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

Source

Campaign - Cut Late Diagnosis

posted: 03/12/2009

Late diagnosed HIV is bad news in NW England – we have England’s worst regional rate for late HIV diagnosis. Across the NW an average of 35.9% are diagnosed late, compared with the national average of 31%.
 

It matters because up to a third of people with HIV are diagnosed late, after the immune system has already been damaged by the virus. Late diagnosis makes

• treatment more complex 
• people more ill,
• life significantly shorter - and
• accidental HIV transmission more likely, because they don't know they have it.

e-mail your PCT

We're asking you to write to your PCT and encourage them to cut late diagnosis of HIV, so people stay healthy for longer.

Postcode to email easily
If you enter your details and postcode, the SHout-Loud website creates a custom letter about late diagnosed HIV in your own PCT. For Manchester, it tells the PCT that 38% are diagnosed late when the national average is only 31%, and that means a lot of people are diagnosed late here.

Click on the link below to take part, and remember to check the box to join ‘SHout Loud’ so you receive updates on other campaign actions.

Bit by bit, we can improve sexual health locally.

Click here to write to your local PCT

It may take a few moments for the e-mail letter to appear – please be patient!
 

Why bother?
More and more decisions about health services are now taken at a local level, and decision-makers have to take the views of local communities into account. The SHout Loud (Sexual Health out loud) aims to help you affect local decisions and improve sexual health in our community.
 

NW England – the late diagnosis hotspot
The late diagnosis rate varies dramatically between PCTs in NW England, and the figures are often distorted because the numbers diagnosed in some PCTs each year are very small, but North Lancashire has twice the national average rate (62% late diagnosed).

Late diagnosis figures for each Primary Care Trust in NW England

Worrying is Manchester ,because it has by far the largest number diagnosed late last year, 54 out of 142 people, 38% late. But this is next door to its twin city Salford, where just 23.9% were late (11 out of 46). It is difficult to understand how living on one side or the other of the River Irwell can make such a difference.
 

Commonwealth Stops HIV Funding

posted: 30/11/2009

The Commonwealth Foundation agreed to switch almost all of its entire £400,000 HIV funding from HIV to cultural activities, without consultation, in April, it has just emerged.
 

The leaders of Commonwealth countries, ending their annual meeting in Trinidad and Tobago, were last night facing dealing with the scandal. The Commonwealth has 30 per cent of the world's population but 60 per cent of the people with HIV in the world, and HIV is acknowledged as a "Commonwealth emergency". Despite this, and without public consultation, it was decided to end the only Commonwealth programme that directly tackles HIV.
 

Commonwealth HIV Network abandoned
Over the past four years, nearly £400,000 has been spent through the Commonwealth Foundation to create an international network of experts, activists and civic organisations working on HIV/AIDS. The Foundation, funded by taxpayers of the 53 member states of the Commonwealth, decided in April to switch the money from the Pan-Commonwealth HIV/AIDS Network to cultural activities. It did not tell those involved, according to confidential emails seen by The Independent.
 

A storm of protest followed behind closed doors in which the foundation was accused of "jumping ship" and its director, Mark Collins, was asked to explain the "abandonment". In an email exchange with Mr Collins in April, the Canadian scientist John W Foster, of the North-South Institute in Ottawa, wrote to express his "deep surprise and concern regarding the news that HIV/AIDS is no longer a priority of the ... foundation". Mr Foster asked for the decision to be reversed and demanded to know the rationale behind it.
 

Denial
The foundation's response to the furore was to deny any change in strategy. Mr Collins insisted yesterday that the network's funding had reached the end of a "three-year commitment". He has told the foundation's partners they can apply individually for small grants through a website. But one of the founding members of the network, Dr Robert Carr, of the International Council of Aids Service Organisations, rejected this explanation as nonsensical.
 

"When we enquired about next year's funding we were told there was to be no funding," he said.
They came to us and persuaded us to start a civil society network and then unilaterally decided they couldn't be bothered with it." Dr Carr said it made "no strategic sense" to spend time and money building up a network and then closing it down "without asking what happened and what did it achieve?". The network, designed to share expertise, lobby governments, set up education schemes and strengthen civil society has been credited with shaping national strategic plans on HIV in at least two countries.
 

Silencing the HIV programme manager
In September, confusion over the goings-on at the foundation deepened when Mr Collins abruptly suspended his own programme manager, Anisha Rajapakse, without explanation. Ms Rajapakse, who previously worked for the UN and the German government, is thought to have objected to moves to downgrade the importance of AIDS work. Attempts to contact her were unsuccessful. The foundation refused The Independent's request to speak to her and would not discuss the grounds for her suspension, insisting yesterday that the matter was "internal and confidential".
 

Simply asking why?  means cancelled invites

When members of the AIDS network, all of them recruited by Ms Rajapakse, demanded to know why she had been "silenced", several of them, including Dr Carr, were "dis-invited" from the Commonwealth People's Forum – the main civil society event in the build-up to this week's summit of Commonwealth heads of government. Lisa Williams-Lahari, an HIV and gender activist from the Pacific region, was originally invited to Trinidad by the foundation but found herself "dis-invited". The justification given was that that the forum was oversubscribed, yet the next day someone else from the same Pacific network was invited to register. "I went from an invitation, my name on a programme and preparing for my sessions in September to a wall of silence six weeks long," said Ms Lahari. "To date no one at the foundation has withdrawn their invite. They simply pretend it never happened."
 

Colonial arrogance detected in cuts and silence
James Onyango from Kenya's Aids Intervention and Prevention Project Group, said it was a scandal that members who should be working to save lives were wasting time trying to find out what was going on. "Colonialism came to an end and this arrogance shouldn't be there," he said. "The foundation is meant to work with the people to bring change."
 

Mr Collins denied any strategic shift on the Commonwealth's HIV and AIDS policy and said a meeting had been held by the forum this week. "There is no intention to lower the priority of HIV and AIDS in our programme. HIV and AIDS remains high on the list of concerns," he said in a statement from Trinidad.  

Shambolic meeting

Dr Carr, who attended the meeting, described it as "a shambles". Others, speaking anonymously after the session, said it had been "incoherent" and "inconsequential".
 

The Commonwealth and HIV

• The Commonwealth has 53 member countries
• 30 per cent of the world's population, but 60 per cent of its HIV-infected people
• 24 million HIV-positive people live in the Commonwealth
• The Commonwealth Foundation invested £387,700 to create a HIV network. Members were told to reapply to a separate fund that last year issued just £37,772.
• The Caribbean has the second-highest prevalence of HIV of any region in the world
• The pandemic is the leading cause of death among Caribbean people between 15-42
• There are 430,000 people living with HIV in the Caribbean
• In NW England 32 people were infected in the Caribbean (almost all these infections took place in Jamaica) and there are 75 people with a Caribbean ethnic background diagnosed with HIV in NW England.

Source

New HIV Respite Centre

posted: 27/11/2009

Cornish HIV charity, Kernow Positive Support, has been given £270,000 from the Government to create a HIV respite centre. It will be the only one in England, as the alternative is Tyddyn Bach, in north Wales.

Kernow Positive Support said it still needs planning permission from Cornwall Council, but has found a suitable property for conversion in north Cornwall, near Camelford. The Department of Health's AIDS Support Grant awarded the charity the special capital funding for the building conversion.

Centre will help boost people's outlook

Nicky Salisbury, a consultant in HIV at the Royal Cornwall Hospital, said the facility is not for medical care. She said: "It's not like a hospice for sick people, it's for respite care, for the psychological recharging rather than any medical recharging."
 

Kernow Positive Support have found a Grade II listed farmhouse near Camelford that needs renovating and conversion. Anthony Basnett, of the charity, said: "It's in a beautiful but fairly remote part of Cornwall and offers peace and quiet and beautiful scenery."

AIDS Support Grant
Mostly AIDS Support Grant is used by councils to pay for HIV support services, social care, HIV needs assessments and expert training, but they can also apply for money to pay for capital (building) projects. In NW England one council recently proposed this to fund development of special housing for people with HIV.

Running costs

Following the dramatic impact of modern combination HIV treatments since the mid 1990s, the small network of UK HIV hospices and respite centres has now almost completely vanished. A major problem is meeting the annual running costs - persuading NHS Primary Care Trusts and others to pay for someone to have a respite break is not easy. Obtaining the capital grant for a building conversion is the easy part.

We do wish Kernow Positive Support well, but hope that the competition doesn't threaten almost the last of what is left, Tyddyn Bach.

Source
 

Kernow Positive Support 

Tyddyn Bach HIV respite centre, North Wales 
 

AIDS Support Grant

HIV Statistics for NW England 2008

posted: 02/09/2009

The 2008 HIV statistics have recently been published. Here is a table showing the pattern of change in the number of new cases ('new cases' means new to the North West of England - it is mainly people newly diagnosed in the region, but also includes people who were diagnosed outside the region and now attended a HIV clinic in the region for the first time in 2008). The table also shows the total number of people who attended a NW HIV clinic sometime in 2008.

At first glance the number of new cases leapt by almost 100 between 2008 and 2009, and comments in the media have made much of this increase. The media also leapt on to the fact that 42% of people were infected abroad. Both points are true, but we need to read between the lines and not leap to false conclusions. 

Yes the number of new cases is up, about 100 more than in 2007, but hardly different to 2005 and 2006.

For the last 5 years new cases have been broadly around 800 – 900 a year. We need to bear in mind that the numbers testing positive in 2008 tells us nothing about when the person became HIV positive, which may have been several, or even many years ago. We shouldn't leap to conclusions about any year to year change in the numbers, because there are all kinds of explanations. Here are a few -

• More people are testing each year
• Gay men especially have recently been encouraged to test at least once a year in high prevalence areas of the NW such as Manchester, Salford and Blackpool
• A larger number of people at higher risk of HIV who attend Sexual Health clinics may now be agreeing to take HIV tests - many refuse, especially people from groups more likely to have HIV, gay men and other men who have sex with men, migrants especially from regions with high rates of HIV such as sub-Saharan Africa, people from ethnic minorities, injecting drug users
• More pregnant women may be agreeing to antenatal HIV testing
• The greater availablility of community testing services
• More people are taking more sexual risks by having unprotected sex
• Random variation - when you flip a coin 100 times you don't get 50 heads and 50 tails each time - because of random variation. Sometimes it's a few more than 50, sometimes a few less. Sometimes a lot fewer of one than the other. It's always at work in HIV statistics - it depends on thousands of people's decisions about whether and when to go get tested.  

'Infected abroad' pot stirred

The media reports picked out that 42% of the new cases in 2008 were infected abroad - particularly people from sub-Saharan Africa. This is old news - a quick look at the 2007 figures would have revealed an almost identical percentage. The explanation is simple. Britain is a global travel hub with strong ties to Commonwealth countries, many of which have high rates of HIV. Millions of people come and go here each year - as students, as workers (including doctors and nurses the NHS depends on), as visitors and tourists, and as people seeking safety here through asylum. Asylum applications are very much lower than in some previous years. Some people arriving here have HIV, but a George House Trust / Terrence Higgins Trust survey found most people have no idea of this before travelling here.

Use of NW HIV Voluntary Organisations chart

We will be carrying out a more detailed analysis of the 2008 HIV statistics for the region and will share this with you in due course.

The 2008 NW HIV Report is now published here 

You can download this report HIV&AIDS in North West England 2008 direct from us - it is a large pdf file (2.48 Mb), so please be patient.