Immigrant women living with HIV in Spain: a qualitative approach to encourage medical follow-up

BMC Public Health

José A Pérez-Molina²  Rogelio López-Vélez²  Fernando Dronda¹  María Jesús Pérez-Elías¹  Belén Pizarro de la Fuente²  Bárbara Navaza²  Anne Guionnet² 

[1] Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain;Tropical Medicine, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Crta. de Colmenar Km 9,1, Madrid 2834, Spain

关键词: Facilitators;    Barriers;    Lost to follow-up;    Migration;    HIV;    Women;   

Others  :  1123118
DOI  :  10.1186/1471-2458-14-1115

 received in 2013-12-19, accepted in 2014-10-17,  发布年份 2014

【 摘 要 】

Background

Immigrant women living with HIV generally have worse adherence to medical treatment and follow-up when compared to native women and immigrant or native men. The general aim of this study was to improve healthcare services for HIV-positive women and to better understand why some of them discontinue treatment. The specific objectives were: (1) to explore the barriers and facilitators to medical follow-up among women and (2) to use the findings to create a guide for healthcare professionals with strategies and tools to encourage the immigrant women to continue with their healthcare treatment.

Methods

We conducted a qualitative, patient-centred research based on semi-structured interviews in order to understand the drivers and barriers for HIV positive immigrant women to adhere to medical follow-up. A total of 26 women in active or discontinued treatment (from sub-Saharan Africa (10), Latin America (8) and Spain (8)) were interviewed in 2012 using a purposive sampling methodology. The semi-structured interviews were transcribed and analysed based on the grounded theory approach and the framework method. Three researchers took part in the triangulation of results.

The study was approved by the Ethical Committee of the Hospital Universitario Ramón y Cajal.

Results

The study revealed eight categories that impacted adherence to treatment and medical follow-up: doctor-patient relationship, relationship between body and HIV, employment, gender roles, representations of AIDS, emotional support received, trust in biomedical system, and psychological condition. Specific barriers and facilitators related to these categories were identified. In immigrant women, the influence of these barriers was greater than in Spanish women.

Recommendations for healthcare professionals based on this study have been compiled in an informative brochure.

Conclusions

Social, cultural, and psychological aspects as well as self-perception of body changes, gender roles, and the relationship with the healthcare system, are key elements that may affect the adherence to medical treatment of immigrant women living with HIV.

Qualitative research focused on the comprehensive experience of living with HIV can be useful for creating tools that pave the way to detect barriers and facilitators to medical follow-up in specific populations.

【 授权许可】

   
2014 Guionnet et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]UNAIDS Report on the Global AIDS Epidemic. 2010. Available at: http://www.unaids.org/globalreport/ webcite. Date last accessed: Octuber 27, 2014
• [2]Lang DL, Salazar LF, Wingood GM, DiClemente RJ, Mikhail I: Associations between recent gender-based violence and pregnancy, sexually transmitted infections, condom use practices, and negotiation of sexual practices among HIV-positive women. J Acquir Immune Defic Syndr 2007, 46:216-221.
• [3]Stirling M, Rees H, Kasedde S, Hankins C: Introduction: Addressing the vulnerability of young women and girls to stop the HIV epidemic in southern Africa. AIDS 2008, 22(Suppl 4):S1-S3.
• [4]Collazos J, Asensi V, Carton JA: Sex differences in the clinical, immunological and virological parameters of HIV-infected patients treated with HAART. Aids 2007, 21:835-843.
• [5]Finkel DG, John G, Holland B, Slim J, Smith SM: Women have a greater immunological response to effective virological HIV-1 therapy. Aids 2003, 17:2009-2011.
• [6]Garcia de la Hera M, Ferreros I, del Amo J, Pérez Hoyos S, Muga R, del Romero J, Guerrero R, Hernández-Aguado I, GEMES: Gender differences in progression to AIDS and death from HIV seroconversion in a cohort of injecting drug users from 1986 to 2001. J Epidemiol Community Health 2004, 58:944-950.
• [7]Nicastri E, Leone S, Angeletti C, Palmisano L, Sarmati L, Chiesi A, Geraci A, Vella S, Narciso P, Corpolongo A, Andreoni M: Sex issues in HIV-1-infected persons during highly active antiretroviral therapy: a systematic review. J Antimicrob Chemother 2007, 60:724-732.
• [8]Prins M, Meyer L, Hessol NA: Sex and the course of HIV infection in the pre- and highly active antiretroviral therapy eras. Aids 2005, 19:357-370.
• [9]Currier J, Averitt Bridge D, Hagins D, Zorrilla CD, Feinberg J, Ryan R, Falcon R, Tennenberg A, Mrus J, Squires K, GRACE (Gender, Race, And Clinical Experience) Study Group: Sex-based outcomes of darunavir-ritonavir therapy: a single-group trial. Ann Intern Med 2010, 153:349-357.
• [10]Squires KE, Johnson M, Yang R, Uy J, Sheppard L, Absalon J, McGrath D: Comparative gender analysis of the efficacy and safety of atazanavir/ritonavir and lopinavir/ritonavir at 96 weeks in the CASTLE study. J Antimicrob Chemother 2011, 66:363-370.
• [11]Staehelin C, Keiser O, Calmy A, Weber R, Elzi L, Cavassini M, Schmid P, Bernasconi E, Furrer H, Swiss HIV Cohort Study: Longer term clinical and virological outcome of Sub-saharan African participants on antiretroviral treatment in the Swiss HIV Cohort Study. J Acquir Immune Defic Syndr 2012, 59(1):79-85.
• [12]Navaza B, Guionnet A, Navarro M, Estevez L, Perez-Molina JA, Lopez-Velez R: Reluctance to do blood testing limits HIV diagnosis and appropriate health care of sub-Saharan African migrants living in Spain. AIDS Behav 2012, 16:30-35.
• [13]Burns FM, Imrie JY, Nazroo J, Johnson AM, Fenton KA: Why the(y) wait? Key informant understandings of factors contributing to late presentation and poor utilization of HIV health and social care services by African migrants in Britain. AIDS Care 2007, 19:102-108.
• [14]Dang BN, Giordano TP, Kim JH: Sociocultural and structural barriers to care among undocumented Latino immigrants with HIV infection. J Immigr Minor Health 2012, 14:124-131.
• [15]Thomas F, Aggleton P, Anderson J: ‘Experts’, ‘partners’ and ‘fools’: exploring agency in HIV treatment seeking among African migrants in London. Soc Sci Med 2010, 70:736-743.
• [16]Ndirangu EW, Evans C: Experiences of African immigrant women living with HIV in the U.K.: implications for health professionals. J Immigr Minor Health 2009, 11:108-114.
• [17]Bandyopadhyay M, Thomas J: Women migrant workers' vulnerability to HIV infection in Hong Kong. AIDS Care 2002, 14:509-521.
• [18]Vigilancia epidemiológica del VIH en España: Valoración de la epidemia a partir de los sistemas de notificación de casos de las CCAA. Actualización a 30 de junio de; 2012. http://www.msssi.gob.es/ciudadanos/enfLesiones/enfTransmisibles/sida/vigilancia/InformeVIHsida_Junio2012.pdf webcite. Last Accessed: Octuber 27, 2014
• [19]Perez-Molina JA, Mora Rillo M, Suarez-Lozano I, Casado-Osorio JL, Teira Cobo R, Rivas Gonzalez P, Pedrol Clotet E, Hernando-Jerez A, Domingo P, Barquilla Diaz E, Esteban H, Gonzalez-Garcia J: Response to combined antiretroviral therapy according to gender and origin in a cohort of naive HIV-infected patients: GESIDA-5808 study. HIV Clin Trials 2012, 13:131-141.
• [20]Perez-Molina JA, Pulido OF: Assessment of the impact of the new health legislation on illegal immigrants in Spain: the case of human immunodeficiency virus infection. Enferm Infecc Microbiol Clin 2012, 30:472-478.
• [21]Glaser B: Theoretical Sensitivity. Mill Valley, California: Sociology Press; 1978.
• [22]Strauss A: Qualitative Analysis for Social Scientists. Cambridge, England: Cambridge University Press; 1987.
• [23]Gale NK, Heath G, Cameron E, Rashid S, Redwood S: Using the framework method for the analysis of qualitative data in multi-disciplinary health research. BMC Med Res Methodol 2013, 13:117. BioMed Central Full Text
• [24]Flores G: The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev 2005, 62:255-299.
• [25]Inmigración, salud y servicios sanitarios: La perspectiva de la población inmigrante. Documentos Técnicos de Salud Pública; 2013. http://www.saludinmigrantes.es/wp-content/uploads/2013/01/Inmiigración_salud_y_servicios_sanitarios.pdf?2e716f webcite. Last accessed: Octuber 27, 2014
• [26]Employment and working conditions of migrant workers-Spain: European foundation for the Improvment of Living and Working Conditions. 2007. http://www.eurofound.europa.eu/ewco/studies/tn0701038s/es0701039q.htm webcite. Date last accessed: Octuber 27, 2014
• [27]Freund KM, Battaglia TA, Calhoun E, Dudley DJ, Fiscella K, Paskett E, Raich PC, Roetzheim RG, Patient Navigation Research Program Group: National cancer institute patient navigation research program: methods, protocol, and measures. Cancer 2008, 113(12):3391-3399.