Prevention Needs of Africans

posted: 16/12/2009

Updated with additional information  - The HIV and sexual health prevention needs of Africans living in England are highlighted in a report out today. During late 2008 and early 2009, Sigma Research worked with over one hundred organisations, including George House Trust, to carry out the Bass Line 2008-09 survey.
More than 2500 African people living in England took part.
 

The main report is in two parts. Part one sets the scene, discusses demographics, HIV testing, sexual HIV transmission behaviour, HIV prevention needs and HIV prevention interventions. The second part aims to identify sub-groups of Africans with high levels of risk behaviours and / or high levels of unmet prevention needs.
 

More detailed findings for NW England are in a supplement based on the 157 people in the region who took part. Most live in Manchester and detailed figures for Manchester are available. The rest of the region is aggregated together, because fewer than 20 took part from each of the other Primary Care Trusts.
This BASS Line survey and particularly the NW regional figures will help identify the most pressing regional HIV prevention needs of African people, and should help planning, delivering and funding HIV prevention services for Africans.

African Men Top in HIV Prevention Needs
Men, not women, should be the top priority among Africans in the UK. This survey suggests that men are more likely than women to report sexual risk behaviours, to know less and be less likely to have been tested for HIV. Women are far more likely to be tested because testing in pregnancy is now routine.

They also recommend that work with men pays particular attention to the needs of men who have sex with both men and women, and to men who only have sex with men. In addition, there are high levels of need among people with limited schooling.

‘I’ve no need to test’
A third have never had a HIV test result and a similar proportion have never been tested for other STIs. Only a half of those who haven’t yet had a HIV test would consider having one.

Men were less likely than women to have tested for HIV, to have diagnosed HIV and to know where to get tested for HIV.

The main reason people gave for not testing was thinking there was no need: only 1 in 3 Africans knew that at least 1-in-20 of all Africans living in England have HIV. The report recommends that to increase uptake of testing, health promoters must increase individuals’ awareness of their vulnerability to HIV and the costs of not knowing their HIV status early enough for HIV treatment to be able to work properly.

Sexually active, sexual risks
Three quarters of the people taking part had sexual partner(s) in the last year. More than half had a regular sexual partner, which was more common in men than in women. One-in-four of the people with regular partners said they had other sexual relationships outside the regular relationship, again more common in men than women.

In addition, one-in-ten who said they had sex in the last year reported definitely or probably having sexual intercourse without a condom with someone of a different HIV status to themselves. Men, and those with more sexual partners were more likely to report this risk.

Moreover, compared to women, men were more likely to be unconcerned about being involved in HIV transmission, and more likely to have a problem getting hold of condoms, and were significantly less knowledge about HIV in general.

Among the men, those who had sex with both women and men were the most likely to report having multiple partners, sex outside a relationship, unprotected sex with someone of a different HIV status and condom failure. Men who only had sex with other men were the most likely to be diagnosed with a sexually transmitted infection or with HIV.

As a consequence, the researchers call for more work with homosexually active African men, including men who also have sex with women.

Some under-educated
Although the sample was generally well educated (three quarters had a university or college education), 4% had no formal education or only went to primary school. The researchers recommend that more prevention resources are targeted at this group. While they were the least likely to be tested for HIV, they were the most likely to be diagnosed with it, or with another sexually transmitted infection. There were also strong associations between low education and risky behaviour, and low education and lower levels of HIV knowledge.

Preferences for information
The survey asked respondents about the ways in which they would prefer to learn more about HIV. Overall, more respondents preferred to get further information through reading compared to talking to someone, although many people mentioned both.

“Reading in private” was the most popular reading option, and of those who specified a particular type of written format, a website was the most popular. However talking face-to-face with a health worker was preferred to using a helpline or internet chat room.

People strongly prefer being given health information by health professionals, especially doctors (49%). The authors therefore advise community organisations that workers need to have sufficient expertise in HIV if they are to engage effectively with service users. Very few people say that the person giving information should be of a certain ethnicity, gender or age, or should have HIV themselves.

England findings
Ignorance is about - 1 in 10 do not know

• that people can have HIV without knowing
• there is still no cure for HIV
• you cannot tell whether someone has HIV by just looking at them.

1 in 5 do not know

• there are HIV treatments
• condoms are free from some services - in Manchester even fewer know this - 1 in 4

2 in 5 do not know

• there have been prosecutions for HIV transmission in England
• Africans are not deported from the UK simply for having HIV
• the high prevalence of HIV among Africans in England.

Condom shame
There are problems with condom access and use. Condoms are unwelcome to 1 in 3 who fear stigma - they worry what people would think of them if they were seen carrying condoms.
Too shy to talk about HIV
1 in 3 have problems with safer sex negotiation skills and confidence who are not sure that they could easily talk about safer sex and HIV with new sexual partners.

1 in 10 feel powerless to manage transmission risks
Among those not diagnosed HIV positive, more than one-in-ten did not feel they were in control of whether or not they became infected.
Similarly, among those diagnosed with HIV, one-in-ten disagreed or was unsure that they had control over exposing sexual partners to the virus or getting infected with another type of HIV.
 

NAHIP programme
This study adds to a body of work undertaken as part of the National African HIV Prevention programme (NAHIP) that will help health promoters tailor interventions for African communities in England:
This was the largest ever study of sexual health and HIV prevention needs among African people in England.

 

Download the main report from George House Trust, or order a free paper copy

 

The NW England report is here.

Other regional reports for England.  
 

African Prevention ToolKits and other resources

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