HIV infection may be a silent epidemic in black Africans
A large survey of sexual behaviour and HIV infection in black Africans in the UK has found a high prevalence of HIV. More than half of HIV-positive participants were undiagnosed.
The Mayisha II survey is one of the largest community surveys of black Africans in the UK. It recruited 1,359 eligible black African men and women aged ? 16 in London, Luton and the West Midlands. Participants were given a 24-item anonymous self-completion questionnaire with linked voluntary anonymous oral fluid sampling. Around 74% of participants provided enough oral fluid for HIV testing.
Nearly 60% of men and 70% of women reported having had no new sexual partners in the past year. Just over one-fifth of both sexes reported ever having an STI, and half of women and slightly fewer men reported ever being tested for HIV.
The overall prevalence of HIV was 14% (13.1% in men and 15% in women); of the 141 respondents who tested positive, 93 were undiagnosed: 51 had not been tested before, 28 reported their last HIV test to be negative and 14 did not know their last HIV test result. These patients constituted 9.2% of the overall sample.
HIV prevalence was significantly higher in men born in East Africa and those who had a previous STI diagnosis, and significantly higher in women who were born in East, Central or Southern Africa, aged ?25 years, had had two new sexual partners in the past year, had a previous STI diagnosis or were single.
This paper reinforces the message that HIV infection may be a silent epidemic, as many people are not aware of their diagnosis.
The Chief Medical Officer issued a cascade to all health professionals in September, calling for extra effort
to improve detection of undiagnosed HIV in primary care and other settings.1 We need to accept that people from African communities may be at risk of HIV infection. HIV risk needs to be tackled sensitively in this already marginalised group, many of whom may be immigrants to the UK.
Sadler KE, McGarrigle CA, Elam G et al. Sexual behaviour and HIV infection in black-Africans in England: results from the Mayisha II survey of sexual attitudes and lifestyles. Sex Transm Inf 2007; 83:523-9Reviewer
Dr Richard Ma
GP principal, North London and staff grade in sexual and reproductive health, Margaret Pyke Centre, London