Aids
...culturation and other factors influence these. there is a predominance of traditional attitudes towards sexual relationships and behaviours; Religious faith plays a significant role in the lives of African Communities living in England; there is a relatively high incidence of detrimental outcomes of sexual behaviour such as HIV and unwanted pregnancies; in some communities, older respected females (aunts) have an 9 important role in imparting information on sexual matters and behaviours to young girls; there is uncertainty within communities and in sexual health services about the HIV related risk of some traditional sexual practices; travel to home countries was more likely to be reported by communities who had been resident for longer periods of time, with twice the number of men than women reporting having a new sexual partner in the visited country; the widespread intention to use condoms with new sexual partners was, as in other groups, not reflected in the numbers actually using them with new partners; a significant number of reports of sexually transmitted infections amongst Africans, despite low self-perceived risk and only a third reporting having ever knowingly had an HIV test. There is a more visible population of African gay men in the UK who face a degree of discrimination from both African and gay communities. HIV prevention initiatives targeted at each population should be aware of this small but important sub-group. 2.9 Many Africans face discrimination and isolation on a daily basis, which can be compounded by HIV. Africans with HIV often experience additional stigma, not only from mainstream society, but also from within their own communities. This prompts many HIV positive Africans not to disclose their HIV status, which, in turn, can have a detrimental impact by masking needs for social and emotional support and delaying access to medical treatments. Female Genital Mutilation (FGM) - sometimes misleadingly called female circumcision - involves the partial or total removal of the external genitalia and sometimes other injuries to the organs of girls, usually between the ages of four and ten. It is widely practised in certain parts of Africa. All procedures involving the partial or total removal of the external female genitalia or other injury to the female genital organs, whether for cultural or other non-therapeutic reasons have been illegal in the UK since 1985. However, it has been possible to circumvent the law by having the procedure done out of jurisdiction. The prohibition is included in the new FGM Act, which received Royal Assent in October 2003 and took effect on 1 February 2004.The FGM Act amends and strengthens the 1985 legislation. It explicitly makes it illegal to take girls abroad for FGM. Apart from the violation of human rights that it represents, and the mental trauma it entails, FGM also causes considerable physical problems, particularly at menarche, first intercourse and at childbirth. All those dealing with women from cultures where FGM is practised need to be sensitive to the problems and conflicts it entails. There are also obvious issues of child protection that may have a significant impact on the planning of social care. Health professionals should familiarise themselves with the guidance and statements issued by their relevant professional bodies (i.e. the BMA and the RCM) so that they will be prepared if they encounter patients who have undergone this procedure. 10 Figures from the Communicable Disease Surveillance Centre (CDSC) show that, in 2003, there were 4431 men, 8126 women and 1 person for whom sex was not reported (a total of 12,558) described as 'black African' who were living with diagnosed HIV infection and attending HIV related treatment and care centres in England. Of these, 57% (7133) were resident in London. The total number of people with HIV seen for care in England in 2003 was 34,689; black Africans accounted for 36% of this total. (2003 data are the latest SOPHID figures available). An estimated 24,500 adults infected through heterosexual sex were living in the UK in 2002. Of these, 9400 (38%) were unaware of their infection (more men than women). This is a higher proportion than for other transmission routes, e.g. 24% of homo/bisexual men are estimated to be undiagnosed and 18% of injecting drug users. Black African men and women accounted for 70% of the total diagnosed infections in heterosexuals and 51% of the undiagnosed infections. 3.7 Between 1997 and 2003, there was a 351% increase in patients seen for care in England, Wales and Northern Ireland who had been infected heterosexually. Within this sub-group, the largest increase has been in Black African patients. Of the 15,726 heterosexual men and women seen for care in England, Wales and Northern Ireland in 2003 for whom ethnicity was reported, 70% (11068) were Black African, 19% (3009) were white and 4% (657) Black Caribbean. Africans feature in all the main transmission routes for HIV, but most cases of HIV diagnosed in the UK were reported as heterosexually acquired. HIV infected Africans tend to be diagnosed later than other population subgroups. There is also some evidence to suggest that Africans have a lower uptake of anti- retroviral treatments. These factors can have a major impact on subsequent heal...