title: Never tested for HIV in Latin-American migrants and Spaniards: prevalence and perceived barriers.
abstract: BACKGROUND
  Increasing 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.
  
  
  METHODS
  Between 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.
  
  
  RESULTS
  Of 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%.
  
  
  CONCLUSIONS
  Latin-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.
authors.affiliation: National Epidemiology Centre, Carlos III Health Institute, Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Hoyos
authors.forename: Sonia
authors.initials: S
authors.lastname: Fernández-Balbuena
authors.forename: Luis
authors.initials: L
authors.lastname: de la Fuente
authors.forename: Luis
authors.initials: L
authors.lastname: Sordo
authors.forename: Mónica
authors.initials: M
authors.lastname: Ruiz
authors.forename: Gregorio
authors.initials: G
authors.lastname: Barrio
authors.forename: María José
authors.initials: MJ
authors.lastname: Belza
mesh_terms: D000328:Adult; D005006:Ethnicity; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000517:prevention & control / Q000523:psychology; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007603:Jurisprudence; D008297:Male; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D015995:Prevalence; D012725:Sexual Behavior; D063508:Social Discrimination; D057545:Social Stigma; D013030:Spain / Q000453:epidemiology; D014171:Transients and Migrants; D055815:Young Adult
keywords: Europe; HIV; Latin America; barriers; testing; transients and migrants