Cultural barriers and lack of outreach services have sent rates of
HIV/Aids among black African immigrants soaring
Tuesday 22 December 2009 15.00 GMT
My research in the west Midlands with postgraduate student Betselot
Mulugeta, talking to groups of immigrant men and women from the
Ethiopian and Eritrean communities, has revealed serious
misconceptions about the nature of the HIV/Aids epidemic in the UK.
Lack of information tailored for different migrant groups, alongside
lower awareness of HIV/Aids through media coverage as a whole, is a
problem with real consequences.
Newly reported cases of HIV in the UK are higher than ever before.
Between 1995 and 2006, the rate of HIV infection among black Africans
in the west Midlands increased 100-fold, compared to a two-fold
increase among white people, a three-fold increase among black
Caribbeans and a six-fold increase among other mixed ethnic groups
(according to the region's strategic health authority figures).
Taking the Ethiopian and Eritrean population as one example: they are
predominantly young and single, tend to live alone and are often
sexually active. Their culture and language restrict the information
available to them. This group therefore represents a reservoir of HIV
infection which is both a concern for the immigrant community itself
and the host population. As social networks among the Ethiopian and
Eritrean communities in the west Midlands do not condone or tolerate
the discussion of sexual issues, external information networks are
crucial in raising awareness of the HIV situation in the west Midlands
and reducing stigma and discrimination of those who are HIV-positive.
The respondents in our study said they believed the UK was "civilised"
and therefore they could not contract HIV/Aids, that the problem had
been left behind in Africa. Some commented that they believed all
migrants were screened before being allowed entry, and that drugs were
available in the UK that would "cure" Aids. Perhaps most tellingly,
interviewees said that Aids wasn't talked about in the UK and no
information or warnings were provided, so they had assumed there
wasn't a problem. Culturally, condoms are a difficult issue. It is
considered unacceptable for either partner in a sexual relationship to
ask for a condom to be used, because it's thought to suggest the woman
is promiscuous or a prostitute, or that there is a lack of trust
One of the main reasons for this lack of appreciation of the HIV risk
environment in the west Midlands appears to be a lack of communication
and understanding between HIV-related service providers and immigrant
communities. In particular there are very few culturally sensitive
outreach sexual health promotion programmes aimed at different
immigrant groups from high HIV-prevalence source regions in the west
Midlands, with hidden groups such as failed asylum seekers and
irregular migrants often ignored.
The ruling by the UK court of appeal earlier this year that refused
asylum seekers and other "not ordinary UK residents" are not entitled
to free NHS treatment and care is creating a reservoir of HIV
infection in the UK. It is these marginalised and often hidden groups,
who are highly vulnerable to HIV infection due to their socio-economic
situation, that are being denied free medical treatment. Denying
unrestricted NHS HIV treatment to this group is a serious public
health issue which may well fuel the epidemic in the UK.
There is a desperate need to understand the social context of the
disease both in terms of the migrants' region of origin as well as in
their new UK communities. The British government is yet to address the
steep rise in rates of the disease among heterosexuals and a new Aids
awareness campaign targeted at those most at risk of spreading it is
imperative. It's a campaign they are reluctant to undertake because of
the sensitivities around immigration, race and perceptions of
Sub-Saharan Africa is home to 67% of global cases of HIV/Aids, but it
is dangerous to think of the disease as just an African problem now
that we can travel easily between continents. Surely it is time we had
another UK national campaign to bring this deadly disease to
everybody's attention and to correct the misconceptions both the host
and migrant communities have of the HIV/Aids epidemic in the UK.