EN ES
Vol. 23. Num. 3. 2014. Pages 177-185

Determinants of late diagnosis of HIV infection in Spain

[Determinantes del diagnóstico tardío de la infección por VIH en España]

María José Fuster Ruiz de Apodaca1 , Fernando Molero Alonso2 , Encarnación Nouvilas2 , Piedad Arazo2 , David Dalmau2

1Sociedad Española Interdisciplinaria del Sida SEISIDA ,2Univ. Nal. Educación Distancia, España

Abstract

The main goal of this study was to analyse the determinants of late diagnosis of HIV infection. Secondly, westudied the role of the perception of risk and sexual orientation in HIV testing. Twenty-five people withlate HIV diagnosis were interviewed. They were contacted through hospitals and non-governmentalorganizations (NGOs). To design the interview, we integrated the variables considered in the main modelsof health-related behaviour. We followed a mixed strategy of analysis. Firstly, we carried out thematicanalysis of the interviews, followed by quantitative analysis of the initially qualitative data. The resultsrevealed that the most relevant determinants were the appraisal of the threat of HIV and the low perceptionof HIV risk. Also, the study found many missed opportunities for diagnosis in health-care setting. Lowperception of HIV risk was related to unrealistic optimism, low levels of information about HIV, and thepresence of stereotypes about people with HIV. High perception of HIV risk was related to strategies toavoid testing. Homosexuals reported a more positive balance between the benefits of knowing theirdiagnosis and having the disease. The results provide clues that can guide the design of future strategies topromote early diagnosis. 

Resumen

El objetivo principal de este estudio fue analizar los determinantes del diagnóstico tardío de la infecciónpor 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 organizacionesno gubernamentales (ONG). Para el diseño del guión de la entrevista se partió de una integración delas variables consideradas en los principales modelos de conductas de salud. Se siguió una estrategia mixtade análisis. Primeramente, se realizó análisis temático de las entrevistas. Seguidamente, se realizaron análisiscuantitativos sobre los datos cualitativos. Se halló que los determinantes más relevantes eran la valoraciónde amenaza del VIH y la baja percepción de riesgo. Se hallaron también oportunidades perdidas dediagnóstico en el sistema sanitario. La baja percepción de riesgo se asociaba con el optimismo irrealista, lapoca información sobre el VIH y los estereotipos sobre las personas con VIH. La alta percepción de riesgo serelacionaba con las estrategias de evitación del test. Los discursos de las personas homosexuales mostraronun balance más positivo de los beneficios de conocer el diagnóstico. Los resultados sugieren claves quepueden guiar el diseño de futuras estrategias de promoción del diagnóstico precoz. 

Keywords

HIV
Late diagnosis
Determinants of health behaviour Qualitative study

Palabras clave

VIH
Diagnóstico tardío
Determinantes de conductas de salud Estudio cualitativo
References
Adler et al., 2009
A. Adler
S. Mounier-Jack
R.J. Coker
Late diagnosis of HIV in Europe: Definitional and public health challenges
AIDS Care
21
2009
284-93
Ajzen, 1991
I. Ajzen
The theory of planned behavior
Organizational behavior and human decision processes
50
1991
179-211
Ajzen and Fishbein, 1980
I. Ajzen
M. Fishbein
Understanding Attitudes and Predicting Social Behavior
1980
Becker, 1974
M.H. Becker
The health belief model and sick role behavior
Health Education Monographs
2
1974
409-19
Belza et al., 2014
M.J. Belza
C. Figueroa
M.E. Rosales-Statkus
M. Ruiz
F. Vallejo
L.D.L. Fuente
Low knowledge and anecdotal use of unauthorized online HIV self-test kits among attendees at a street-based HIV rapid testing programme in Spain
International Journal of Infectious Diseases
25
2014
196-200
Boyatzis, 1998
R.E. Boyatzis
Transforming qualitative information: Thematic analysis and code development
1998
Bradley et al., 2011
H. Bradley
A. Tsui
A. Kidanu
D. Gillespie
Client characteristics and HIV risk associated with repeat HIV testing among women in Ethiopia
AIDS and Behavior
15
2011
725-33
Braun and Clarke, 2006
V. Braun
V. Clarke
Using thematic analysis in psychology
Qualitative research in psychology
3
2006
77-101
Brooks et al., 2011
R.A. Brooks
S.J. Lee
G.N. Stover
T.W. Barkley
HIV testing, perceived vulnerability and correlates of HIV sexual risk behaviours of Latino and African American young male gang members
International journal of STD & AIDS
22
2011
19-24
Burns et al., 2008
F.M. Burns
A.M. Johnson
J. Nazroo
J. Ainsworth
J. Anderson
A. Fakoya
K.A. Fenton
Missed opportunities for earlier HIV diagnosis within primary and secondary healthcare settings in the UK
Aids
22
2008
115-22
Catania et al., 1990
J.A. Catania
L. Pollack
L.J. McDermott
S.H. Qualls
Help-seeking behaviors of people with sexual problems
Archives of Sexual Behavior
19
1990
235-50
Cohen et al., 2007
M.S. Cohen
C. Gay
A.D. Kashuba
S. Blower
L. Paxton
Narrative review: Antiretroviral therapy to prevent the sexual transmission of HIV-1
Annals of Internal Medicine
146
2007
591-601
Deblonde et al., 2010
J. Deblonde
P. De Koker
F.F. Hamers
J. Fontaine
S. Luchters
M. Temmerman
Barriers to HIV testing in Europe: A systematic review
European Journal of Public Health
20
2010
422-32
Delva et al., 2008
W. Delva
F. Wuillaume
S. Vansteelandt
P. Claeys
H. Verstraelen
D.V. Broeck
M. Temmerman
HIV testing and sexually transmitted infection care among sexually active youth in the Balkans
AIDS Patient Care and STDs
22
2008
817-21
Dorr et al., 1999
N. Dorr
S. Krueckeberg
A. Strathman
M.D. Wood
Psychosocial correlates of voluntary HIV antibody testing in college students
AIDS Education and Prevention
11
1999
14-27
European, 2011
European Centre for Disease Prevention and Control [ECDC]/WHO Regional Office for Europe (2012). HIV/AIDS surveillance in Europe 2011 . Stockholm: Author. Retrieved from h t t p & # 5 8 ; & # 4 7 ; & # 4 7 ; e c d c & # 4 6 ; e u r o p a & # 4 6 ; e u & # 4 7 ; e n & # 4 7 ; p u b l i c a tions/Publications/20121130-Annual-HIV-Surveillance-Report.pdf.
Ewart, 1991
C.K. Ewart
Social Action Theory for a Public Health Psychology
American Psychologist
46
1991
931-46
Fernández-Dávila et al., 2012
P. Fernández-Dávila
F. Lupiáñez-Villanueva
K. Zaragoza Lorca
Actitudes hacia los programas de prevención on-line del VIH y las ITS y perfil de los usuarios de Internet en los hombres que tienen sexo con hombres
Gaceta Sanitaria
26
2012
123-30
Forsyth et al., 2008
S.F. Forsyth
E.A. Agogo
L. Lau
E. Jungmann
S. Man
S.G. Edwards
A.J. Robinson
Would offering rapid point-of-care testing or non-invasive methods improve uptake of HIV testing among high-risk genitourinary medicine clinic attendees?. A patient perspective
International Journal of STD & AIDS
19
2008
550-2
Glaser and Strauss, 1967
B. Glaser
A. Strauss
The Discovery of Grounded Theory: Strategies for Qualitative Research
1967
Goodman and Berecochea, 1994
E. Goodman
J.E. Berecochea
Predictors of HIV testing among runaway and homeless adolescents
Journal of Adolescent Health
15
1994
566-72
Hoyos et al., 2013
J. Hoyos
M.J. Belza
S. Fernández-Balbuena
M.E. Rosales-Statkus
J. Pulido
L. de la Fuente
Preferred HIV testing services and programme characteristics among clients of a rapid HIV testing programme
BMC public health
13
1
2013
1-9
Kalichman and Hunter, 1993
S.C. Kalichman
T.L. Hunter
HIV-related risk and antibody testing: An urban community survey
AIDS Education and Prevention
5
1993
234-43
Krentz and Gill, 2011
H.B. Krentz
M.J. Gill
The direct medical costs of late presentation (< 350/mm3) of HIV infection over a 15-year period
AIDS Research and Treatment
2011
1-8
Kwapong et al., 2014
G.D. Kwapong
D. Boateng
P. Agyei-Baffour
E.A. Addy
Health service barriers to HIV testing and counseling among pregnant women attending ANC; a cross-sectional study
BMC health services research
14
2014
267
Landis and Koch, 1977
J.R. Landis
G.G. Koch
The measurement of observer agreement for categorical data
Biometrics
1977
159-74
Lebart and Salem, 1994
L. Lebart
A. Salem
Statistique textuelle
1994
Liddicoat et al., 2004
R.V. Liddicoat
N.J. Horton
R. Urban
E. Maier
D. Christiansen
J.H. Samet
Assessing missed opportunities for HIV testing in medical settings
Journal of General Internal Medicine
19
2004
349-56
Maguen et al., 2000
S. Maguen
L.P. Armistead
S. Kalichman
Predictors of HIV antibody testing among gay, lesbian, and bisexual youth
Journal of Adolescent Health
26
2000
252-7
Myers et al., 1993
T. Myers
K.W. Orr
D. Locker
E.A. Jackson
Factors affecting gay and bisexual men's decisions and intentions to seek HIV testing
American Journal of Public Health
83
1993
701-4
Ostermann et al., 2007
J. Ostermann
V. Kumar
B.W. Pence
K. Whetten
Trends in HIV testing and differences between planned and actual testing in the United States, 2000-2005
Archives of internal medicine
167
2007
2128-35
Rodríguez-Marín, 2001
J. Rodríguez-Marín
Psicología social de la salud [Social psychology of health]
2001
Rogers, 1983
R.W. Rogers
Cognitive and physiological processes in fear appeals and attitude change: A revised theory of protection motivation
Social Psychophysiology
Guilford
New York, NY
1983
153-76
Ryan and Bernard, 2000
G.W. Ryan
H.R. Bernard
Data management and analysis methods
Handbook of qualitative research (2nd Edition
Sage
Thousand Oaks, CA
2000
769-802
Sambisa et al., 2010
W. Sambisa
S. Curtis
V. Mishra
AIDS stigma as an obstacle to uptake of HIV testing: Evidence from a Zimbabwean national population-based survey
AIDS Care
22
2010
170-86
Secretaría, 2012
Secretaría del Plan Nacional sobre el Sida/Centro Nacional de Epidemiología. Área de Vigilancia y Conductas de Riesgo (2012). Vigilancia epidemiológica del VIH/Sida en España: Sistema de información sobre nuevos diagnósticos de VIH y registro nacional de casos de Sida [Epidemiologic surveillance of HIV/AIDS in Spain: Information System of new diagnoses of HIV and national registration of AIDS cases]. Madrid: Author. Retrieved from h t t p & # 5 8 ; & # 4 7 ; & # 4 7 ; w w w & # 4 6 ; m s c & # 4 6 ; e s & # 4 7 ; c i u d a d a n o s & # 4 7 ; e n f L e s i o n e s & # 4 7 ; e n f T r a n smisibles/sida/vigilancia/InformeVIHsida_Junio2012.pdf.
Sobrino-Vegas et al., 2009
P. Sobrino-Vegas
L.G.S. Miguel
A.M. Caro-Murillo
J.M. Miró
P. Viciana
C. Tural
S. Moreno
Delayed diagnosis of HIV infection in a multicenter cohort: Prevalence, risk factors, response to HAART and impact on mortality
Current HIV Research
7
2009
224-30
Stokes et al., 2007
S.H. Stokes
P. McMaster
K.M. Ismail
Acceptability of perinatal rapid point-of-care HIV testing in an area of low HIV prevalence in the UK
Archives of Disease in Childhood
92
2007
505-8
Stolte et al., 2007
I.G. Stolte
J.B. de Wit
M.E. Kolader
H.S. Fennema
R.A. Coutinho
N.H. Dukers
Low HIV-testing rates among younger high-risk homosexual men in Amsterdam
Sexually Transmitted Infections
83
2007
387-91
Weinstein, 1980
N.D. Weinstein
Unrealistic optimism about future life events
Journal of Personality and Social Psychology
39
1980
806-20

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