A considerable minority of African people have significant gaps in their understanding of HIV testing and treatment, which is likely to have a profound effect on whether they will access testing services, according to BASS Line, the largest study ever conducted of HIV prevention needs among African people in England. A quarter of those who would like to test do not know where tests are available, and one fifth do not know that effective HIV treatment exists. These findings highlight the need for targeted HIV prevention and information services for African people, say the researchers.
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 key findings on safer sex are reported elsewhere on aidsmap.com.
Just under half (47%) of respondents had never tested for HIV. Over a third had tested negative, and 16% of all respondents had tested HIV-positive.
Although 16% being HIV-positive is much higher than the Health Protection Agency’s estimate of a prevalence of 4% in the adult black African population, the researchers say that the over-representation of people with HIV is unsurprising given the survey’s distribution by HIV prevention, treatment and care providers.
The survey also found that one third of those who had not tested HIV positive would like to take an HIV test (either again or for the first time). However 28% of that group did not know where they could be tested, highlighting the need for more information on service provision.
Moreover, respondents were also presented with a number of key facts about HIV testing and treatment, and asked to say whether they were already aware of the information. On the one hand, more than nine out of ten respondents knew that HIV is a virus that causes AIDS or that HIV is never passed on through everyday social contact. However a number of respondents did not know or were unsure about some other key statements:
- “There is a medical test that can show whether or not you have HIV”: 12% did not know or were not sure about this.
- “People can have HIV without knowing it”: 16% did not know or were not sure about this.
- “There are HIV medicines that can help people with HIV to stay healthy”: 19% did not know or were not sure about this.
- “Africans are NOT deported from the UK solely because they have HIV”: 42% did not know or were not sure about this.
The researchers say that these gaps in understanding are likely to discourage people from testing for HIV.
Among the people who had never tested, there may have been an unrealistic certainty that they did not have HIV. Half thought they were “definitely” HIV-negative and a quarter thought they were “probably” negative. Only one fifth of those who had never taken a test said they did not know or were not sure of their HIV status.
At the same time, the majority of participants were unaware that around one in twenty African people in the UK have HIV.
Moreover, when those who had never tested were asked why not, one reason was far more common than all the others: the respondent had no reason to think he or she had HIV (69%). All other reasons had the agreement of 12% or less of the sample.
The researchers recommend that in order to increase testing, “it will be necessary to increase ambivalence about the likelihood that [individuals] could have HIV infection”.
Among people who had been diagnosed with HIV, the survey also identified some confusion over the meaning of test results. Respondents were asked, “What do you think your current HIV status is (whether or not you’ve ever tested)?” Among those who said elsewhere in the survey that they had tested HIV positive, a number still thought they were HIV negative (9%), or were unsure (3%).
Angelina Namiba of the National African HIV Prevention Programme commented: “The report re-affirms the importance of making HIV testing services, treatment and information easily available and accessible”.