Determinants of late diagnosis of HIV infection in Spain

Abstract

The main goal of this study was to analyse the determinants of late diagnosis of HIV infection. Secondly, we studied the role of the perception of risk and sexual orientation in HIV testing. Twenty-five people with late HIV diagnosis were interviewed. They were contacted through hospitals and non-governmental organizations (NGOs). To design the interview, we integrated the variables considered in the main models of health-related behaviour. We followed a mixed strategy of analysis. Firstly, we carried out thematic analysis of the interviews, followed by quantitative analysis of the initially qualitative data. The results revealed that the most relevant determinants were the appraisal of the threat of HIV and the low perception of HIV risk. Also, the study found many missed opportunities for diagnosis in health-care setting. Low perception of HIV risk was related to unrealistic optimism, low levels of information about HIV, and the presence of stereotypes about people with HIV. High perception of HIV risk was related to strategies to avoid testing. Homosexuals reported a more positive balance between the benefits of knowing their diagnosis and having the disease. The results provide clues that can guide the design of future strategies to promote early diagnosis.El objetivo principal de este estudio fue analizar los determinantes del diagnóstico tardío de la infección por VIH. Asimismo, se estudió el papel que jugaban en ello la percepción de riesgo y la orientación sexual. Se entrevistó a 25 personas con VIH, con las que se estableció contacto a través de hospitales y de organizaciones no gubernamentales (ONG). Para el diseño del guión de la entrevista se partió de una integración de las variables consideradas en los principales modelos de conductas de salud. Se siguió una estrategia mixta de análisis. Primeramente, se realizó análisis temático de las entrevistas. Seguidamente, se realizaron análi-sis cuantitativos sobre los datos cualitativos. Se halló que los determinantes más relevantes eran la valoración de amenaza del VIH y la baja percepción de riesgo. Se hallaron también oportunidades perdidas de diagnóstico en el sistema sanitario. La baja percepción de riesgo se asociaba con el optimismo irrealista, la poca información sobre el VIH y los estereotipos sobre las personas con VIH. La alta percepción de riesgo se relacionaba con las estrategias de evitación del test. Los discursos de las personas homosexuales mostraron un balance más positivo de los beneficios de conocer el diagnóstico. Los resultados sugieren claves que pueden guiar el diseño de futuras estrategias de promoción del diagnóstico precoz.

Diagnóstico tardío y enfermedad avanzada de VIH en pacientes adultos en un hospital de la seguridad social de Perú

“…Aún más, Crabtree-Ramírez y cols., demostraron que alrededor de 76% de los pacientes iniciaban tardíamente la TARV en seis países de Latinoamérica y el Caribe (56% Argentina, 80% Chile, 76% Haití, 91% Honduras, 79% México y 86% Perú), de los cuales 55% tuvo un testeo tardío 27 . Nuestros resultados muestran porcentajes superiores tanto de DT (82,6%), como de EA (64,5%), constituyendo un problema relevante de salud pública en Perú, debido que los pacientes con estas condiciones acudirían a recibir atención médica, en su mayoría, con un deterioro clínico e inmunológico que no sólo repercutiría sobre la salud del individuo, sino también del colectivo, y del propio sistema de salud [28][29][30] . En el análisis se encontró que los pacientes de sexo masculino y que los grupos sobre de 40 años de edad tienen mayor frecuencia de DT; estos datos se ven respaldados por hallazgos en estudios que indican que tanto la edad como el sexo se asocian a un DT de infección por VIH 31,32 .…”

Psychosocial determinants of HIV testing across stages of change in Spanish population: a cross-sectional national survey

“…Firstly, a literature review on the topic under study was performed. Secondly, a qualitative study was conducted in which 25 people with late HIV were interviewed [16]. The third step included drafting a pool of potential items covering the variables under study.…”

“…The survey contained a first group of items ( n =  18) of psychosocial determinants of health behaviors considered by the models cited in the introduction (HBM, PMT, SCT, TRA, TPB) [16, 22–29]. The following determinants were assessed: perceived HIV risk, underestimation of risk of HIV infection, invulnerability associated with stereotypes, perceived threat, perceived severity, perceived stigma, self-efficacy to undergo testing and to deal with a positive test outcome, social proximity to HIV-tested people, motivation to be tested if so requested by reference people, perceived benefits of being tested, and attitude (instrumental and emotional dimensions).…”

“…This perspective includes theories such as the Health Belief Model (HBM) [10, 11], the Protection Motivation Theory (PMT) [12], the Social Cognitive Theory (SCT) [13], or the Theory of Reasoned Action or Planned Behavior (TRA, TPB) [14, 15]. These theories include, among others, the following psychosocial determinants that are relevant for the purpose of this research: (a) the perception of personal vulnerability to the health problem; (b) the perception of threat posed by the disease, both by the risk to health and, in the case of HIV, by the threat of stigma [16]; (c) the assessment of one's coping, that is, of the behavioural alternatives that may reduce the threat and the expectation of the efficacy of one's response; (d) the belief in one's personal capacity or self-efficacy to successfully perform the health behavior; (e) the expectation of behavioural outcomes, that is, the positive or negative effects produced, the appraisal of the outcomes of performing the health behavior; (f) attitude, which is determined by beliefs and the appraisal of the outcomes of the behavior; (g) the subjective norm, which consists of beliefs about referents’ opinions and the motivation to comply with those referents; and (h) signals for taking action.…”

“…People will be more or less willing to perform a health behavior depending on their current stage within the change process. One of those models is the Model of the Precaution Adoption Process (MPAP) [16, 17], which considers several stages in the recognition, adoption, and maintenance of health behavior. The core of this model is a sequence of six stages: “unaware of the issue”, “aware of the issue but not personally engaged”, “engaged and deciding what to do”, “planning to act but not yet having acted”, “acting”, and “maintenance”.…”