HIV testing in the UK – black African communities

With black African people disproportionately affected by HIV in the UK, promotion of regular testing remains a key priority. While there have been some success in this regard, challenges remain that need to be addressed if we are to hasten progress.

In 2017, 39% of all diagnoses amongst heterosexuals were of black African people, when according to the 2011 census black African people constitute less than 2% of the population. African men had the highest level of late diagnosis at 69% of all new diagnoses against an average of 43%. It therefore makes sense that promoting regular HIV testing should be a key intervention for reducing the high levels of late diagnoses and stopping any associated new infections that may result from people living with undiagnosed HIV.

As an organisation Terrence Higgin Trust has been working with people from African communities as well as other partners to explore ways, and offer solutions, to overcome some of these challenges. National HIV Testing Week is one such initiative to normalise HIV testing and ensure that people are aware of the importance and ease of testing.

When talking of black African people, it is important that we recognise that they are a diverse range of people with unique experiences and cultures.

For example, there are those who have lived all their lives in the UK and those who have spent significant parts of their lives in different African countries and other places before settling in the UK. Resultantly they might have different experiences of and views on HIV. Understanding this is important as sometimes differently nuanced messages and approaches are required if we are to be relevant to all.

At the same time, while there is diversity, there are also some common threads, such as stigma, that cut across different African communities. Addressing some of these provides opportunities for designing interventions that are far-reaching.

Stigma remains a common issue across different African communities to the response to HIV. Stigma often results in heightened concerns around privacy and confidentiality when it comes to HIV and can lead to people not getting tested or even having conversations about it. People also worry about whether they’ll get the support they need if diagnosed with HIV.

Our challenge is to ensure that people are given different testing options that work for them and to ensure they have up-to-date knowledge of the realities of HIV. We also have to reassure people on access and the effectiveness of treatment as sometimes the stigma is driven by negative experiences of HIV in high prevalence countries where they might have experienced deaths of friends or family and seen people struggle to access treatment.

To address this we have focused on providing lots of case studies of people living well with HIV as well as expanding testing options, such as home testing, to make it easier for people to get tested.
Through a Public Health England funded scheme, black Africans in England are one of the groups eligible to order free self-sampling test kits from www.test.hiv for the whole of November and December. With this kit one takes a sample of blood from a finger-prick and they send it to a laboratory and then receive the results by text, email or by phone depending on the option they choose.

People can also use a test where they read their own results. These are available to buy online and in some high street shops and they can also be obtained for free online from some organisations such as Terrence Higgins Trust. This can be delivered to any address and Terrence Higgins Trust offers an option of using Click and Collect, just as happens already with other online purchases www.test.tht.org.uk

Introducing the Click and Collect option due to the fear of others knowing that they received an HIV test kit. Some have expressed concerns that the/package

Since we started self-testing in March 2018, we have given out over 3000 free tests to black African people and black African are twice as likely to use the click and collect option that everyone else. This is interesting because it suggests that Black African men, who have the highest rates of late diagnosis of HIV, are responding positively to the privacy which this option allows.

Our message to everyone is that testing is free and if it is positive, you can access free treatment which will make a huge impact on your life and help you stay healthy.