Fiorentino Marion, Suzan-Monti Marie, Vilotitch Antoine, Sagaon-Teyssier Luis, Dray-Spira Rosemary, Lert France, Spire Bruno
Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France.
ORS PACA, Southeastern Health Regional Observatory, Marseille, France.
Antivir Ther. 2018;23(5):443-450. doi: 10.3851/IMP3220.
This study aimed to estimate the frequency of renunciation of health care among people living with HIV (PLHIV) in France, including health care unrelated to HIV, and to characterize associated socioeconomic and psychosocial risk factors.
The cross-sectional ANRS-VESPA2 survey was conducted on adult PLHIV attending French hospitals in 2011. Correlates of health-care renunciation in the 12 months before the survey were assessed through logistic modelling.
Among the 3,020 PLHIV included in the sample, 17% declared health-care renunciation during the preceding year and 42% had a high level of social insecurity. During the previous 2 years, 8% and 11%, respectively, were discriminated against by medical staff and family. In multivariate analysis, positive associations were found between health-care renunciation and a high level of social insecurity (adjusted odds ratio [95% CI] 3.44 [2.54, 4.65]; P<0.001), having children (1.52 [1.10, 2.10]; P=0.01), smoking tobacco (1.50 [1.13, 1.98]; P=0.01), discrimination by medical staff (1.53 [1.22, 2.29]; P=0.04) or family (2.48 [1.75, 3.52]; P<0.001), major depressive episodes (1.46 [1.02, 2.09]; P=0.04), past or current drug injection (1.54 [1.03, 2.30]; P=0.04), and younger age (0.98 [0.97, 1.00]; P=0.03). Health-care renunciation was also negatively associated with HIV diagnosis after 1996 (1996-2002: 0.64 [0.46, 0.90]; P=0.01; ≥2003: 0.56 [0.40, 0.77]; P=0.001).
In spite of universal health insurance in France, barrier- and refusal-renunciation of health care by PLHIV remain frequent. Poor psychosocial outcomes and discrimination by families and health-care providers compound the negative effect of social insecurity on health-care seeking in this population. To ensure optimal medical care, strategies are needed to prevent discrimination against PLHIV in health-care services. Special attention must be provided to patients experiencing social insecurity.
本研究旨在评估法国艾滋病毒感染者（PLHIV）放弃医疗保健的频率，包括与艾滋病毒无关的医疗保健，并确定相关的社会经济和心理社会风险因素。
2011年对在法国医院就诊的成年PLHIV进行了横断面ANRS-VESPA2调查。通过逻辑模型评估调查前12个月内放弃医疗保健的相关因素。
在纳入样本的3020名PLHIV中，17%的人表示上一年放弃了医疗保健，42%的人有高度的社会不安全感。在前两年中，分别有8%和11%的人受到医务人员和家人的歧视。在多变量分析中，发现放弃医疗保健与高度的社会不安全感（调整后的优势比[95%CI]3.44[2.54,4.65]；P<0.001）、有子女（1.52[1.10,2.10]；P=0.01）、吸烟（1.50[1.13,1.98]；P=0.01）、受到医务人员（1.53[1.22,2.29]；P=0.04）或家人（2.48[1.75,3.52]；P<0.001）的歧视、重度抑郁发作（1.46[1.02,2.09]；P=0.04）、过去或现在注射毒品（1.54[1.03,2.30]；P=0.04）以及年龄较小（0.98[0.97,1.00]；P=0.03）之间存在正相关。放弃医疗保健也与1996年后的艾滋病毒诊断呈负相关（1996 - 2002年：0.64[0.46,0.90]；P=0.01；≥2003年：0.56[0.40,0.77]；P=0.001）。
尽管法国有全民医疗保险，但PLHIV放弃医疗保健的情况仍然很常见。心理社会状况不佳以及家庭和医疗服务提供者的歧视加剧了社会不安全感对该人群寻求医疗保健的负面影响。为确保最佳医疗护理，需要采取策略防止在医疗服务中歧视PLHIV。必须特别关注经历社会不安全感的患者。
