Cultural barriers and lack of outreach services have sent rates
of HIV/Aids among black African immigrants soaring
Tuesday 22 December 2009 15.00 GM
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 between them.
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 neo-colonialism.
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.