HIV testing and high risk sexual behaviour among London's migrant African communities: a participatory research study.

OBJECTIVES: To describe the demographic and behavioural factors associated with HIV testing among migrant Africans in London. METHODS: A cross sectional survey of migrants from five sub-Saharan African communities (Congo, Kenya, Uganda, Zambia, Zimbabwe) resident in London was carried out. The study formed part of a larger community based participatory research initiative with migrant African communities in London-the MAYISHA project. Trained, ethnically matched interviewers recruited study participants in a variety of community venues. A brief self completion questionnaire collected data on demographic characteristics, utilisation of sexual health services, HIV testing history, sexual behaviour, and attitudes. RESULTS: Valid questionnaires were obtained from 748 participants (396 men and 352 women), median ages 31 and 27 years, respectively. Median length of UK residence was 6 years. 34% of men and 30% of women reported ever having had an HIV test. HIV testing was significantly associated with age and previous STI diagnosis among women; and additionally, nationality, education, employment, and self perceived risk of acquiring HIV among men. After controlling for significant demographic variables, previous diagnosis of an STI (adjusted odds ratio and 95% confidence interval for men: 2.96, 1.63 to 5.38, and women 2.03, 1.06 to 3.88) and perceived risk of acquiring HIV for men (adjusted OR 2.28, 95%CI 1.34 to 3.90) remained independently associated. CONCLUSION: Among these high HIV prevalence migrant communities, these data suggest that HIV testing remains largely associated with an individual's STI history or self perceived risk. This strategy may be inappropriate given the potential for onward and vertical transmission. Antenatal HIV testing combined with proactive targeted HIV testing promotion should be prioritised

Perceptions of the Vhavenda regarding the significance of IKS rituals and customs in women's health : "The other side of the coin"

The paper aimed to explore and describe the perceptions of the Vhavenda people regarding the significance of indigenous knowledge systems (IKS) rituals and customs in promoting Women’s Health. Indigenous knowledge should be given a platform to add to our understanding of the world and advance philosophies that inform research approaches and interventions that sustain and acknowledge the role played by IKS in promoting women’s health. The HIV epidemic, disproportionately affecting sub-Saharan African women and their families, has put an academic spotlight on African beliefs systems and IKS. Most of the academic studies are based on western approaches, which are built predominantly around individualistic western beliefs and cultures that perceives IKS as the ‘other’ form of knowledge that can pose a threat to African women’s health. A qualitative descriptive study was conducted. In depth interviews were held with key informants who were knowledgeable about Vhavenda cultures. The findings demonstrate that beliefs about polygamy, widow inheritance and initiation schools are more complicated as participants perceived these customs as having benefits and risks to women’s health. The paper recommends adopting the African philosophy of ubuntu to assist in harmonizing the Vhavenda IKS to assist in addressing women,s health challenges.http://www.krepublishers.com/journalofsocialsciences.htmlam2016Nursing Scienc

Families, children, migration and AIDS

Migration is very often a family affair, and often involves children, directly or indirectly. It may give rise to better quality of life for an entire family, or to bitter disappointment, and may also increase vulnerability to HIV and AIDS. This review, carried out for the Joint Learning Initiative on Children and AIDS, links the literature on “migration”, on “HIV and AIDS” and on “families”. Three themes are sketched: (1) As both HIV prevalence and circular migration increase, former migrant workers affected by AIDS may return to their families for care and support, especially at the end of life, often under crisis conditions. Families thus lose promising members, as well as sources of support. However, very little is known about the children of such migrants. (2) Following patterns of migration established for far different reasons, children may have to relocate to different places, sometimes over long distances, if their AIDS-affected parents can no longer care for them. They face the same adaptation challenges as other children who move, but complicated by loss of parent(s), AIDS stigma, and often poverty. (3) The issue of migrant families living with HIV has been studied to some extent, but mainly in developed countries with a long history of migration, and with little attention paid to the children in such families. Difficulties include involuntary separation from family members, isolation and lack of support, disclosure and planning for children's care should the parent(s) die and differences in treatment access within the same family. Numerous research and policy gaps are defined regarding the three themes, and a call is made for thinking about migration, families and AIDS to go beyond description to include resilience theory, and to go beyond prevention to include care

HIV in East London: ethnicity, gender and risk. Design and methods

BACKGROUND: While men who have sex with men remain the group at greatest risk of acquiring HIV infection in the UK, the number of new diagnoses among heterosexuals has risen steadily over the last five years. In the UK, three-quarters of heterosexual men and women diagnosed with HIV in 2004 probably acquired their infection in Africa. This changing epidemiological pattern is particularly pronounced in East London because of its ethnically diverse population. DESIGN AND METHODS: The objective of the study was to examine the social, economic and behavioural characteristics of patients with HIV infection currently receiving treatment and care in hospitals in East London. The research focused on ethnicity, gender, sexuality, education, employment, housing, HIV treatment, stigma, discrimination, religion, migration and sexual risk behaviour. People diagnosed with HIV infection attending outpatient treatment clinics at St Bartholomew's, the Royal London, Whipp's Cross, Homerton, Newham and Barking hospitals (all in East London) over a 4–6 month period were invited to participate in the study in 2004–2005. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire. During the study period, 2680 patients with HIV attended the outpatient clinics in the six participating hospitals, of whom 2299 were eligible for the study and 1687 completed a questionnaire. The response rate was 73% of eligible patients and 63% of all patients attending the clinics during the survey period. DISCUSSION: A clinic-based study has allowed us to survey nearly 1700 patients with HIV from diverse backgrounds receiving treatment and care in East London. The data collected in this study will provide valuable information for the planning and delivery of appropriate clinical care, social support and health promotion for people living with HIV not only in East London but in other parts of the capital as well as elsewhere in the UK

Transnational social networks, health, and care : a systematic narrative literature review

While transnational social ties and exchanges are a core concern within migration studies, health researchers have often overlooked their importance. Continuous and circular exchanges of information within transnational networks, also defined as social remittances, facilitate the diffusion of innovations, potentially driving contemporary social and cultural change. Influences on health, wellbeing, and care-seeking are important, but under-researched, dimensions for consideration. We undertook a systematic narrative evidence synthesis to describe the current state of knowledge in this area and to identify gaps and future directions for health researchers to take. Between April 2017 and May 2019, an iterative series of searches in Medline, Embase, PsycINFO and PubMed, plus backward and forward citation searches identified 1,173 potential papers. Screening resulted in 36 included papers, eighteen focused on migrant populations and eighteen on those who remain behind. The top three health topics were health-seeking strategies, sexual and reproductive health issues, and healthcare support. And, while not always explicitly identified, mental health and wellbeing was a further prominent, cross-cutting theme. Articles on migrant populations were all conducted in the global North and 13 out of 18 used qualitative methods. Five main themes were identified: therapeutic effect of the continuing social relationships, disrupted social relationships, hybridisation of healthcare, facilitation of connections to healthcare providers, and factors encouraging or undermining transnational social exchanges. Papers concerned with those who remain behind were mainly focused on the global South and used a mix of qualitative and quantitative approaches. Four main themes were identified: transnational transfer of health-related advice, norms, and support; associations between migrant linkages and health behaviours/outcomes; transnational collective transfer of health knowledge; and power and resistance in exchanges. Findings suggest that transnational social exchanges can both support and undermine the health of migrants and those who remain behind. This review confirms that the volume and quality of research in this area must be increased so that health policy and practice can be informed by a better understanding of these important influences on the health of both migrants and those who remain behind

The knowledge, the will and the power: a plan of action to meet the HIV prevention needs of Africans in England

Funded by the Department of Health and managed by the African HIV Policy Network, the National African HIV Prevention Programme (NAHIP) works mainly with African-led organisations to deliver HIV prevention interventions across England. NAHIP aims to enable Africans to access appropriate information and services to equip them to make informed sexual health decisions and to fight discrimination and stigma. The NAHIP partner organisations have worked closely with Sigma Research to devise this consensus document. It articulates the central issues for planning sexual HIV prevention interventions targeting Africans living in England. This document describes some of the obstacles to meeting HIV prevention need and focuses on overcoming these barriers in order to achieve change. This document is a plan for action. Many different people influence sexual HIV transmission to and from African people living in England. They include Africans (with HIV and without HIV), people planning and delivering HIV prevention interventions, community leaders, health care providers, faith leaders, educators, police, commissioners of services, charitable funders, legislators and researchers – the actions of each can make significant contributions to meeting HIV prevention needs and thereby decreasing the likelihood of HIV transmission. One of the aims of this document has been to foster a sense of common purpose among a very diverse group of organisations undertaking HIV prevention, treatment and care interventions with African people living in England. The result of this collaborative process is a plan of action that offers a clear and purposeful vision. We are proud of the commitment to partnership that this plan embodies and are hopeful that it will support all those who are concerned with HIV infection and who have the capacity to influence it

Global migrants, gendered tradition & human rights: Africans and HIV in the United Kingdom

bioethics, feminism, black African

Young African Londoners affected by HIV: making sense of rights

This paper examines how young black migrant African Londoners affected by HIV/AIDS make sense of the language of rights. The paper is based on a survey and interviews with African adults infected with HIV and interviews with their HIV affected children (Chinouya 2002a). Results show tensions for children between having rights and having respect for adults, family and community. Children varied widely about wanting ‘rights’. However, many said that they did want HIV related information and decision-making capacity, accorded by rights artefacts. Although a majority of the parents believe that children should be informed about how HIV affects them, few of the children had had their information rights upheld