Men, not women, should be prioritised by health promoters working with African communities in England, researchers reported earlier this month. The findings from the latest BASS Line survey suggest that men are more likely than women to report sexual risk behaviours, to have lower levels of knowledge and are less likely to have been tested for HIV.
The researchers also recommend that work with men pays particular attention to the needs of men who have sex with both men and women, and those who only have sex with men. In addition, there are high levels of need among those with limited schooling.
After a first survey conducted in 2007, the second BASS Line survey was conducted with a convenience sample of Africans living in England from October 2008 to January 2009. A total of 2,580 valid responses were received from individuals completing the survey either in booklet form (distributed by health agencies) or online (promoted by African community or commercial websites).
A great many of the results confirm the findings of the first BASS Line (extensively reported on aidsmap.com, here, here and here). With 4,712 valid responses, the 2007 study was the largest ever study of sexual health and HIV prevention needs among African people in England.
A third of all respondents had never received an HIV test result and a similar proportion had never been tested for other STIs. Only a half of those who had never tested for HIV said they were willing to test.
Men were less likely than women to have tested for HIV, to have diagnosed HIV and to know where to test for HIV.
The main reason respondents gave for never having tested was perceiving no need. (In line with this, only a third of respondents knew that at least 1-in-20 of all Africans living in England have HIV infection.) The authors recommend that to increase uptake of testing, health promoters must increase individuals’ awareness of their vulnerability to HIV and the potential consequences of not knowing their HIV status.
Three quarters of all respondents were sexually active 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.
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.
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.
Interventions
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 face-to-face conversations were preferred to talking to health workers via a helpline or an internet chat room.
Respondents were asked who they would most prefer to be giving information or advice about HIV. A strong preference emerged for health professionals, especially doctors (49%). The authors comment that workers in community organisations will need to have sufficient expertise in HIV if they are to engage effectively with service users. Very few individuals specified that the person giving information should be of a certain ethnicity, gender or age, or should have HIV themselves.
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:
- The planning framework, The Knowledge, the Will and the Power which outlines priority groups and strategic aims for HIV prevention.
- The African HIV Prevention Handbook which gives practical advice and shares best practice in delivering a range of HIV prevention interventions.
- The previous BASS Line survey.