Development and psychometric testing of a barriers to HIV testing scale among individuals with HIV infection in Sweden; The Barriers to HIV testing scale-Karolinska version

Abstract

BackgroundBarriers to HIV testing experienced by individuals at risk for HIV can result in treatment delay and further transmission of the disease. Instruments to systematically measure barriers are scarce, but could contribute to improved strategies for HIV testing. Aims of this study were to develop and test a barriers to HIV testing scale in a Swedish context.MethodsAn 18-item scale was developed, based on an existing scale with addition of six new items related to fear of the disease or negative consequences of being diagnosed as HIV-infected. Items were phrased as statements about potential barriers with a three-point response format representing not important, somewhat important, and very important. The scale was evaluated regarding missing values, floor and ceiling effects, exploratory factor analysis, and internal consistencies.ResultsThe questionnaire was completed by 292 adults recently diagnosed with HIV infection, of whom 7 were excluded (≥9 items missing) and 285 were included (≥12 items completed) in the analyses. The participants were 18–70 years old (mean 40.5, SD 11.5), 39 % were females and 77 % born outside Sweden. Routes of transmission were heterosexual transmission 63 %, male to male sex 20 %, intravenous drug use 5 %, blood product/transfusion 2 %, and unknown 9 %. All scale items had <3 % missing values. The data was feasible for factor analysis (KMO = 0.92) and a four-factor solution was chosen, based on level of explained common variance (58.64 %) and interpretability of factor structure. The factors were interpreted as; personal consequences, structural barriers, social and economic security, and confidentiality. Ratings on the minimum level (suggested barrier not important) were common, resulting in substantial floor effects on the scales. The scales were internally consistent (Cronbach’s α 0.78–0.91).ConclusionsThis study gives preliminary evidence of the scale being feasible, reliable and valid to identify different types of barriers to HIV testing.

Place and practice: Sexual risk behaviour while travelling abroad among Swedish men who have sex with men

“…More studies have focused on barriers than motivators for HIV testing. In recent studies in contexts where ART is readily available barriers have often been addressed in relation to delayed testing and late HIV diagnosis [103][104][105][106] . With about a quarter untested in a key population for HIV prevention, there is a need to continue to identify motivators and barriers for HIV testing among MSM and assessing associations with actual HIV testing.…”

Motivators and barriers for HIV testing among men who have sex with men in Sweden

“…We also find reason to suggest cross‐validation with the Wiklander et al . () study although their study population were people newly diagnosed with HIV rating barriers to HIV testing retrospectively. They had 18 response options, of which 15 matched ours, and their factor analysis resulted in four factors out of which three factors were similar to ours.…”

“…, Wiklander et al . ). The survey was distributed to in Sweden residing MSM who were members of the Scandinavian online gay community, Qruiser.…”

“…() and Wiklander et al . () but was adapted to be applicable to respondents regardless of HIV status in a Swedish MSM context: ‘I did not think about it’, ‘I believe that I have not taken any risks’, ‘I am living in a monogamous relationship with a person who does not have HIV’, ‘I have been denied an HIV test by the healthcare system even though I have wanted one’, ‘I do not know where to get tested’, ‘The clinic is not open when I could go and get tested’, ‘It is difficult for me to get to a clinic’, ‘I do not trust the code of confidentiality in the healthcare system’, ‘I am afraid that staff or other visitors to the clinic will recognise me’, ‘I do not want to know my HIV status’, ‘I am afraid I will become ill’, ‘There is no cure for HIV, so I see no point in getting tested’, ‘I do not want to get tested because of the regulations in the Communicable Disease Prevention Act’, ‘I do not want to get tested because of how the Swedish Penal Code is applied to HIV’, ‘I am afraid I will lose my job’, ‘I am afraid I will lose my partner’, ‘I am afraid I will lose my family and/or friends’, ‘I am afraid the test result would have a negative influence on my sex life’, ‘I am afraid I will feel like a failure if I have HIV’, ‘I am afraid the test result would affect my chances of staying in Sweden’ and ‘Other’.…”

“…, Berg , Wiklander et al . ). We have found two studies, published in the past decade that have used exploratory factor analysis as a means of studying barriers for HIV testing among MSM (Awad et al .…”