Increasing TB-HIV awareness
With over 9,000 new cases last year alone, the rise in tuberculosis infections has serious implications for HIV prevention work in the UK. This is because of the interrelationship between TB and HIV, which makes a person infected with HIV more vulnerable to TB. In this article, Elias Phiri of TB Alert talks about the risks from TB, particularly for people living with HIV.
In the developing world, TB is the leading cause of death amongst people living with HIV. According to the World Health Organisation, HIV-positive people are 20 - 40 times more likely to develop TB than people who are not infected, with those with a low CD4 cell count being at greatest risk (CD4 is the name given to a type of blood cells that helps to protect the body against harmful infections). Also, TB occurs earlier than other opportunistic infections in the course of HIV, and it progresses faster in positive people than in negative people; TB is also more likely to be fatal in a positive person if undiagnosed or left untreated.
Stressed out? Relax!
Many people in the African community in the UK face serious financial hardship regardless of the state of the economy; the current economic downturn has led to loss of jobs and several welfare benefits are destined for cuts. Poverty, unemployment and ill health can cause a person serious stress and anxiety. In this interview, Zhana*, a stress management consultant gives advice on how a simple relaxation technique can help people living with HIV reduce stress levels.
MAMBO: What made you choose relaxation skills as a career?
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Africa Round-up
KENYA
Never been inside a lecture theatre, and doesn’t speak a work of English, but for Barack Obama’s grandmother, these are no handicaps. The 87-year-old granny of the US president was recently awarded an honorary Doctorate of Letters by the Great Lakes University of Kisumu (GLUK) in recognition for her charitable work. Mama Sarah Obama has been active in helping poor and sick people in Kenya and further afield. Last year, she was given the honour of flagging off a local motor rally organised as part of World AIDS Day.
MALAWI
Catholic bishops in the Bamenda region of Malawi have announced that couples intending to marry in the church must first produce an HIV test certificate before they can wed. The bishops say the requirement is part of the Church’s efforts to control the spread of HIV in the region, which has one of the highest prevalence rates in sub-Saharan Africa; however, the move has been criticised by some commentators, who argue people with HV have just as much right to wed in church as those who are negative.
ZAMBIA:
A farming community in the Ndola district have welcomed a newly-invented stove that could revolutionise the way rural Zambians cook their food. The invention could also help save forests and reduce global warming. Made from a 5-litre used pain tin, the stove uses saw dust as energy source for cooking and boiling water. It sports a 4-centimentre hole drilled at the bottom, and a pipe inserted in the middle which acts as a chimney. The stove is then packed with bricks of compacted saw dust, and fire is lit at the bottom using a piece of clot dipped in kerosene. Farmers who have tried the stove say it is very efficient, and, with free saw-dust in abundant supply, a cheaper alternative to the charcoal stove.
NAMIBIA:
A primary school girl has hit the silver screen, following her part as the lead female character in a new movie made by a Spanish film company. Eva Maureen Gerretsen beat stiff competition to win the role of Jana, a 10-year old girl who meets a young Bushman boy in the streets of Barcelona, Spain, and then embarks on an enchanted adventure journey to Africa. Accompanied by her magical winged horse, she sets out in search of the Bushman boy, and becomes good friends with Mel, a Himba villager who guides her through encounters with magical beings and creatures. The film, ‘Magic journey to Africa’, was screened for the first time, in Spain, an event attended by Eva and her parents.
NIGERIA
A wild plant that grows well in dry areas is set to become a low-cost source of fuel for rural communities. A recent United Nations report said the seeds of the jatropha plant can be processed into less-polluting bio-diesel to provide light and cooking fuel for poor rural families. Seed cake, a by-product from the process, can be used as fertiliser and animal feed, according to the report. The advantage of japtropha over other biofuels such as maize and soya, is that it is not edible, and can grow well dry lands where food cannot grow, and animals do not graze on it.
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To Cut or not To Cut
Millions of men across the world have done it, but many millions more haven’t. Now the debate about whether or not it’s good to get circumcised has taken on a new importance, with researchers suggesting it helps to protect a man from getting HIV. Not surprisingly, calls for male circumcision have become louder, and in some African countries, governments are encouraging men to get cut. In this article, we explain the link between male circumcision and HIV risk, and examine the relevance, if any, to HIV prevention work with African men who live in London.
Medically speaking, male circumcision is a term used to describe the removal of the foreskin of the penis using a sharp cutting implement. Men get circumcised for different reasons; it could be for health, cultural, religious or lifestyle reasons. Nowadays, most circumcision is done in the hospital by doctors, but in some developing countries, the practice is still being carried out by elders, often using non-sterile cutting equipment.
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Vienna AIDS Conference report
CAPRISA trial results hold promise for African women
A research team from South Africa created excitement among delegates at the recent International AIDS Conference when they announced findings of a study suggesting a microbicide could offer 39% protection against HIV. Following the series of poor results from previous microbicide trials, the CAPRISA study could be just what AIDS campaigners have been hoping for. However, until the findings are replicated in more wide scale trials, any celebrations are probably premature.
For many years now, researchers have been frustrated at the lack of a breakthrough in the development of a microbicide capable of preventing HIV infection in women. All previous studies, including Carraguard, the large scale study conducted in South Africa from 2004-2006, which involved 6,202 women, produced poor results. So when in Vienna the CAPRISA research team announced that their experimental microbicide offered 39% protection against HIV, the audience gave them a standing ovation (CAPRISA stands for ‘Centre for the AIDS Programme of Research in South Africa’).
What is a microbicide?
A microbicide is a substance that can substantially reduce the risk of acquiring or transmitting a sexually transmitted infection such as HIV, when it is applied in the vagina or rectum. A microbicide would most likely be formulated as a vaginal gel, cream, foam, or ring. No proven microbicide exists on the market, yet.
What did the CAPRISA study involve?
The study enrolled 889 women, who were drawn from KwaZulu-Natal’s rural community and an urban centre. The women, who were HIV negative at the start of the study, were then split into two groups. One group was given an experimental microbicide gel made up 1% of the anti-HIV drug tenofovir. The other group received a placebo (a dummy gel that did not contain any active ingredient). The women were asked to apply the gel 12 hours before they had sex, and again 12 hours or sooner afterwards. The gel was to be used only once in a day.
After 30 months, the researchers found that 98 women from the group that took the dummy gel had acquired HIV, while only 38 women from the group that received the experimental microbicide tested positive. They therefore concluded that, on average, the microbicide offered a 39% protection against HIV.
Why is a microbicide needed?
Most women in poor developing countries have difficulty getting condoms, currently the most effective barrier against HIV. This is because they either cannot afford to buy condoms in enough quantities, or their male partners refuse to use them. A microbicide would offer two distinct advantages:
It can be applied independently by the woman, without needing to tell the male partner;
It can prevent HIV infection while allowing a woman to become pregnant.
Too early to celebrate:
Despite the excitement at the CAPRISA presentation, there remain doubts about the importance of the findings. It has been noted, for example, that adherence rate at the end of the study (i.e. the extent to which study participants were taking their gel as instructed) was low, at only 39%. There is also concern about the potential for tenofovir to cause resistance in participants who became infected and might in future need to take the drug for treatment. Another question concern the difficulty women would face in ensuring they took the microbicide 12 hours before sex, as often sex happens at short notice.
Based on past experience, studies of HIV vaccines and microbicides have promised much, but delivered little in the end. It remains to be seen, therefore, whether the findings of the CAPRISA study will be replicated in larger trials. Should they be confirmed, then the world could be on the verge of reversing the spread of the epidemic. But until then, it’s probably too early to celebrate.
For more information about the CAPRISA study, please visit www.pag.aids2010.org/session.aspx?s+3, or www.caprisa.org
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African round-up
KENYA
More than 1,000 farmers in the country’s Eastern Province stand to gain from the decision by a leading beer manufacturer to start using locally-grown sorghum as a substitute for imported barley. East African Breweries Limited has pledged to buy all the sorghum that will be produced in this semi-arid region, giving the local community a welcome respite from the poverty and unemployment caused by failed crops and poor farming methods. Rising prices of barley, mainly grown in Europe and America, and increased shipping costs have forced beer companies in Africa to look at cheaper alternatives. The white ‘gaddam’ sorghum is being seen as a solution – not just as a raw material for beer-making, but also as a source of nutritious food.
SAO TOME AND PRINCIPE
Efforts to control malaria in this country are beginning to off, raising hopes of achieving the UN Millennium Development Goal. The small island state is one of nine other countries where the use of insecticide-treated mosquito nets and medicines has driven malaria cases closer to elimination; a further nine countries are in the pre-elimination phase – where less than 5% of suspected malaria cases are confirmed to be so. In Sao Tome and Principe, deaths of children aged five and under have declined by 53%; in the island of Zanzibar, child mortality has declined by 57%, and in Zambia, by 35%. If this trend continues, many African countries will be able to achieve a two-thirds reduction in child mortality by 2015, in line with the Millennium Development Goal.
NIGERIA
A Nigerian state has enacted a by-law that makes it an offence for parents not to send their daughters to school. In a bid to promote girl education and to ensure women play a bigger role in the development of Nigeria, the state council said all girls can now expect to receive education on the same level asboys. The council has promised free learning materials to female students at secondary schools and bursaries to those studying in pos-secondary institutions.
SOUTH AFRICA
The government is training extra health workers to screen visitors arriving in the country during the soccer World Cup. The extra workers are part of preparations for the tournament, scheduled for June and July; the preparations include importation of 4.3 million doses of swine vaccine. Health workers will check the vaccination status of visitors landing at the country’s air, land and sea-ports and also inspect any foodstuffs they bring with them. Visitors to the World Cup are being urged to check their vaccination status before starting their journey to South Africa.
UGANDA
A human rights organisation has asked court to ban polygamy on the basis that being married to more than one wife undermines the wellbeing of women, making them vulnerable to sexually transmitted infections. Mr Patrick Ndira, an official of the Mifumi (U) Ltd, said polygamy “also causes hemorrhage of resources that would otherwise be expended on the wife in the home, contrary to the provisions of the Constitution.” In a petition field in the high court, Mifumi has called for the Marriage Act, the Marriage and Divorce of Mohammedans Act, and the Customary Marriages Registrations Act amended because he claims they all have loopholes that allow men to marry more than one wife, while restricting women to one man. It claims the current laws are against the principle of equality and women’s human rights.
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John Amaechi
The Mambo Interview: Leaping for success
MAMBO: What has been the main driving force behind your incredible rise from a disadvantaged life in working class Stockport to international fame and wealth?
JOHN: Failure - or the fear of failure, to be more precise. I am a person who gets very upset each time I fail at something. As a kid, I faced many challenges. We weren’t rich and my mum had to work extremely hard to put food on the table for me and my sisters. I was determined to do something for my life, but many were a time when I failed to achieve what I set out to achieve. Fortunately, I’d an incredible capacity for coming back after failure. Failure isn’t necessarily a bad thing; anybody who’s successful has probably failed a multiple of times.
MAMBO: You did not come out as a gay until much later on, after you’d retired from American basketball. Why is that?
JOHN: Anyone who is familiar with America will know that it is, by a large, a very religious country. In my view, the more religious a people are, the more homophobic they are likely to be. It’d have been impossible for me to live openly as a gay young man and continue playing basketball in the manner and level I was playing. I wanted people, including my fans, to see me for what I was, not for my sexual preference.
MAMBO: Since you came out, have you suffered any homophobic attacks?
JOHN: Yes, mostly via email. There’s a lot of homophobia in the UK, although I say it’s not as bad as in America. Here, homophobia is most prevalent in sports. For example, Sol Campbell, who is not gay, is often the victim of homophobic chants by fans. The late John Fashanu was continually harassed for his sexuality. Sadly, not enough is being done to tackle homophobia in UK sports.
MAMBO: And how do you handle homophobic attacks?
JOHN: By not responding. If it is not physically targeted at me, I’ll ignore it. That way, I do not give the perpetrators the dignity of my response.
MAMBO: Africans are among the most homophobic population groups. Any ideas about how such they can be persuaded to be more tolerant?
JOHN: Black communities community find it hard to accept that some people are different. As a psychologist, I think the best solution is for people to talk more openly and frankly about homosexuality. Education is the key.
MAMBO: What’d be your advice to a young gay African who is struggling with his sexuality?
JOHN: One of the biggest problems facing young people who are gay is that they pay too much attention to protecting their image and have a fear of what other people might say. Often, this is because they have witnessed the way gay men are treated. This can prevent a young man from looking after his sexual health, to the extent that he may choose not to use condoms during sex. For such a person, the opportunity for sex is rare, and when one presents itself, he may take it without paying due attention to things like safer sex and condom use. My advice to young people would be, your body is more important than your image. Accept your sexuality and be frank about it. You do not have to tell everybody; you can find an individual with whom you connect; they’re likely to help you deal with many issues. Also, there are support groups that can help you to better deal with your sexuality.
Let's talk about sex
How many of us talk about sexual health with our partner? Not very many, according to a recent survey commissioned by the government. Yes, people in the UK may do lots of sex, but very few of us are willing to engage in conversations about issues related to sex - and this may be putting our health at risk.
Conducted by research company Onepoll (www.onepoll.com), the survey found 31% of adults in the UK never discuss sexual health issues with their partners, and more than a quarter are too embarrassed to ask the questions they would really like to. Also, one in six people questioned were not aware that some sexually transmitted infections, such as herpes and genital warts, cannot be cured using antibiotics, while 11% believed having sex when standing up cannot lead to pregnancy.
An earlier sex survey of Africans paints a similar picture. Conducted by SIGMA research, the survey found 36% of Africans questioned either did not know how to or indicated a lack of confidence in their ability to talk bout sexual health with a new partner (source: BASS Line 2007 Survey; Assessing the sexual HIV prevention needs of African people in England; SIGMA Research; 2008).
Knowing the risks
Not asking questions about sexual health may lead to unnecessary risk-taking during sex, particularly if a condom is not used. Infections that can be picked up or passed on include:
- Gonorrhoea;
- Syphilis;
- Chlamydia;
- Herpes;
- Genital warts;
- Hepatitis B;
- HIV
The risk of getting or passing on a sexually transmitted infection increases with the number of sex partners we have. Many of us come from a cultural background where having multiple partnerships are widely accepted (South African President Jacob Zuma has three wives!). In the UK, it is illegal to be married to more than one wife; last year in Croydon, a man originally from Malawi was charged in court with being married to three different women at the same time. In the BASS Line 2007 survey, one in eight African men questioned said they had five or more different sex partners in the last year, as compared to one in 18 women.
Talking about sexual health
There is no single magic formula for getting your new partner to talk about their sexual health. The main thing is for both of you to be clear about the risks involved in a sexual act. Often, letting the partner know that you care for their welfare as well as yours will help make them feel more at ease.
The following are among the things you may want to talk about:
- Safer sex: Let them know why you think it is important to use a condom;
- You can begin by talking about your own sexual health first, and then go on to ask your partner about their sexual health;
- Find out about your partner’s preferred sexual techniques, bearing in mind that some styles or techniques are dangerous. You could get hurt or suffer pain, which would spoil the joy of sex for you.
Other things to think about:
- Be prepared: If you have arranged to have sex with a new partner, it is safer to have it in a place you are familiar with and feel secure in;
- Carry a condom - do not assume that your partner will bring one.
- Don’t make assumptions: Some people may assume that they are negative, while in fact they have the virus. Around one in three people with HIV in the UK are unaware they are infected;
- Your partner may have taken the HIV test some months ago, but if in the interim period they engaged in unsafe sex, they could have picked up the virus;
- In the UK, people who are aware they have HIV can now be prosecuted if they have unprotected sex with someone which leads to infection, unless they can prove they told the partner well before-hand.
Condoms
Condoms remain the best protection against sexually transmitted infections. The good news is that, nowadays, it is easier to obtain condoms free of charge from some African community organisations, sexual health charities, some family doctors, family planning or sexual health clinics.
Condom myths
- Condoms are too small for African men: This is not true. Condoms are made from very flexible latex materials; they can accommodate any size of penis;
- Condoms are being donated to people in Africa primarily because the West wants to slow down population growth in the continent: Not true: Condoms save lives – by preventing the transmission of serious infections such as HIV and hepatitis. Many people in African cannot afford condoms;
- Condoms exported to Africa have been deliberately contaminated with HIV and other viruses so Africans can get diseases and die: There is no evidence this sort of thing has happened.
For more information on condom use and how to get free condoms, please visit www.doitright.uk.com. Alternatively, you can check out THT’s booklet ‘Your sexual health’ (to get a copy please call THT Direct on 0845 1221200) or call the African AIDS Helpline on 0800 0967500 or African Culture Promotions on 020 8687 0339.
PEP
A condom may break or slip off, or there could be spillage of semen. If you have been exposed to HIV in this or any other manner, you can quickly go to a NHS hospital and request for PEP (or post-exposure prophylaxis). PEP involves giving antiretroviral drugs to a person who has recently had an accident or unsafe sex. The drugs kill off the HIV virus before it has entered and infected the human cell. For PEP to work, you’d need to start taking it within 24 hours of exposure. After 72 hours, PEP is unlikely to be of any help.
For more information about PEP or where you can ask for PEP, please call THT Direct on 0845 1221200 or visit www.tht.org.uk. Alternatively, visit www.nhs.uk.
Other common myths about sex
- HIV cannot be transmitted if the man withdraws just before ejaculation: HIV can also be in pre-cum (the colourless fluid that comes out of a man’s penis when he is turned on); the virus can be transmitted during sex unless a condom is used;
- Sex without a condom is more enjoyable: There is no evidence to back up this myth. It can be argued that, on the contrary, using a condom gives a couple the peace of mind that will make them enjoy sex more;
- A woman cannot become pregnant as a result of sex during her period: Contrary to popular belief, the period of ovulation may vary from month to month. It’s possible for a woman to ovulate twice over a one- or two-week period. The male sperm can survive for up to seven days. If a sperm penetrates an egg released during an early second period, pregnancy can occur;
- A woman cannot become pregnant as a result of ‘upright sex’ (having sex when standing up): The male sperm has a tail that can propel it in all directions, including upwards.
Sex toys
Nowadays, many people are choosing to use toys when having sex. Sex toys can be fun because they add to the excitement of love-making; however, they can also be a health risk, especially if shared by many people or stored in dirty places.
Looking after your sex toy
These are some of the measures you can take to ensure your sex toy remains safe for use:
- Avoid sharing your sex toy with people who are not your regular partner;
- Cover your sex toy with a condom, to reduce the risk of acquiring or passing on a sexually transmitted infection;
- Check your newly-bought sex toy for any imperfections, such as discoloration, tears, or cracks;
- Use the right lubricant. Water-based lubricants can be used with any type of sex toy.
- Regularly cleanse your sex toys, certainly before and after each time you use them.
- Store your sex toys in a cool, clean, dry place, away for pets or children. Always remove the batteries before storing.
For more information about the safe use of sex toys, please check out NAM’s book, hiv transmission & testing (2009 edition, page 47). To order a copy, please call 020 7840 0050. Also visit out http://www.sexuality.org/sextoys for more information on sex toys.
Oral sex
Oral sex involves stimulation of a partner’s sexual organs using the mouth or tongue. There are two main types of oral sex: ‘fellatio’, or sucking of the penis, and ‘cunnilingus’, the sucking or licking of the vagina.
HIV can be passed on via oral sex, although the risk is not as big as in unprotect vaginal or anal sex. The level of risk depends on the following factors:
- The presence of sores or inflammation on the mouth or throat;
- Whether the partner ejaculated in the mouth;
- Whether the person giving the oral sex brushed or flossed recently;
- How many times a person engages in oral sex;
- The amount of HIV in the saliva of the person giving the oral sex.
If you want to give or receive oral sex, it’s wise to note the following:
- Avoid brushing or flossing your teeth nearer to the time of oral sex;
- Avoid ejaculating or taking semen in the mouth;
- Use a dental dam;
- Avoid giving oral sex if you have sores or inflammation in your mouth or throat.
For more information about oral sex, please refer to NAM’s booklet hiv transmission & testing (2009 edition). To order a copy, please call 020 7840 0050.
Tags: HIV, PEP, sex, transmission, sexually transmitted infections
HIV: It's better to know
HIV: It's better to know
In March 2007 after returning to London from a BHIVA (British HIV/AIDS Association) conference, a staff member of Willesden-based Community Health Action Trust (CHAT) put forward a proposal to do a pilot HIV testing project. The idea was to see whether testing in the community could make more Africans want to test. By then, HIV testing services were mostly being offered at NHS establishments and at some GP surgeries.
With funding from NHS Brent, a small clinic was set up next to the charity’s offices in Moran House, High Road Willesden. Today, two years later, the ‘Better to Know Than Not to Know’ testing service has grown from strength to strength, and it is helping to scale up access by African and other Black people in and around north-west London.
The testing project was set up because studies as well as anecdotal evidence showed many Africans have particular issues regarding HIV testing. These include:
- Some people fear being seen at a genito-urinary medicine (GUM) clinic; people might think if they are promiscuous or may already be infected;
- Others wrongly believe that clinic staff will report them to the police, Social Services or (in the case of asylum seekers) the Home Office;
- Those with English language difficulties may they won’t be able to communicate with GUM clinic staff;
- Some Africans, including those who may have been tortured in their home country, have a fear of engaging with authorities.
CHAT’s pilot project was successful right from the start. In the first year, 90 people visited the clinic and took the test. With such an impressive start, NHS Brent decided to roll over the funding for a second year. That enabled CHAT to employ a sexual health nurse and an outreach worker. With the two additional staff, the service has been on the growth path.
According to Dr Edwin Mapara of CHAT, the success of the pilot project is down to the thoughtful way in which the service was promoted. A team of volunteers worked with the Outreach Worker to pass on information about the service, and there was press coverage in The Brent Magazine, which is published by Brent Council and distributed throughout the borough. Other publicity tools used included a website (www.knowyourstatus.co.uk), local radio stations and fly posting.
In the 12 months to May 2009, a total of 580 people visited the CHAT clinic and took the test. Out of these, 8 tested positive. Clients who test positive at the CHAT clinic are referred to Central Middlesex Hospital, although some prefer to go to another hospital.
Work with faith groups
CHAT is also working with faith groups to promote access to the HIV testing service. Pastors and other local church leaders have participated in the organisation’s Community Integrated Sexual Health Initiative (CISHI) course, from where they gained useful HIV prevention skills. The skills are helping them to promote the service to members of their congregation, and this is resulting in many referrals to visit the clinic.
Why it’s good to know
There are real advantages to knowing one’s HIV status, whether the test result is positive or negative. The main advantages include:
If you are negative:
- You will have a stronger reason to remain free of the virus;
- It might help you to decided whether to have baby;
- You will better plan for your future and that of any dependants;
- If your partner is also negative, you may not need to use condoms every time you have sex.
If you are positive:
- You will have the opportunity to discuss about treatment and support services with your doctor;
- With proper treatment, an adult aged 35 can now expect to live well into the 70s;
- You will be able to make better plans for you and your family;
- If you want to have a baby, you can discuss with your doctor what precautions to take in order to cut the HIV transmission risk to the baby;
- Information about your test result will not be given to your GP or any other person without your knowledge and permission (although a court may ask your doctor to reveal the information if required);
- Nowadays, HIV tests take much less time than before; results can come out within an hour, meaning you won’t have to spend a long time at the clinic.
For more information about CHAT’s HIV testing services, please call ACP on 020 8830 3392 Other HIV testing services available in west London include:
West London Centre for Sexual Health: text ‘WLC appt’ to 07786 201 816
African AIDS Helpline: 0800 0967500
THT Lighthouse West London: 020 7229 1258
THT Direct: 0845 1221 200.
Standing up to stigma
Standing up to stigma
HIV-related Stigma has remained a major problem ever since the onset of the epidemic two decades ago. Now, however, people living with HIV have had enough, and they have decided to confront the problem head-on. Over the past one year, a group of them have been conducting a research into levels of HIV stigma and how positive people can best overcome the problem.
Called ‘The People Living with HIV Stigma Index’, the research is a global initiative between the International Planned Parenthood Federation (IPPF), UNAIDS, The Global Network of People living with HIV/AIDS (GNP+) and The International Community of Women with HIV/AIDS (ICW. The research has been conducted in several regions of the world.
Preliminary findings of the UK arm of the research were unveiled at a ceremony that took place in the Houses of Parliament on 30th November 2009. The findings were based on the testimonies of 867 HIV positive people who responded to an in-depth questionnaire. Interviews were carried out in more than 40 locations around the country, from Aberdeen to Portsmouth, including Wales, Northern Ireland, Scotland, Manchester and London.
Key highlights
The findings show very high levels of stigma and discrimination in the UK:
- 21% (185 of the 867 participants in the research) of people living with HIV had been verbally assaulted or harassed;
- 12% had been physically harassed because of their HIV status in the previous 12 months.
The results also highlight concerns that stigma and discrimination within some parts of the NHS are denying comprehensive and quality care for some people living with HIV and can create obstacles that impede access to care and support services:
- 146 participants (17%) report being denied health services because of their HIV status at least once in the previous 12 months;
- 18%, nearly 1 in 5 people, stated that it was clear to them that their medical records were not being kept confidential, a further 42% of participants felt uncertain that their medical records are being kept confidential.
The research also revealed the negative impact on individuals living with HIV, many of whom reported low self esteem as a consequence of stigma and discrimination, often involving feelings of guilt and blame in the previous 12 months. More positively, the research makes it clear that people living with HIV are at the forefront of confronting and overcoming devaluing attitudes, speaking out against prejudice and challenging stereotypes:
- 45 % of people living with HIV had personally confronted, challenged or educated people who were stigmatizing them
- 84 % had supported other people living with HIV.
More than 60% of the people who participated in the research said they feel they can influence positive change for the future—the same as the number of people who voted in the last election in this country.
For further information or for a copy of the full report please contact:
Paul Bell at the International Planned Parenthood Federation on 020 7939 8233 or 07799 335533 or
Lucy Stackpool-Moore at the International Planned Parenthood Federation on 020 7939 8283.
Walsall's community-based HIV testing
A new dimension to HIV Testing
For many Africans living in the Midlands, it’s often not easy to find a place where you can get a sexual health check-up, but one project is taking services closer to the people, in what could have important lessons for community-based initiatives to improve sexual health in African communities. In Walsall, a partnership between the local NHS trust and Terrence Higgins Trust have led to the launch of a rapid HIV testing service – in a church!
From last October, the congregation at the Seventh Day Adventist Church, North Street, Walsall have been given the opportunity to have themselves and their friends screened for HIV infection. The service is being delivered within the church premises because of two reasons: For convenience (members do not have to travel to the hospital to get tested), and secondly, because it is easier for members to get support from each other, should there be a need for it.
Even though African communities have been disproportionately affected by HIV, the rate of HIV testing remains low, and government as well as voluntary sector organisations have been looking for ways of persuading people to visit the clinic. This is because of the real and significant benefits for early testing. A person whose infection has been diagnosed early will have the following benefits:
- The opportunity to discuss with the doctor about starting medication;
- The opportunity to access support services such as counselling and emotional support;
- The opportunity to plan for themselves and relatives;
- The opportunity to join a support group of service users.
The Seventh Day Adventist church has congregation that includes people African people. Many of these are recently –settled migrants who are still not very confident about requesting for and taking up essential services.
Once every week, staff from the Department of Genitourinary Medicine at the Walsall Manor Hospital provides a rapid HIV test using buccal swabs. Results of the tests are usually available in 30 minutes. Those who test positive have their result confirmed by conventional tests at the Manor Hospital.
The testing service will run for a few months. If it proves to be popular, a proposal will be presented to the Walsall Primary Care Trust for on-going funding. Dr Joseph Arumainayagam, lead consultant in HIV and GU Medicine at the Walsall Manor Hospital said “this project has given us an ideal opportunity to diagnose those infected with HIV early so that we can prevent those being diagnosed late with the condition with associated high morbidity and mortality and also prevent onward transmission of HIV”.
For more details about this clinic, please contact Dr Joseph Arumainayagam at the Walsall Gum clinic on 01922633341.
Negotiating safer sex
Negotiating safer sex: It’s about making choices
Sex is such a private and subjective matter that it’d be presumptiuous of me to think I can fully analyse other people’s ability to negotiate safer sex. I can say, however, that in order for us to understand why many African women have difficulty negotiating safer sex, we need to look at our culture and traditional practices, and at how much things have changed, or need to change, in this era of HIV.
Is it a given that African women are vulnerable to HIV because of culture and tradition? In today’s dynamic world, has the African woman’s thinking and behaviour remained static, or has she made some progress in taking control of her sexual life? I challenge the stereotype of African women as being helpless, hopeless and powerless, because I know different. Also, I want to challenge the stereotype that the African man is promiscuous and spreads diseases, because I know that most of our men are loving, caring, and responsible.
This is not to say that we do not need change, because we do. And if so, do we continue with our existing cultures, or should we reinvent something completely new? If the desired change is to happen, perhaps we should take a joint responsibility and accept that we all - health promoters, care-givers, educators and health auhtorities - need to climb on the bandwagon of change.
It’s not easy to change established cultural beliefs and practices. The reason why a woman will have sex largely depends on whether she is having sex for pleasure, for procreation, or in expectation of a material benefit. For many women, being able to produce children is synonymous with womanhood, and if this is the priority, ‘safer sex’ may become a lesser priority.
Many women also produce children in order to cement a relationship; again in this scenario, the issue of condom use can take a back seat. Even where procreation is not the primary objective, a woman’s basic need to be accepted or wanted may outweigh any considerations for safer sex, not because she is not empowered but because she wants to ‘belong’. In any case, a relationship is for life, and for many women ask themselves: ‘how many times shall I continue negotiating safer sex?’
Finally, the expectation of a material benefit – whether in money or money’s worth – can influence a woman’s ability to negotiate safer sex. Often, it boils down to her capacity to choose between long-term good sexual health and short-term benefit.
For people living with HIV, disclosure can be a very difficult thing to do. Balancing the need for intimacy and the real risk of being rejected is like walking on a tight-rope. An HIV diagnosis can kill intimacy or affect a relationship, whether or not disclosure has taken place. That said, disclosure plays a necessary role in negotiating safer sex, and we should encourage it.
Negotiating safer sex requires confidence, trust and some degree of intimacy between the people involved. When you have confidence in yourself, you will disclose things about yourself that you ordinarily wouldn’t, and this is not a bad thing to bring into your relationship.
