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Introduction
As a woman of black African decent, I am sometimes overwhelmed with disbelief about the negative perception of others towards other black African women in terms of HIV and AIDS. Some incidents such as a routine visit to the hospital in Belgium for a thigh rush led to a test for HIV/AIDS.
On a recent visit to hospital in England for a routine headache with tummy pains I was surprised the first question I was asked was if I have had an abortion recently or and then a suggestion, I take an HIV test next much to my disbelief. I began to wonder whether this perception has been created from the experience of the health care professionals or just from me being a black African and a woman. This necessitated the choice of the topic for this research, one that is formed by my own personal experience in the United Kingdom and Europe.
In the past decade, the prevalence of HIV among various populations has been very high even though research suggest a decline across the world (WHO, 2018).
This research paper starts with a literature review followed by data analysis. This is proceeded by left, centre and right-wing media analysis on the topic after which a reflective summary is provided. A detailed research proposal for further study precedes a general conclusion of key points relating to the prevalence of HIV among Black African communities. A list of references is provided at the end.
Literature review
This literature review will research the prevalence of HIV among the Black African community in the UK. Since this is secondary study, data and information used in this research will be collected from secondary sources such as relevant newspaper articles, published peer reviews, white papers and journals and key word searches on Google scholar. In addition, evidence will be taken from the libraries and websites of organisations whose core mandate is linked to the research topic such organisations include WHO, Public Health England, National Aids Trust in England and Wales as well as a range of selected reading publications.
According to Owuor (2009), about 77,400 people were estimated to be living with HIV in the UK by the end of 2007, but a quarter of these (28%) did not know they were actually infected. 7,370 new HIV diagnoses were recorded in 2008 (HPA, 2009a). Black Africans are the heterosexual group most affected by HIV in the UK. Although most of the infections among this group were acquired outside the UK (NAT, 2014).
In London alone, Black Africans represent 5.5% of the population but account for a third of newly diagnosed HIV cases and a third of diagnosed people assessing care (Pebody, 2014). In the UK overall, Black Africans represent only 1.8% of the UK population but account for 34% of all people infected with HIV. It is estimated that there are 101,200 people living with HIV in the UK, out of which 19,300 are Black African women, who are twice as much to get infected than their male counterparts. This figure highlights inequalities in the reporting of the HIV. This is because not all HIV infected individuals report their status just to portray the gravity of the disease (Pebody, 2014).
Statistics have shown that research has focused mainly on the disclosure of HIV among Black Africans living in the UK. However, the available evidence suggests that this population may be reluctant to disclose to significant others (Calin, 2007).
According to Richard, M (2014), many people see gay men as a key risk group when it comes to testing of HIV. It is a fact that there are a risk group, but current evidence has shown that there may be unmet needs when it comes to HIV testing among black African society in the UK. By looking at 2012 data from the Health Protection Agency (now known as Public Health England), almost 31,800 black African men and women were living with HIV in the UK.
Pebody (2014), states that NAT (National AIDS Trust) has long argued for more prevention work for the general population. In their report, they suggested that interventions which reach black African people should be integrated with wider work for the sexually active heterosexual population (Pebody, 2014). Instead of having a focus on ethnicity, communications did identify more risks specifically, for example around multiple concurrent partners, unprotective sex with new and casual partners, and sex in countries of high prevalence, they recommend. It was noted that about 25% of HIV infections acquired in the UK, have nothing to do with neither gay men nor black African communities. It is the second-generation people of black African ethnicity who are born in the UK that are likely to have different sexual health needs to their parents, especially if they are more likely to have sexual partners from other ethnic groups (NAT, 2014).
The majority of black Africans living with diagnosed HIV in the UK are aged between 20 and 49 years (Chinuoya and Davidson, 2003; Dodds et al,2008). Overall, more women than men are tested for HIV, possibly through antenatal care to prevent mother-to-child transmission. This suggested the need for testing interventions that target men (HPA, 2009a). Evidence suggest that a person in their twenties who starts treatment at CD4 (white blood cell) can be expected to live to be 70 years old, whereas a 35-years-old who start treat treatment at the same level of CD4 cell count can be expecting to live to be 72 years old. However, those who start treatment with a lower CD cell count can expect to reduced life expectancies.
Fakoya et al (2008) identified cultural, social and structural barriers, such as access to testing and care, fear of death and disease, lack of political will, restrictive immigration policies and lack of African representative in decision-making processes. This was is supported by Owuor (2009).
In Owuor (2009), a 2007 survey, found that many Africans did not test for HIV because they felt they had no reason to think they have HIV . Other reasons given by the respondents for not testing for HIV includes; Misconception that testing positive would lead to deportation, fear of testing positive, fear of relationships breaking up after testing positive, not knowing where to get tested, fear of changes in life and work or business patterns as a result of positive diagnosis (Owuor, 2009).
Data Analysis
NAT (2018) provides reassuring but worrysome statistics on HIV among the Black African community.
Late HIV diagnoses remains a major problem among Black Africans in England (CDC, 2016). In 2007, about 42% of Black Africans diagnosed with HIV were diagnosed late (HPA, 2008b). This compromises their survival chances because evidence indicated that starting treatment with a CD4 cell count below increased the risk of disease progression and death. The reason for late diagnosis among Black Africans was not clear-cut but included persistent HIV-related stigma and discrimination (WHO, 2006).
Earlier studies of late diagnosis are supported by NAT (2018), where of the 18% newly diagnosed HIV in the Black African community, 52% of those were diagnosed late. Of the late diagnosis 78% were heterosexuals while 6% were gay men, the remaining 16% had undetermined sexual orientation
The importance of early diagnosis cannot be overemphasis. Fig 1 below shows the percentage of early and late new diagnosis. This is too close to call as the key to treatment is early diagnosis and, in this regard, more must be done within the Black African community.
In terms of sexual orientation, a huge number of all new HIV diagnosis within the Black African community are from heterosexuals with a relatively smaller number of people who are classified as sexually gay. For a huge number of new diagnosis in 2018, their sexual orientations could not be determined.
The most striking of the data is the age distribution of HIV infected cases within the Black African community in the UK. Of glaring notice is the 35-49-year group who accounts for the largest of all HIV infectious group. This group also represents the most active with some education and work experience and hence are educatable in terms of the dangers of HIV.
The disproportionality of representing Black Africans in terms of HIV dominance is supported by Public Health England (2018). 25 out of 1000 and 47 out of 1000 Black African heterosexual men and women respectively had acquired HIV in the UK out of an estimated 18400 and 20900 heterosexual men and women who lived in the UK, in 2017.
The statistics for the newly diagnosed heterosexual Black African appears to have decreased over the last decade to below 63%. Mainly due to a combination effectively of strategies as well as changing migration patterns.
Media Analysis
The Guardian carried a touching story about the experience of a black woman with HIV, at the very place where one will think discrimination and prejudice will not exist, at the hospital. Her hospital chart was marked with HIV positive and she recounts and when she queried as to why she was told by the nurse that people need to know she Had HIV positive, for fear of contracting the virus from HIV positive patients. For someone who had been ARTs for some time and working in the HIV prevention and support area she was horrified about this experience from well-educated and informed professionals. This highlights that stigma still exist today in reporting HIV which may cause women in particular, to under report it, hence increasing the risk to deaths.
Her story also touches on the omission of black women in the campaign to fight the HIV disease even though the number one killer for women aged between 15-49. From using white gay men as an indicator of progress in reducing HIV to fighting sexism, racism and misogyny which act as barriers to women involvement in strategy formulation to reduce the HIV epidemic (Reid, 2018).
The independent carried an article on the much-needed campaign in supporting black women with HIV to have a pleasurable sex life through access to PrEp drug and the use of photo and interactive videos as well as discussions about safer sex. Knowing the black minority communities are at most risk as per the data, HIV activist takes the fight direct to the communities that need it most. Boyed by biased HIV mainstream campaigns which features white or gay men while those who really are at risk are the black women in the UK according the data provided by NAZ Project London. 75% of newly diagnosis women are from black African minorities and 67% of women living with HIV are Black African. This further places Black women at higher risk of sexual and reproductive health inequalities. The article highlights the inequalities and politics in gaining treatment through PrEp, as where it has been provided for free such as in Wales, there has been no single HIV infection. So, the question is why has this drug not been provided to those communities with the highest incidence of HIV? such as among black women and Black African women communities in particular (Raymond-Williams, 2019).
In a different twist an eye-catching headline by Browne (2003), Africa is new source of HIV cases in Britain , drew much critics as expected in the Times paper. The suggestion was viewed and critiqued by many for being absurd and racist in some form. His view followed a 50% increase in HIV/AIDS cases among heterosexual men in the UK in the previous year and while a 6% increase among homosexual in the UK. He attributed all cases of rises if HIV/AIDS to immigration from Africa and advocated for health test form immigrant. This explains why until now perhaps immigrants are expected to take an HIV test for routine checks as I experienced and experienced by many other Black African women. (Browne, 2003).
Reflective Summary
This topic is one that is of concern to me personally as a black woman and secondly as a black woman of Black African descent. Clearly, while many governments have picked up the battle to reduce the spread of HIV/AIDs in their various countries others are many not be doing enough especially countries in Sub Saharan Africa partly due to in effective educational campaigns or lack of funds to make ARTs available in their countries for free. In the UK, while of HIV/AIDs infected individual are white gay men who tend to be used as progress measure for all HIV/AIDS campaigns. However, a look at heterosexual HIV/AIDS infections throws a huge light on women of Black African decent with high infection rates due to socio cultural barriers and stigmas that hinder early reporting and diagnosis. While right wing press demonises Black African women for the rise of HIV/AIDS in the UK , others are more sympathetic and fights for support for HIV/AIDs infected Black African women to have access to free drugs and be involved strategies and campaigns to fight the further spread of the HIV/AIDS.
There is clearly more that can be done in terms of further research on this topic. I have outlined below what I deem an appropriate reseacrh proposal for further study.
Background to the research: Many studies including Pebody (2014), Owuor (2009), Calin (2007) and NAT (2014), to assess factors that are associated with HIV testing among Black Africans in Britain seem to suggest that Black Africans have relatively high rates of HIV testing reflecting at least partially, awareness of risk behaviours and potential exposure to HIV.
Prost et al (2008), reports that the number of HIV diagnosis as a result of heterosexuality has exceeded that from gay men since 1999.
Some claim that the UK heterosexual HIV epidemic is intimately linked to that in sub Saharan Africa, reflecting both historical and recent migratory patterns and to a lesser extent, in country transmission of HIV. It is assumed that many HIV infections among Africans are acquired before migration to the UK. However, migration favours those who are younger and economically productive, and therefore who are less likely to be sexually active with reproductive ambitions. As the prevalent pool of HIV infected Africans increases, so too will the potential for onward sexual transmission between Britain, especially among those from the same ethnic background given the huge extent of sexual mixing.
Research question: Is HIV/AIDS prevalent among Black African women in London?
For the research question to be operational, the following specific research objectives have been formulated:
- To understand the spread of the HIV/AIDs among the Black African Community in London
- To understand the extend of HIV/AIDS infection among Black African heterosexual women in London
- To understand how those affected by HIV/AIDS receive support in the Black African community in London
- To understand sexual habits of women of Black African decent in London
Research methodology: An exploratory approach suits the overall objective and hence will be adopted. Greener(2008) makes a clear distinction between reseacrh methods and methodology and while the former relates usually to the specific activities designed to generate data for research such as interviews, the latter has to do more with the researchers attitude and understanding of the research and the strategy chosen to answer those questions. This research will be guided by the viewpoint and an approach that will allow knowledge gained to fully understand a social problem.
Research methods: Since this will be based on primary data, information will be collected through the use of questionnaires and unstructured interviews.
Data analysis: Key phrases and ideas will be coded to fully understand the research question. Also, where needed charts will be used to depict statistical information. A grounded theory approach will be adopted for this research overall.
Ethics, Validity and Reliability: Agar (2003) claims that personal involvement in data collection process and the depth of participant responses will be enough to ensure an acceptable level of validity and reliability. As I will be personally involved in designing the questionnaires and collecting the data, the questionnaires will be designed to allow a level of triangulation of emerging issues.
Cohen et al (2011), advices a great deal of thought must be put into considering ethical issue. For this research the British Educational Research Association BERA (2011), statement of ethical practice will be followed. Participants will be recruited via personal emails and assured of anonymity and non-traceability. They will also be informed in advance that their involvement is on a free to leave basis.
Conclusion
Made curios by my own experience as a Black African woman who I was asked to take an HIV test on a routine visit to the hospital, this research has focused on an exploration of HIV/AIDS among Black African background in the United Kingdom. Evidence from this research suggest so far, the spread of HIV/AIDS among Black African Women in the United Kingdom can be attributed to socio-cultural barriers that allow cases not to be reported earlier and hence to get treatment early. Stigma within the society as a whole even from those who are highlight educated and well enlightened also creates a barrier for a free and open conversation about the disease. Even tough women of Black African background are heavily represented in large numbers on the HIV/AIDS infection charts not enough is done within those communities to foster early reporting and testing and hence support. Also, the non-availably of essential medication such as ARTs within such communities does not support those infected. More needs to be done in such communities by both the government and NGOs to educate and support in particular Black African women who are disproportionally represented in large numbers on the HIV/AIDS infection charts.
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