Never tested for HIV in Latin‐American migrants and Spaniards: prevalence and perceived barriers

Abstract

IntroductionIncreasing 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.MethodsBetween 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.ResultsOf 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%.ConclusionsLatin-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.

Barriers and Facilitators to HIV Testing in Migrants in High-Income Countries: A Systematic Review

“…Feeling healthy, lack of symptoms, and lack of preventive healthcare were barriers to HIV testing across the board [8,11,16,28,41,51,52]. It was identified that African migrants' contact with traditional medicine in their home country was usually greater than that with western medicine, and this acted as a barrier in the receiving country [52].…”

“…Research on migrants in Australia, the US, Canada and Europe highlight migrants' vulnerability to HIV, with rates exceeding those of the general host population [7][8][9][10][11][12]. A striking example of this comes from Belgium where, between 2002 and 2006, figures showed that, despite accounting for \1 per cent of the population, migrants from Sub-Saharan Africa accounted for nearly half (45.7 per cent) of newly diagnosed cases of HIV [11].…”

Approval and Potential Use of Over-the-Counter HIV Self-Tests: The Opinion of Participants in a Street Based HIV Rapid Testing Program in Spain

“…It has been hypothesized that in the process of deciding and taking the test, psychosocial factors interact with health system variables [8]. Some barriers to testing pointed out in several studies, besides those related to the perception of not having been at risk for infection and the fear of dealing with the disease and the social consequences of a positive result [9,10], could be related to characteristics of the diagnostic services, such as the need and anxiety created by having to return for a second visit to find out the result [8][9][10][11][12], knowing where to go [11], finding a place to get tested [11], the inconvenience of having to visit health services for testing during working hours [12], embarrassment about testing [11], discomfort about talking to health workers about sex life [13], avoidance to go through counselling [13].…”

The rapid test in Spanish pharmacies: a novel programme to reach heterosexual men?

“…However, this could not be ascertained as we have not found any similar pharmacy-based programmes in which testing was offered free of charge. Nevertheless, recent studies show that money is not a major barrier when deciding to be tested for HIV [37]. Also, we were unable to perform a proper cost−benefit analysis but, according to some studies, the programme can be deemed to be cost-effective as we identified more than 1 undiagnosed person per 1000 tests performed [38,39].…”