Last week at the Commonwealth Club in London two groundbreaking reports on the treatment information and other needs of African people living with HIV in the UK were launched.
The research into the treatments information needs of African people living in the UK (Project Nasah) was developed, designed and conducted by four collaborating agencies (NAM, The National AIDS Trust, the African HIV Policy Network and Sigma Research). The findings are discussed in a related news story. A second report (Padare) was undertaken by the former Camden and Islington Health Authority, London Borough of Islington and the African HIV Policy Network to examine HIV-related knowledge, sexual attitudes and practices amongst Africans living with HIV accessing HIV-related services in Camden and Islington.
The word Padare refers to a traditional space where intimate matters, including sexual matters are discussed in a number of African cultures. The concept and ethos of the Padare was recreated in London in which HIV-positive African men and women were able to share their experiences of living with HIV as well as make recommendations regarding service delivery. A padare was set up at the HIV service provider icare in Islington and people who attended were asked to complete a confidential questionnaire.
The questionnaire covered various topics that included demographic information, HIV infection, service use, disclosure, discrimination, contraception and reproductive issues, sexual partnerships, and a range of questions regarding HIV-related knowledge, beliefs and behaviours.
Over a three-month period in 2002 214 respondents were recruited. Three quarters (73%) of the respondents were female and the remaining 27% were males. The majority of respondents were born in Zimbabwe, Uganda, Zambia and Congo and most were aged between 25 and 39 years of age, hence likely to be at their most sexually active. Only one fifth of respondents reported living in the boroughs of Camden and Islington. This supports the notion that services within these north central London boroughs are accessed by African community members from a wide range of London boroughs.
Most of the Padare respondents (89%) reported that their sexual partners were usually of the opposite sex (80% of men and 93% of women) The remaining 20% of the men reported same sex partners, with no men reporting sex partners of both sexes. Of the women 5% reported same sex partners whilst 2% reported both sexes.
Slightly over half (53%) reported having learnt of their HIV status within the last 2 years whilst just under a third (28%) had been diagnosed in the last 3-5 years.
Significance of religious beliefs
Sixty-five percent of respondents reported that their religious beliefs were strong.
Just over one fifth (21%) believed that prayer cured HIV.
Understanding of key HIV concepts
One fifth of respondents reported that they did not know what ‘undetectable viral load’ meant. The majority (83%) of respondents did not agree with the statement ‘resistance means that my partner cannot catch HIV from me’. However, a small minority (7%)disagreed with the statement, worryingly suggesting they felt resistance was positive and made them less infectious. Three quarters of respondents reported that a pregnant woman taking HIV tablets could effectively reduce the risk of passing on HIV to her unborn baby.
Most respondents reported that they trusted health care professionals to provide information on living with HIV and preventing infections; however elders and peers were also identified as credible sources of such information.
Condom use
Just under one third (30%) reported that they did not expect to use condoms forever and 40% reported that it was hard to use condoms with new sexual partners. Sixty-one percent reported having had unprotected sex with one or more sexual partners in the last year, whilst one third (33%) had not used condoms with their most recent sexual partner.
Sexual behaviour
All Padare respondents were asked about the biological sex of their sex partners in the last year. Only 83% responded with an answer, of the 178 who did respond, 89% reported that their sexual partners in the last year were of the opposite sex (80% of the men and 93% of the women). The remaining 20% of the men reported same sex partners, with no men reporting partners from both sexes. Of the women, 5% reported same sex partners with 2% reporting partners of both sexes.
These findings are important since the needs of gay and bisexual African men and women are unknown.
A smaller proportion (70%) responded to questions regarding their sexual activity in the last month, than in the last six months (75% response rate) and in the last year (79% response rate)
The range of primary and secondary risk behaviours reported by the African respondents accessing services in Camden and Islington are in line with other samples of HIV-positive people accessing services in the same location (e.g. gay men attending the Mortimer Market Centre interviewed for the SHARP study.
Study recommendations
On the basis of these findings the study authors recommend that a larger study be undertaken to assess the levels of HIV-related knowledge, attitudes and behaviour, and that this be incorporated into the national HIV behavioural surveillance programme. Aiming prevention interventions at HIV service staff should help them ensure that HIV-positive Africans in the UK are fully aware of the notions of ‘drug resistance’ and ‘undetectable viral load’. In addition the researchers recommend the development of peer intervention for youth and interventions directed at community and religious leaders to help improve the accuracy of HIV-related information provided by older community members.