BHIVA: Fear of stigma and discrimination prevent Africans from testing for HIV in the UK

Fear of stigma and discrimination are preventing Africans in the United Kingdom from testing for HIV, according to a qualitative study presented to the Twelfth Annual Conference of the British HIV Association in Brighton on March 30^st. Although investigators found that a high proportion of individuals participating in the study were willing to undergo anonymous oral HIV testing, they also established that almost half of all individuals had never had an HIV test, and that a significant number of individuals participating in the study had undiagnosed HIV infection.

People born in Africa are the group most affected by HIV in the UK after gay men. Investigators from the UK’s Health Protection Agency, Camden NHS Trust, and the Royal Free and University College London Hospitals undertook a qualitative study to measure the amount of diagnosed and undiagnosed HIV infection in the African population in the Midlands and southern England. Information on attitudes towards HIV and HIV risk behaviours were also gathered.

A total of 1359 individuals of African origin participated in the study, called Mayisha II, between 2004 and 2005. Participants were recruited by outreach workers at community settings. A total of 75% agreed to have anonymous oral HIV tests, but only 50% of men and 42% of women had had a previous HIV test which they knew the results of. Over a third of individuals who tested HIV-positive using the anonymous oral test had never had an HIV test previously. This is remarkably consistent with data from anonymous unlinked HIV prevalence testing at sexual health clinics that suggest that a third of HIV infections amongst gay men are undiagnosed.

In interviews researchers asked individuals about their attitudes to HIV and reasons for not having an HIV test. Some individuals said that they feared a positive HIV test would jeopardise their right to remain in the UK. HIV was frequently associated with “immorality” and sexual “misbehaviour” and there was a fear of rejection, retribution or reprisals from family members or the wider community. An African gay man told the investigators of the tensions that his sexuality caused, and how he was denounced as an “abomination” in his church when the pastor became aware of his sexuality.

The investigators concluded that fear of stigma and discrimination were major barriers to the wider uptake of HIV testing in the UK African community. However, community outreach work was increasing the acceptability of HIV testing.