National Center of Epidemiology, Insituto de Salud Carlos III, Madrid, Spain.
Centro Sanitario Sandoval, Madrid, Spain.
Eur J Public Health. 2018 Jun 1;28(3):451-457. doi: 10.1093/eurpub/ckx225.
In Spain, migrants are disproportionately affected by HIV and experience high rates of late diagnosis. We investigated barriers to health care access among migrants living with HIV (MLWH) in Spain.
Cross sectional electronic survey of 765 adult HIV-positive migrants recruited within 18 health care settings between July 2013 and July 2015. We collected epidemiological, demographic, behavioral and clinical data. We estimated the prevalence and risk factors of self-reported barriers to health care using multivariable logistic regression.
Of those surveyed, 672 (88%) had information on health care access barriers: 23% were women, 63% from Latin America and Caribbean, 14% from Sub-Saharan Africa and 15% had an irregular immigration status. Men were more likely to report barriers than women (24% vs. 14%, P = 0.009). The main barriers were: lengthy waiting times for an appointment (9%) or in the clinic (7%) and lack of a health card (7%). Having an irregular immigration status was a risk factor for experiencing barriers for both men (OR: (4.0 [95%CI: 2.2-7.2]) and women (OR: 10.5 [95%CI: 3.1-34.8]). Men who experienced racial stigma (OR: 3.1 [95%CI: 1.9-5.1]) or food insecurity (OR: 2.1 [95%CI: 1.2-3.4]) were more likely to report barriers. Women who delayed treatment due to medication costs (6.3 [95%CI: 1.3-30.8]) or had a university degree (OR: 5.8 [95%CI: 1.3-25.1]) were more likely to report barriers.
Health care barriers were present in one in five5 MLWH, were more common in men and were associated to legal entitlement to access care, perceived stigma and financial constraints.
在西班牙，移民受到艾滋病毒的影响不成比例，并且诊断较晚的比例很高。我们调查了西班牙艾滋病毒感染者（MLWH）获得医疗保健方面的障碍。
2013 年 7 月至 2015 年 7 月期间，在 18 个医疗保健机构内对 765 名成年 HIV 阳性移民进行了横断面电子调查。我们收集了流行病学、人口统计学、行为和临床数据。我们使用多变量逻辑回归估计了自我报告的医疗保健障碍的流行率和危险因素。
在接受调查的人中，有 672 人（88％）提供了有关医疗保健获取障碍的信息：23％为女性，63％来自拉丁美洲和加勒比地区，14％来自撒哈拉以南非洲地区，15％的移民身份不合法。男性报告的障碍比女性多（24％比 14％，P = 0.009）。主要障碍是预约时间长（9％）或在诊所时间长（7％）以及缺乏健康卡（7％）。身份不合法是男性（OR：（4.0 [95％CI：2.2-7.2]）和女性（OR：10.5 [95％CI：3.1-34.8]）经历障碍的危险因素。经历种族歧视（OR：3.1 [95％CI：1.9-5.1]）或粮食不安全（OR：2.1 [95％CI：1.2-3.4]）的男性更有可能报告障碍。由于药物费用（6.3 [95％CI：1.3-30.8]）或具有大学学历（OR：5.8 [95％CI：1.3-25.1]）而延迟治疗的女性更有可能报告障碍。
在五分之一的 MLWH 中存在医疗保健障碍，在男性中更为常见，并且与合法获得医疗保健的权利、感知的耻辱和经济限制有关。
