Figures released this month by the UK Health Protection Agency (HPA) show that, in 2007, 42% of African people living in the UK who were HIV-positive had their HIV diagnosed late. This means their HIV was only diagnosed when they already had, or were at risk of developing, a serious HIV-related illness, and late diagnosis of HIV is often the factor underlying many of the HIV-related deaths still seen in the UK. The report raises several public health concerns and recommends measures to improve access to and services for particular groups.
"The sooner HIV and other sexually transmitted infections are diagnosed and treated, the less likely it is they will be passed on", said Professor Mike Catchpole, Director of the HPA's Centre for Infections The key public health concerns arising from the report were highlighted by Deborah Jack, Chief Executive of the National AIDS Trust, who commented: “The alarming proportion of late HIV diagnoses amongst Africans in the UK results in increased illness and death as well as increasing the risk of onward transmission”.
According to the report, in 2007, 42% of black Africans who were diagnosed with HIV in the UK, had their infection diagnosed late (late diagnosis is defined as taking place either when the CD4 cell count has fallen below 200 cells/mm3 or when an AIDS-defining illness is present at the time of HIV diagnosis). A high rate of late diagnosis - 27% - was seen in black Caribbeans.
The report also showed that black Africans had the highest HIV prevalence of any ethnic group in the UK. Prevalence of HIV was 3.7% for black Africans, 0.4% in black Caribbeans, and 0.09% in the white population.
Overall, 2691 black Africans were diagnosed with HIV in 2007, although this represents a significant fall compared to recent years, 40% of all new HIV infections in the UK were still amongst this population. The majority acquired the infection heterosexually and in Africa. New diagnoses in black Caribbeans remained low at 189, with over half of heterosexuals acquiring their infection in the UK. However, this group was disproportionately affected by bacterial sexually transmitted infections (STIs), such as gonorrhoea. The report notes that the higher rates of STIs in both black African and black Caribbean populations means that “even though levels of high risk sexual behaviour may be similar to other communities, there is an increased risk of acquiring an infection”.
Titise Kode, Chief Executive Officer of the African HIV Policy Network, which analyses health needs and addresses inequalities that exacerbate the impact of HIV, commented: "The HPA report illustrates the dire need for a targeted, well-resourced and evidence-based response that is informed by African people, especially people living with HIV. The fact that a significant number of African people are being diagnosed late also indicates that people are not obtaining the full benefits from the treatment they need to stay alive.”
“Efforts to reinforce testing campaigns and the evaluation of successful strategies lie at the heart of our work to empower Africans affected by HIV," said Kode.
Updated HIV testing guidelines were recently published with the aims of normalising HIV testing and cutting the rate of late diagnosis. Deborah Jack suggested that “GPs in particular need to start testing for HIV and become better at recognising the signs and symptoms of HIV infection.” In addition, to meet the needs of black Caribbeans, she recommends that Strategic Health Authorities and Primary Care Trusts use local HPA data to plan and support HIV prevention strategies.
The HPA report concludes that easy access should be assured for both communities to sexual health services that can provide advice, screening and treatment for STIs including HIV. “HIV testing should be promoted extensively to black Africans as early diagnosis benefits the individual, through improved prognosis for those found to be HIV-positive, and the community through reduced HIV transmission,” the report says. In addition, the evidence base needs to be reviewed to improve interventions, which need monitoring for continuing effectiveness. The report also recommends: “The sexual health needs of black African and black Caribbean men who have sex with men need to be assessed so that services targeted at these groups can be enhanced,” and “an STI prevention strategy should be developed for the black Caribbean communities.”