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Table 2 Leaflet’s guidelines for healthcare professionals

From: Immigrant women living with HIV in Spain: a qualitative approach to encourage medical follow-up

Leaflet’s guidelines for healthcare professionals

Doctor-Patient relationship

- Use an accessible language for the patient according to their level of education, explain technical terms and ask open questions.

 

- Use professional interpreters if the patient has no proficiency in Spanish. Avoid using family members, friends or untrained interpreters.

 

- Explore the emotional sphere by asking questions such as: How are you feeling today? Do you think much about the disease? Try not to talk only about the physical aspect of the disease.

 

- Ask if she feels comfortable talking about her sexuality with a male professional.

Body - HIV relationship

- Explain the stages of the disease and the advantages of a prompt treatment and follow-up to avoid these barriers.

Employment

- Find out the purpose of their immigration. If it is economic, remember that work may be a more important priority for the patient than health.

 

- Bear in mind that the administrative status (documented/undocumented) and work conditions of the patient are fundamental to understanding if they will be able to attend follow-up consultations.

 

- Be flexible with consulting hours, allow consultations by telephone and avoid making appointments for superfluous matters.

 

- Verify if she has any family/friend who can help her to pick up the medication or can accompany her to the consultations.

Gender roles

- Ask if she has a partner or children (how many) and where they live.

 

- If she is single, explore her personal desires, explain that a person with HIV can build a family.

 

- Recommend strategies to make the use of condoms easier with their stable partner until they are ready to disclose their diagnosis (they can say, for example, they need to use it due to a gynecological problem).

 

- Teach them how to use the masculine and feminine condoms and lubricants.

 

- Encourage the patient to participate in enjoyable activities.

Representations of AIDS

- Explore what the woman thinks about HIV (now and before being infected) and what her family, friends and other people around her think about the infection.

 

- Make a clear distinction between HIV and prostitution or promiscuity. This will help to prevent feelings of guilt and shame.

 

- Pay attention to the fears and myths related to HIV.

Emotional support received

- Investigate if she has a support person (family or friend); and the quality of the relationship with her partner.

 

- Try to get a support person involved in her medical follow-up.

 

- Encourage the patient to create a support network.

Trust in Biomedical system

- Bear in mind the possibility of looking for an “expert patient” who can assist with your patient: this would be a woman who has HIV and who comes from the same culture as the patient, so she could provide support and improve the patient’s trust in the healthcare system.

 

- The patient’s perceptions can also be a useful tool in this respect.

Psychological condition

- Separate the HIV diagnosis from death and from stigma.

 

- Investigate the patients’ representations of the disease and the impact of the loss of people close to them (i.e. a child or a partner).

 

- Explain the advantages of seeing a psychologist or psychiatrist when necessary and encourage them to seek support from traditional/religious practices, as long as they do not have harmful effects on the treatment.