Among Africans living in the UK HIV prevalence is around 5%. There are 16000 African women with HIV in the UK ( 67% of all African diagnosed with HIV) and 6000 African men. Among African men late diagnosis are still common and many remain undiagnosed. Most Africans acquire HIV while in the UK, so this is definitely not a case of health tourism. Those figures are a stark reminder that much more needs to be done in the UK to address the health needs of African communities.
Valerie Delpech, from Public Health England, presented this data at the plenary session of the African Health Promotion Summit organised by Terence Higgins Trust and the Black Health Agency last week.
The summit was very well attended with a good mixture of health professionals and community activists. At the opening session my friend and colleague Thandi Haruperi spoke of her journey as an African woman who was diagnosed with HIV while in the UK, and the difficulties that many Africans face in accessing services and in navigating a different cultural and social system. Thandi explained that family hierarchies are reversed in the UK. Traditionally in Africa men are at the top of the pyramid and have most of the power followed by women, children are at the bottom. In the UK, especial when accessing health and social care, our structures are very children centred. The rights of children are paramount, and often women access much greater protection and opportunities than in their countries of birth: therefore the pyramid is reversed. This has a huge impact on men self esteem and masculinity and can, in part, explain the alienation of African men, who often are not accessing health services. This power reversal can also be behind the escalation of Intimate Partner Violence in some African families once arrived in the UK.
Thandi spoke at length on how many Africans, who have university qualifications are pushed in some of the worst badly paid jobs: she called them 3 D jobs and stated: ”Dirty, Dangerous and Demanding jobs are undermining the health of Africans in the UK.”
The opening plenary was also addressed by Diane Abbott MP, who has her constituency in Hackney, one of the boroughs most affected by HIV in London. Diane made a really good speech. She spoke of how lack of representation of Africans and other people of color at decision making level is affecting the funding and provision of services for all Black and Ethnic Minority people. Diane Abbott spoke of her concerns that the new NHS and immigration laws are creating more obstacles for Africans to access health services, and ultimately contributing to health inequalities. Diane spoke loud and clear and didn’t shy away from addressing the issue of homophobia among black communities, and the urgent need to challenge it in order to address HIV. She also pointed the finger to the responsibility of African churches, and demanded to stop any moral judgement on homosexuality and support LGBT people of color.
Scaling up testing took a huge slice of the morning discussion. This is obviously necessary because half of Africans still get diagnosed late, and over a quarter remain undiagnosed. Testing is also considered as a shortcut to prevention. It is believed that most HIV transmission in the UK is driven by those who are not yet diagnosed, and/or are seroconverting. This group of people are very likely to have a very high viral load that makes them more likely to sexually transmit HIV . People who know that are HIV positive, most of the time use condoms and/or are on ARV treatment ,that is scientifically proven to significantly reduce the risk of transmission to extremely low levels. I really liked Catherine Dodds, a researcher at Sigma, comments on this discussion:
‘Thinking that HIV testing is the answer to HIV prevention is like thinking that giving a scale to somebody who needs to loose weight is the solution to weight loss.”
There is concern among researcher, social scientists and people living with HIV that by focusing only on testing we will loose sight of the importance of understanding behavioural and structural change, and their role in ensuring prevention and health.
The discussion also looked at the importance of evidence, in order to design effective interventions as well as fundraising. Evidence is crucial, nobody can argue with this. But evidence is economically and politically driven and we can not just believe in it as a form of new gospel. I really liked the comment of Dr Ike Anya, a Nigerian Public Health Doctor who works in Kensington & Chelsea, who said “ Not everything that counts can be counted. And not everything that can be counted counts’. I think this is also very relevant to an intervention like testing. Public health institutions like testing because it is an easily quantifiable intervention with clear measurable outcomes. However what matters are also things that are more difficult to count: for example the quality of support which enables people who test HIV positive to be healthy and live good lives.
What happens after testing is as important as testing, and probably more important. Personally I am really worried about the quality of lives of people living with HIV. Positively UK has recently released the findings from a survey on mental health for people living with HIV: ‘States of Mind’.
This piece of research shows alarmingly high levels of mental health issues among people living with HIV in the UK. Half of the men who responded reported having experienced mental health issues and most shockingly 7 out of 10 women reported mental health problems. It was not a surprise that people said they were unable to take their HIV treatment, and 25% of those experiencing poor mental health had missed doses. The report also revealed that 40% of respondent had experienced discrimination in the last 12 months and found accessing support services extremely difficult.
The morning discussion was brought to a close by a poignant statement by my dear friend and fellow activist Winnie SSeruma:
‘I feel a sense of déjà vu, I could have been at this conference 10 years ago…we are looking at the same problems over and over…It is time to focus on what needs to change, on what actions we need to take to see change. I am tired of focusing on the same old problems, as Africans we need to step up and focus on solutions’ .