A study has found a very high level of undiagnosed HIV infection amongst black Africans in the UK. Results of the Mayisha II study, published in the December edition of Sexually Transmitted Infections, found an overall HIV prevalence of 14% in a study population of 1300, and that 66% of those found to be HIV-positive were unaware of their infection status.
Individuals born in sub-Saharan Africa bear the brunt of the heterosexual HIV epidemic in the UK. It is thought that 64% of all heterosexual HIV infections in the UK are located in patients born in sub-Saharan Africa, and in 2005 just over half of all new HIV diagnoses were in Africans.
Previous studies looking at HIV and sexual health risk behaviours in black Africans include the 1999 Mayisha I study and the Second British National Survey of Sexual Attitudes and Lifestyles (Natsal), which was conducted in 2000.
Investigators designed the Mayisha II study to establish an estimate of HIV prevalence and high-risk sexual behaviour amongst black Africans in the UK as well as the use of sexual health services and level of HIV testing.
The study involved men and women aged 16 years and above. Individuals were recruited from the areas with the largest and best-established African populations in the UK: London, Luton and the West Midlands.
A total of 1.359 individuals participated in the study which involved completion of a 24-topic questionnaire and optional provision of an oral fluid sample for HIV testing. The survey was conducted in late 2004. The study was anonymous, but participants were given the details of local HIV support organisations and told how they could obtain an HIV test.
Investigators involved African community-based organisations throughout the study's design, development and implementation. Africans were trained as fieldworkers and recruited study participants from social and commercial venues including bars, clubs, colleges, churches, shops, barbers/hairdressers and community venues.
Just over half (52%) the sample were men, and although individuals came from 36 different African countries, most were from east Africa (mainly Uganda and Zimbabwe). Median time since arrival in the UK was four years, and 79% had completed secondary education or had a university degree.
More men (49%) than women (39%) were in employment, although women (36%) were more likely than men (30%) to report being in full- or part-time education.
Women were also more likely to be single than men (41% vs. 36%). Of those who were married, 26% had a partner living abroad.
HIV and sexual health risk
Most women (70%) and men (59%) reported no new sexual partners in the past twelve months. However, a fifth of men and 8% of women reported more than two recent partners. The investigators also found that approximately 5% of men and women had had a same-sex sexual partner in the past year.
Ever having had a sexually transmitted infection was reported by 21% of men and 22% of women.
Just over 50% of men and 43% of women said they had had an HIV test and 6% of men and 7% of women said that they had tested HIV-positive. Furthermore, 6% of men and 9% of women said that they thought they were HIV-positive.
HIV testing
Overall, 74% of men and 76% of women provided an oral fluid sample for HIV testing. The investigators found that individuals who had ever had a sexually transmitted infection were significantly more likely to have agreed to provide such a sample (78% vs. 70%, p = 0.001).
HIV prevalence was 14% (13% men and 15% in women). In multivariate analysis, the investigators found that HIV prevalence in women was significantly associated with region of birth (southern and central Africa, p = 0.02), increasing age (p < 0.001), marital status (lowest risk for married with partner in UK, p < 0.001) and ever having a sexually transmitted infection (p = 0.01).
HIV prevalence in men was associated with region of birth (southern, central and western Africa, p = 0.001), ever having had a sexually transmitted infection (p = 0.001), and recruitment to the study in a pub, restaurant, bar or nightclub (p = 0.002).
Of the 141 individuals who tested HIV-positive, 93 (66%) were unaware that they had the infection. The prevalence of diagnosed HIV infection in the entire study sample was 5% with the prevalence of undiagnosed HIV in the study population being 9%.
“Our study confirms relatively high HIV prevalence among black Africans, many of whom have migrated from high-prevalence areas of sub-Saharan Africa, and yet are unaware of their HIV serostatus”, conclude the investigators. They add, “our findings indicate that current efforts to promote HIV testing and awareness of HIV serostatus among black Africans living in the UK should be further strengthened and culturally competent education programmes promoting risk reduction strategies must continue.”
Sadler KE et al. Sexual behaviour and HIV infection in black-Africans in England: results from the Mayisha II survey of sexual attitudes and lifestyles. Sex Transm Infect 83: 523 – 529, 2007.