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Barriers to HIV testing in Europe: a systematic review

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Abstract
Background: In the European Union (EU) and neighbouring countries, HIV/AIDS, of all infectious diseases, has one of the highest morbidity and mortality rates. An estimated 30% of people living with HIV are unaware of their infection, and may therefore not benefit from timely treatment or may transmit HIV to others, unknowingly. Evidence shows that opportunities are being missed to diagnose HIV infections in EU Member States, particularly in regular health care settings. There is a need to better understand the barriers to HIV testing and counselling with the aim to contribute to the decrease of the number of undiagnosed people. Methods: A systematic review of literature on HIV testing barriers in Europe was conducted, applying a free text strategy with a set of search terms. Results: A total of 24 studies published in international peer-reviewed journals and meeting the review's eligibility criteria were identified. Fourteen studies report on barriers at the level of the patient; six on barriers at health care provider level and seven on institutional barriers referring to the policy level. The barriers described are centralized around low-risk perception; fear and worries; accessibility of health services, reluctance to address HIV and to offer the test; and scarcity of financial and well trained human resources. Conclusions: Some barriers to HIV testing and counselling have been illustrated in the literature. Nevertheless, there is lack of structured information on barriers considering (i) legal, administrative and financial factors, (ii) attitudes and practices of health care providers and (iii) perception of patients. Such data is critical to improve effectiveness of HIV testing and counselling.
Keywords
systematic review, ACTIVE ANTIRETROVIRAL THERAPY, barriers, missed diagnoses, Europe, HIV testing, HIV, COMMERCIAL SEX WORK, UNITED-KINGDOM, GAY MEN, CARE, LONDON, INFECTION, DIAGNOSIS, UK, AFRICAN

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Chicago
Deblonde, Jessika, Petra De Koker, Francoise F Hamers, Johann Fontaine, Stanley Lüchters, and Marleen Temmerman. 2010. “Barriers to HIV Testing in Europe: a Systematic Review.” European Journal of Public Health 20 (4): 422–432.
APA
Deblonde, J., De Koker, P., Hamers, F. F., Fontaine, J., Lüchters, S., & Temmerman, M. (2010). Barriers to HIV testing in Europe: a systematic review. EUROPEAN JOURNAL OF PUBLIC HEALTH, 20(4), 422–432.
Vancouver
1.
Deblonde J, De Koker P, Hamers FF, Fontaine J, Lüchters S, Temmerman M. Barriers to HIV testing in Europe: a systematic review. EUROPEAN JOURNAL OF PUBLIC HEALTH. 2010;20(4):422–32.
MLA
Deblonde, Jessika, Petra De Koker, Francoise F Hamers, et al. “Barriers to HIV Testing in Europe: a Systematic Review.” EUROPEAN JOURNAL OF PUBLIC HEALTH 20.4 (2010): 422–432. Print.
@article{1022895,
  abstract     = {Background: In the European Union (EU) and neighbouring countries, HIV/AIDS, of all infectious diseases, has one of the highest morbidity and mortality rates. An estimated 30\% of people living with HIV are unaware of their infection, and may therefore not benefit from timely treatment or may transmit HIV to others, unknowingly. Evidence shows that opportunities are being missed to diagnose HIV infections in EU Member States, particularly in regular health care settings. There is a need to better understand the barriers to HIV testing and counselling with the aim to contribute to the decrease of the number of undiagnosed people.
Methods: A systematic review of literature on HIV testing barriers in Europe was conducted, applying a free text strategy with a set of search terms.
Results: A total of 24 studies published in international peer-reviewed journals and meeting the review's eligibility criteria were identified. Fourteen studies report on barriers at the level of the patient; six on barriers at health care provider level and seven on institutional barriers referring to the policy level. The barriers described are centralized around low-risk perception; fear and worries; accessibility of health services, reluctance to address HIV and to offer the test; and scarcity of financial and well trained human resources.
Conclusions: Some barriers to HIV testing and counselling have been illustrated in the literature. Nevertheless, there is lack of structured information on barriers considering (i) legal, administrative and financial factors, (ii) attitudes and practices of health care providers and (iii) perception of patients. Such data is critical to improve effectiveness of HIV testing and counselling.},
  author       = {Deblonde, Jessika and De Koker, Petra and Hamers, Francoise F and Fontaine, Johann and L{\"u}chters, Stanley and Temmerman, Marleen},
  issn         = {1101-1262},
  journal      = {EUROPEAN JOURNAL OF PUBLIC HEALTH},
  language     = {eng},
  number       = {4},
  pages        = {422--432},
  title        = {Barriers to HIV testing in Europe: a systematic review},
  url          = {http://dx.doi.org/10.1093/eurpub/ckp231},
  volume       = {20},
  year         = {2010},
}

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