There is evidence of “significant de-motivation and powerlessness” among African people in England in relation to using condoms, discussing safer sex and avoiding HIV infection, according to the findings of BASS Line, the largest study ever conducted of HIV prevention needs in this group. Over a third of HIV-negative respondents did not feel in control of whether they get HIV; just under a third of condom users had experienced condom failure; and just under a third of all respondents would worry about the social repercussions of carrying condoms.
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. More demographic information as well as the findings on barriers to HIV testing are reported elsewhere on aidsmap.com.
Although the respondents were largely recruited by health organisations that distribute condoms, 25% of respondents did not know that condoms are freely available from sexual health clinics, family planning clinics and community organisations. A similar number (23%) said that they sometimes had problems getting hold of condoms.
Moreover, just under a third of respondents (29%) agreed with this statement: “If I carried a condom I would worry what people thought of me.” Those who agreed also tended to say that they had a problem getting hold of condoms, confirming that getting and using condoms can be difficult in a context of social disapproval.
As a measure of the respondent’s confidence in his or her ability to discuss safer sex with a new partner (self-efficacy), they were asked to agree or disagree with this statement: “I would find it easy to talk about safer sex and HIV with new sexual partners.” Whilst 63% agreed; 37% either disagreed or chose “don’t know”.
Similarly, in response to the statement “I can use a condom with a sexual partner if want to”, 29% either disagreed or chose "don’t know".
Furthermore 30% of respondents who had used condoms in the past year said that a condom had broken or come off during that period of time. Those respondents were more likely to report behaviours that are likely to lead to condom failure, especially using a condom for more than half an hour and not using water-based lubricant.
Among people who did not think they were HIV-positive, 92% said that they did not want to get HIV. However in response to the statement “I am in control of whether or not I get HIV”, 38% either disagreed or chose "don’t know". Moreover, 25% of those with diagnosed HIV did not agree with a similar statement about control over HIV transmission.
The researchers note that a key aim of health promotion is that people have control over HIV in their everyday lives, but that these findings suggest that a significant proportion of respondents lack the knowledge, skills and resources to exercise that control. Interventions to increase confidence and skills to avoid risky sex are therefore required.
The report also recommends that condom-use interventions should address confidence in negotiating their use, and should aim to increase the social acceptability of carrying and using condoms. Moreover such interventions and condom distribution programmes need to address the behaviours that contribute to condom failure.
Lead researcher Catherine Dodds commented: “The findings clearly identify the kinds of HIV prevention that are most needed by African people living in England. Having detailed information about which Africans need the most support will help the organisations that fund and deliver services to better target their scarce resources.”