们分析了来自EMIS的关于ART及未接受ART原因的自我报告数据，EMIS是一项针对男男性行为者（MSM）的大型泛欧互联网调查。
来自38个欧洲国家的受访者报告其最近一次HIV检测结果，若被诊断为HIV，则报告其治疗状况，以及从一份7项多项选择列表中选择未接受或已停止ART的原因，和/或回答一个开放式问题以给出其他原因。根据因素分析，将回答分类为对后果的恐惧、认为缺乏必要性以及无法获得ART。在多变量回归模型中确定因恐惧后果而未接受ART与人口统计学、行为和背景指标之间的关联。
174,209名受访者中有13,353人（7.7%）被诊断为HIV。其中，3391人（25.4%）从未接受过ART，278人（2.1%）已停止接受ART。认为缺乏必要性是未接受或停止ART最常见的原因（3259名（88.8%）受访者提到），其次是对后果的恐惧（428名（11.7%））和无法获得ART（86名（2.3%））。就所有原因而言，可以看到东西方差异，中欧和东欧有更大比例的男性报告未接受ART的原因不是医疗建议。少数男性不顾医疗建议不愿开始接受ART，这与在医疗保健系统中遭受歧视的经历有关。
在欧洲，被诊断为HIV的MSM可广泛获得ART。未接受治疗主要是因为医生未推荐治疗和/或受访者认为不需要治疗。
