The largest ever study of sexual health and HIV prevention needs among African people living in England shows that monogamy is more common amongst women than men, that six out of ten men are circumcised, that many behaviourally bisexual men do not identify as being attracted to men, and that there is a large demand for information on HIV. The BASS Line study contains a wealth of demographic and behavioural information that will help HIV prevention interventions be better targeted, say the report’s authors.
Key findings from BASS Line on barriers to HIV testing and safer sex are reported in more depth elsewhere on aidsmap.com. This report summarises some of the other new data from the study.
BASS Line was developed by Sigma Research and the National African HIV Prevention Programme (NAHIP) to assess HIV prevention need amongst adults identifying as African and living in England. Self-completion surveys were made available in booklet form (distributed by health agencies) and online (promoted by African community and commercial websites).
A total of 4712 valid responses were received, making this the largest ever study of its kind. There was a fairly even split between men and women, and the average age of respondents was 32.
Over half of respondents were born in five countries: Zimbabwe, Nigeria, Uganda, the United Kingdom and Kenya. Respondents had lived in the UK for a mean of 8.4 years, with 18% in the country for three years or less, and 27% for at least ten years.
Two-thirds of respondents had university or college-level education, and the majority of the remaining respondents had attended high school. Despite this, one fifth of respondents were not involved in regular employment, training or education.
The vast majority of respondents were Christian (73%), fewer than one fifth (18%) were Muslim, 2% belonged to an African traditional religion, and only 6% said that they did not belong to any religion.
Language
There is little information available to help health promoters decide whether translation of written information is needed, and which languages should be prioritised. Although the survey did not ask about respondents’ fluency in English, there is helpful information on their first language.
English was the most common first language (30%), followed by Shona (11%), French (6%), Kiswahili (6%), Luganda (4%), Ndebele (3%), Arabic (3%), Yoruba (3%), Lingala (2%), Somali (2%) and 321 other languages (30%).
Older respondents were less likely to report English as their first language, suggesting that any translated material should be tailored to the needs of older people.
Sexual partners
Almost a fifth of respondents (19%) had no sexual partners in the past year, and 46% had one partner only. A total of 28% had between two and five partners, and 6% had six or more partners.
However this varied markedly by gender – women were more likely to have no partners (24%) or one partner only (52%), and less likely to have six or more partners (3%). Men who had sex with men (either sometimes or always) reported higher numbers of partners.
Over half of both men and women (55%) reported having a regular sexual partner. Concurrent regular partnerships were uncommon: a further 7% of men and 2% of women reported having more than one partner.
Moreover, 57% of men and 81% of women who had a primary relationship reported that they had been monogamous in the relationship. The majority of those who had not been monogamous had had one or two other partners (26% of men, 14% of women).
Of those with a regular partner, 7% of the partners lived in Africa.
Circumcision and female genital mutilation (FGM)
Previous studies have shown that men who are circumcised are less likely to acquire HIV than those who are not. Circumcision was reported by 61% of men in the study, but was least common in respondents born in Zimbabwe (22%), Malawi (29%), Zambia (37%) and Uganda (39%).
Female respondents were also asked about circumcision, otherwise known as female genital mutilation (FGM). Women who have been circumcised are more likely to have genital infections and injuries, which could in turn leave women more vulnerable to HIV infection.
A total of 11% of women were circumcised, but this was much more common according to country of birth. It was most common in women born in Somalia (69%), Eritrea (50%), Sudan (50%) and Sierra Leone (47%).
Dry sex
It is thought that using substances (such as herbs, powders and lemon juice) which tighten, dry or heat the vagina before sex may make women more vulnerable to HIV infection. However only 9% of respondents reported dry sex.
Homosexual desire and behaviour in men
Respondents were not asked to identify with labels such as ‘heterosexual’ or ‘gay’, but were asked separate questions about the gender of their sexual partners and about the gender of people they were sexually attracted to.
Two thirds of men (69%) said they only had sex with women in the last year; 10% had sex with both men and women; and 5% only had male partners. The rest had no sexual partners in the last year. However, the answers on sexual attraction were slightly different, with 58% of the men who had partners of both genders saying that they were only attracted to women, and 12% of the men who only had male partners reporting only being attracted to women.
The researchers conclude from this that African men who have sex with men are unlikely to benefit from HIV prevention interventions targeted at gay or bisexual men.
Information needs
The survey also asked which HIV and health topics respondents would like to get more information about. Eighty four percent wanted information on at least one topic, and the most requested were: HIV treatments (33%), immigration and HIV (33%), and HIV testing (31%).
Moreover at least one in five wanted more information on the following topics: who is able to get free HIV treatment, preventing discrimination against people with HIV, safer sex, the law and HIV transmission, managing relationships, living well with HIV, sexual confidence, testing and treatment of sexually transmitted infections, and post-exposure prophylaxis.