Patients' Satisfaction with Sexual and Reproductive Health Services Delivered in HIV Clinics across European Regions

SUMMARYBackground: Throughout Europe, differences in satisfaction with HIV-care of people living with HIV (PLHIV) persist, despite a tendency towards harmonisation of policy and management.Methods: A European sample of 1,549 PLHIV responded to an anonymous questionnaire assessing demographic background, general health, mental health, sexual health, and HIV-service provision. We compared the results across 3 regions: Western, Southern and Central/Eastem Europe.Results: PLHIV differed in several socio-demographic variables (gender, migrant status, sexual orientation, and financial situation) as well as specific psychosocial aspects (HIV-related discrimination, satisfaction with sexual and reproductive health (SRH) services in HIV-care settings, and complaints about service provision). Using multivariate analysis, a predictive model for satisfaction with SRH services in HIV clinics was developed, resulting into region of residence, and participants' satisfaction with their own health status as significant predictors.Conclusions: Better integration of SRH services in HIV-care should be encouraged. Service providers should be trained and encouraged to discuss SRH issues with their patients to create a supportive environment, free of discrimination. More time should be allocated to discuss SRH issues with individual patients.Key words: sexual and reproductive health, HIV-care, EuropeINTRODUCTIONHIV continues to be a public health problem in Europe. In the European Economic Area (EEA) - European Union Member States, Norway, Iceland, and Liechtenstein - and Switzerland, 28,038 new HIV cases were reported in 2011, a rate of 5.7 per 100,000 population (1). The four countries with the highest rates were Estonia, Latvia, Belgium, and the United Kingdom, with rates above 10 per 100,000 population. The predominant mode of transmission of HIV in the EU/EEA-region and Switzerland is sex between men, accounting for 39% (10,855 cases) of the HIV-diagnoses reported in 2011, followed by heterosexual transmission excluding individuals originating from countries with generalised epidemics (23%). For 19% of the newly diagnosed cases in 2011, the transmission mode was unknown (1). While trends towards stronger harmonisation of HIV policy and management across Europe have been observed, there are indications that evidence-based policies, programmes and services are still implemented differently in European countries (2). This may have an impact on patients' satisfaction with health care services. A recent review gathered evidence on perceived service quality of HIV-services. Several factors were found to improve patient's satisfaction. They were either related to individual health care provider (i.e. knowledge, caring and respectful attitude, communication skills, and information provision) or to organisations (responsive and flexible services) (3).In this article we present a subset analysis using data from a European public health project on sexual and reproductive health needs of people living with HIV (PLHIV) in 14 European countries. Details on the study design and overall results are described elsewhere (4). Here we compare socio-demographic variables, measures of satisfaction with sexual and reproductive health services delivered in HIV clinics, and perceived levels of HIV-related discrimination across three European regions. The identified critical differences in HIV-service provision could inform HIV policy makers and service providers to improve care.MATERIALSAND METHODSProceduresThe research was carried out in a network of 17 HIV treatment and research centres in 14 European countries between March and October 2007. A self-administered, anonymous questionnaire was developed including questions on demographic background characteristics, general health related aspects, mental health, sexual health, and HIV-service provision. It was translated into 12 languages, and was distributed to consecutive patients at the collaborating sites. …