In the UK substantial numbers of new HIV diagnoses are within migrant African
communities. A continuing feature of HIV in this population is the late presentation to HIV
services. This dissertation sets out to explore HIV testing among Africans in the UK, the
factors associated with late presentation to HIV services, and the extent of HIV
acquisition within the UK in African communities. The main focus of the thesis is the
‘study of newly diagnosed HIV among Africans in London’ (the SONHIA study),
which combined qualitative and quantitative methods in a multi-centre study.
The thesis begins with the work undertaken in preparation for SONHIA. It presents a
literature review to provide epidemiological, cultural and historical background. Next is
an analysis of the 2nd National Survey of Sexual Attitudes and Lifestyles to explore the
factors associated with HIV testing among black Africans in Britain. Finally, the
findings from in-depth interviews with key informants to identify the issues affecting
utilisation of HIV services for Africans in Britain are presented.
The SONHIA study consisted of survey of 269 Africans newly diagnosed with HIV. All
respondents self-completed a questionnaire linked to clinical records, and 26 in-depth
interviews with a purposively selected sub-sample were performed. The findings show
that Africans are accessing services but clinicians are failing to use these opportunities
for preventive and diagnostic purposes with regards to HIV infection. HIV presentation
patterns appear governed by factors linked to the characteristics of, and response to, the
HIV epidemic operating within people’s sociocultural networks. UK acquisition of HIV
in this population appears substantially higher than acknowledged by national
surveillance data, with a quarter to a third of HIV possibly acquired in the UK.
The qualitative findings provide contextual understanding of the factors contributing to
late presentation. They highlight the central role of HIV-related stigma and
discrimination in influencing HIV testing behaviours. Failings within the health care
system offer insight as how clinicians can better address HIV in the future.
The key findings are summarized and contextualised with the literature and the current
socio-political climate. The study’s limitations are addressed, and the thesis concludes
with the public health and policy implications of the study
