title: Immigrant women living with HIV in Spain: a qualitative approach to encourage medical follow-up.
abstract: 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.
authors.forename: Anne
authors.initials: A
authors.lastname: Guionnet
authors.forename: Bárbara
authors.initials: B
authors.lastname: Navaza
authors.forename: Belén
authors.initials: B
authors.lastname: Pizarro de la Fuente
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: Pérez-Elías
authors.forename: Fernando
authors.initials: F
authors.lastname: Dronda
authors.forename: Rogelio
authors.initials: R
authors.lastname: López-Vélez
authors.affiliation: Tropical Medicine, Infectious Diseases Department, Hospital Universitario Ramón y Cajal, IRYCIS, Crta, de Colmenar Km 9,1, Madrid 2834, Spain. jose.perezmolina@gmail.com.
authors.forename: José A
authors.initials: JA
authors.lastname: Pérez-Molina
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara / Q000208:ethnology; D000368:Aged; D001294:Attitude to Health; D054242:Emigrants and Immigrants; D005260:Female; D015658:HIV Infections / Q000208:ethnology*; D006297:Health Services Accessibility; D006801:Humans; D007843:Latin America / Q000208:ethnology; D008875:Middle Aged; D010349:Patient Compliance; D013030:Spain; D011795:Surveys and Questionnaires; D014932:Women's Health Services