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Gesundheitswesen 2019; 81(03): e43-e57
DOI: 10.1055/a-0668-5621
Übersichtsarbeit
© Georg Thieme Verlag KG Stuttgart · New York

Zugangsschwellen zu HIV-Test-Angeboten – Eine systematische Literaturanalyse

Barriers to Accessing HIV Testing Services – A Systematic Literature Review
Michael Wurm
1   Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen
,
Anja Neumann
1   Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen
,
Jürgen Wasem
1   Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen
,
Janine Biermann-Stallwitz
1   Lehrstuhl für Medizinmanagement, Universität Duisburg-Essen, Essen
› Author Affiliations
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Publication History

Publication Date:
15 October 2018 (online)

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Zusammenfassung

Ziel In Deutschland liegen die jährlichen HIV-Neu-Infektionen bei 3100 (2016) und betreffen v. a. Männer, die Sex mit Männern haben sowie intravenös Drogengebrauchende. Es wird eine Rate von 30 % der HIV-Infektionen angenommen, die erst in einer fortgeschrittenen Phase der Infektion diagnostiziert werden, oft jenseits des optimalen Zeitpunkts des Behandlungsbeginns. Die hohe Rate an Late-Presentern ist ein starkes Argument für eine Stärkung von Beratungs- und HIV-Testangeboten. Ziel dieser Literaturanalyse ist es daher zu beschreiben, welche Zugangsschwellen zu HIV-Testangeboten existieren.

Methodik Mit einer Literaturanalyse wurde der aktuelle Erkenntnisstand in Forschung und Praxis darauf hin abgebildet, welche Barrieren Risikogruppen vom HIV-Test abhalten. In die Suche wurden alle Veröffentlichungen zwischen 2010 und 2014 aus Australien, Europa und Nordamerika einbezogen, die sich auf Klienten-initiierte Tests beziehen.

Ergebnisse 132 Veröffentlichungen wurden in eine Volltextanalyse einbezogen. Die meisten Veröffentlichungen basieren auf Klientenbefragungen. Die individuelle Risikowahrnehmung beeinflusst die Entscheidung für oder gegen einen HIV-Test maßgeblich. Diese kann über Öffentlichkeitsarbeit und über aufsuchende Angebote beeinflusst werden. In den Strukturen und Abläufen des HIV-Test-Angebotes sind Vertraulichkeit und Anonymität an jeder Stelle zentral. Darüber hinaus ist den Klienten wichtig, dass ihnen in den Beratungsgesprächen mit Akzeptanz und Vorurteilsfreiheit begegnet wird. Die Angst der Klienten vor Stigmatisierung, Verurteilung und Ausgrenzung verlangt eine besondere Sensibilität und lebensstilakzeptierende Haltung auf Seiten des Personals.

Schlussfolgerung Die Faktoren, die für Klienten bei der Entscheidung über einen HIV-Test und der Auswahl eines Test-Angebots von Bedeutung sind, werden klar abgebildet. Die zentralen Elemente in der Entscheidungsfindung sind die eigene Risikowahrnehmung sowie die Furcht vor Stigmatisierung aufgrund vermeintlich abweichenden Sexualverhaltens oder aufgrund einer befürchteten HIV-Infektion. Die Öffentlichkeitsarbeit sollte Risikofaktoren bzw. -wahrnehmung in Bezug auf HIV sowie Vertraulichkeit und Anonymität des Angebots betonen. Die Nutzung sozialer Netzwerke ist hierbei besonders empfehlenswert. Neue Angebotsformen wie Heimtests könnten die Sorgen hinsichtlich Vertraulichkeit und Anonymität auflösen.

Abstract

Objective In Germany there are 3,100 new HIV infections per year (2016), mainly homosexual men and intravenous drug users. According to experts from Robert Koch Institute, about 30 % of people with HIV are diagnosed late, well past the optimal moment to start the antiretroviral therapy. The high rate of late presenters seems to be a strong argument for an intensification of voluntary counseling and testing services. The main objective of this literature analysis was to describe the barriers to HIV testing.

Methods A systematic literature search was done to evaluate current knowledge on theory and practice regarding barriers that keep vulnerable groups from getting tested. The analysis includes all publications between 2000 and 2014 from western industrial states.

Results 132 publications have been included in a full text analysis. Most of these publications present the result of surveys of clients attending counseling and testing services. Hence, we have a clear idea of the elements that are relevant for clients when they decide whether or where to get tested for HIV. First, the individual risk perception influences the decision on getting tested or not. The risk perception can be influenced through public relations and outreach services. All processes within the counseling and testing service should be adapted to assure confidentiality and anonymity. In addition, clients want to have counseling that is accepting and free of prejudices. These elements are therefore important since HIV is often associated with getting stigmatized. Similar concerns regarding stigmatization occur if clie nts have sexual preferences that can be considered as deviant. The clients’ fear of stigmatization, judgment and social exclusion requires a high sensitivity for the situation of the clients and acceptance of their lifestyle.

Conclusion We have a clear insight into how clients decide on getting tested or not. The factor with the greatest influence in the decision-making process is the individual risk perception and anxiety regarding stigmatization. Stigmatization is suspected as a societal reaction to deviant sexual behavior or to being infected with HIV. Public relations should inform about risk factors and risk perception as well as on confidentiality and anonymity of the service. The use of social media and social networks is highly recommended. New approaches such as home testing could eliminate the concerns regarding confidentiality and anonymity.

Schlüsselwörter

HIV - Aids - HIV-Test - Setting - Late Presenter - Zugangsschwellen

Key words

HIV - Aids - HIV testing - setting - Thresholds - Late presenter
 

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