Introduction
Provider-initiated
HIV testing (PITC) is increasingly adopted in Europe. The success of the
approach at identifying new HIV cases relies on its effectiveness at testing
individuals most at risk. However, its suitability to reach populations facing
overlapping vulnerabilities is under researched. This qualitative study
examined HIV testing experiences and perceptions amongst Latin-American migrant
men who have sex with men and transgender females in Spain, as well as health
professionals’ experiences offering HIV tests to migrants in Barcelona and
Madrid.
Methods
We
conducted 32 in-depth interviews and 8 discussion groups with 38 Latin-American
migrants and 21 health professionals. We imported verbatim transcripts and detailed
field work notes into the qualitative software package Nvivo-10 and applied to
all data a coding framework to examine systematically different HIV testing
dimensions and modalities. The dimensions analysed were based on the World
Health Organization “5 Cs” principles: Consent, Counselling, Connection to
treatment, Correctness of results and Confidentiality.
Results
Health
professionals reported that PITC was conceptually acceptable for them, although
their perceived inability to adequately communicate HIV+ results and resulting
bottle necks in the flow of care were recurrent concerns. Endorsement and
adherence to the principles underpinning the rights-based response to HIV
varied widely across health settings. The offer of an HIV test during routine consultations
was generally appreciated by users as a way of avoiding the embarrassment of
asking for it. Several participants deemed compulsory testing as acceptable on
public health grounds. In spite of—and sometimes because of—partial endorsement
of rights-based approaches, PITC was acceptable in a population with high
levels of internalised stigma.
Conclusion
PITC is a promising approach to reach sexual minority
migrants who hold high levels of internalised stigma but explicit extra efforts
are needed to safeguard the rights of the most vulnerable.
- 1ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.
- 2Centre for Social Science and Global Health, University of Amsterdam, Amsterdam, The Netherlands.
- PLoS One. 2016 Feb 25;11(2):e0150223. doi: 10.1371/journal.pone.0150223.
