Interview with Audrey Prost

Audrey Prost is currently a Research Fellow at the Centre for Sexual Health and HIV Research at University College London. She recently published a Medical Research Council occasional paper - A review of Research Among black African communities Affected by HIV in the UK and Europe (see previous page). We asked her a few questions about her work.

The report describes and summarises 129 studies about African migrant communities affected by HIV in the UK and other European countries. Were you surprised that there were so many?

In fact, there were very few. The majority of these 129 studies were reports, conference abstracts, and online publications. Only a very small number (29) were published in peer reviewed journals. In addition, all peer-reviewed studies were descriptive, and none were about interventions with African communities in Europe. The major finding of this review is the striking lack of studies describing and evaluating interventions. The review includes studies published between 1996 and 2005; twenty-nine peer-reviewed studies in nine years is not nearly enough...

Why do you think there is so little research available for peer-review?

There are a number of reasons for this. First, a lot of interventions with African communities in the UK and Europe are too small to lead to peer-review publications. This is partly due to lack of funding: community-based organisations have a wealth of experience in setting up small scale interventions, but they often lack the funding and academic partnerships to evaluate these or expand them to satisfy the rigorous requirements of randomised control trials. This kind of ‘grass roots’ intervention research hardly gets talked about in formal academic circles, but it is where we might get inspiration for our future intervention trials.

Second, there is a lack of African researchers carrying out observational and intervention research on communities affected by HIV in the UK. Few interventions ‘work’ without strong partnerships with communities; we need more African researchers, and we need to draw on the experience and networks of those who are already there to build successful interventions that lead to good publications.

Six themes emerged from the descriptive studies. Do you think there are any gaps in the literature? Should researchers continue to focus on these themes?

We should certainly keep focussing on these areas, but we should not stop at descriptive research. We need interventions and published intervention studies: this is where the gap lies. Descriptive studies have their place, but if we do not translate their findings into interventions, then we are simply maintaining the status quo. We know that stigma around HIV persists in African communities, and we know that under-employment is a problem among positive Africans. Now we need to find appropriate interventions to tackle these issues. Another example is HIV testing: we actually know quite a bit about where people test and what factors contribute to this decision. We must act on this and develop interventions that build on these findings.

You identified six major areas of need for prevention intervention with black Africans communities. Which of the six do you think is most urgent for black African communities in the UK?

The most pressing need, in my view, is to encourage HIV testing in appropriate and innovative ways. By making HIV testing more accessible, we can fight stigma, deliver important prevention messages, and improve the lives of positive persons. Interventions are needed in several areas of HIV prevention among African communities, and some will be complementary, but promoting HIV testing is in many ways a good starting point.

What research are you currently undertaking?

I am currently involved in two projects together with colleagues at the Centre for Sexual Health & HIV Research (UCL). The first is building a model for a community-based Voluntary Counselling and Testing service based on a successful intervention from Kenya called Liverpool VCT. We want to find out whether community-based testing is possible in the UK, whether it is appropriate, and what the best ways of doing it might be. The idea is that you can train lay counsellors to give rapid HIV test and offer pre and post-test counselling in community venues. These could be shops, pharmacies, or community centres. We will be gathering opinions on this in the coming six months, so get in touch if you want to share your views vct@ahrf.org.uk.

My second project is to explore the possibility of using rapid HIV tests in GP surgeries to encourage people to test more routinely. We want to explore patients’ views on this, and find out whether it is feasible in practice.

Finally, how can people get hold of the paper?

The paper will soon be available online at www.ahrf.org.uk/articles, or they can email me for a print copy at aprost@gum.ucl.ac.uk.