Seminar 8: Researching sexual attitudes and lifestyles with Africans in the UK

20th May 2005

View Slides: Katherine Sadler | Oliver Davidson | Winnie Sseruma

The eighth AHRF seminar day, on the 20th May 2005 was an extraordinary and special event. As usual delegates reflected the multisectorial nature of those interested in the HIV epidemic in the UK: over 120 nurses, doctors, policy-makers, commissioners, social workers, researchers and community activists gathered at the Resource Centre, Holloway Road, London to take part in the seminar day. Most delegates were from London and the South East but many had traveled from places outside the traditional home of Africans in the UK; places like Manchester, Bristol, Birmingham, Newcastle and Glasgow. And as usual the seminar day started with an opportunity for delegates to network and exchange news and information about their local activities and events. Unlike other seminar days however, the entire day was given over to researchers from the Mayisha II team.

In the first presentation, Katharine Sadler, Project Co-ordionator of Mayisha II, explained the background and methods of the study. Mayisha II is the first national study of sexual attitudes and lifestyles of Africans in England and is the result of a major collaboration between African communities, the Health Protection Agency, AHRF, AHPN, NAHIP, Luton PCT, Terrence Higgins Trust and University College London. The original MAYISHA survey was carried out in London in 1999, and focused on the sexual attitudes and lifestyles of people from five African communities in north central London. It provided strong evidence that it is possible to collect sensitive and intimate information from African communities resident in London by way of a community-based survey. The results of the 1999 survey have proved invaluable for researchers, policy-makers, commissioners and healthcare providers alike.

For the second Mayisha survey, researchers broadened the scope of the study, recruiting participants from the whole of London, as well as Luton and Birmingham. Following on from the original model, trained fieldworkers from a range of African communities went in search of respondents in a variety of locations across these areas. Respondents were recruited in places such as churches, bars, clubs, and markets; in total 1608 people originating from 38 different African countries took part in the study. As in the first Mayisha, respondents filled in a self-administered questionnaire. However, Mayisha II participants were asked to provide an oral fluid sample to be sent back to the lab and tested for HIV antibodies. The survey was completely anonymous and confidential and participants were not able to receive the test results.

Winnie Ssanyu-Seruma, a community consultant to the study, told delegates about the challenges faced by the team in trying to recruit venues and participants. Many bar and club owners were reluctant to have fieldworkers at their venues. As with many studies the most difficult aspect was explaining about the confidential and anonymous nature of the study. Moono Nyambe and Joshua Muhindo, spoke about the challenges of being a fieldworker on the study such as empty club nights and introducing a potentially upsetting subject when people are having fun.

Although 1608 respondents took part in the study only 1359 black Africans (872 from London, 252 from Luton and 235 from West Midlands) were eligible for inclusion in the results. Dr Oliver Davidson, a lead investigator, gave delegates an overview of some of the results. Slightly more than half of respondents were men (51.9%), and most of the respondents were in the younger age groups. Over half of respondents reported that they regularly attended a religious service, indicating the importance of religion (see Box 1).

Just over half (50.9%) of female respondents had ever had an HIV test compared to 42.9% of the males. Substantially more men than women reported two or more new sexual partners (20.0% compared to 7.9%) in the part year. The majority of respondents reported that in general they had partners of the opposite sex. Same sex partners were reported by 8.0% of men and women.

When reporting the results of the oral fluid sampling, Dr Davidson made it quite clear that these results related to the MAYISHA II community sample and extrapolations to the wider community should be done very, very carefully. As a result the Maysiha II report refers to “community sample positivity”, based on the results of 1006 resondents who gave an oral fluid sample. Overall uptake of the oral fluid sample was 75.3%, with slightly more women (76.7%) giving an oral fluid sample than men (73.9%). Of the samples that could be analysed 141 were HIV antibody positive (14.0%). More detailed results can be seen in Table 1.

Table 1. HIV Positivity in the Mayisha II community sample

Recruitment Area

HIV positivity in the Mayisha II community sample

Women

Men

London

12.5 (45/361)

12.6 (43/342)

Luton

11.3 (7/62)

9.0 (9/100)

West Midlands

31.4 (22/70)

21.1 (15/71)

Total usable OF sample

15.0 (74/493)

13.1 (67/513)

In addition to filling in the questionnaire individuals were asked if they would like to take part in an in-depth interview. Forty people were recruited to the nested qualitative study, where their perspectives on HIV and sexual lifestyles were further explored. Qualitative researchers Gillian Elam and Gertrude Othieno told Forum members about their experiences and explored some of the themes elucidated from their research.

Having seen all the presentations, delegates were invited to join in parallel discussion groups where they could explore the implications of the findings of the study. Five areas of importance were discussed: Sexual Health Needs; Stigma and discrimination; HIV Testing; Risk Factors; People living with HIV. Each group was asked to come up with five recommendations that could be carried forward into practice (Box 2).

In the final part of the day Dr. Max Sesay, Chief Executive of the African HIV Policy Network, formally launched the report. In his short speech, Dr Sesay commended the efforts of researchers; “Mayisha II is the largest study of sexual attitudes of Africans in England and as such a unique and valuable resource for all involved in HIV in the UK”.

This study is a significant addition to the growing evidence base around HIV and Africans living the UK and should be used by all those planning services and prevention activities.

Box 1. Key Sample Characteristics1359 eligible black African respondents

  • 706 (51.9%) men and 653 Women (48.1%)
  • 38 different countries of birth
  • South Eastern and Eastern Africa 47.1%
  • Horn of Africa and Northern Africa 19.3%
  • Southern Africa 4.4%
  • Central and South Western Africa 8.8%
  • Western Africa 14.0%
  • Outside Africa 6.3%

Education attainment

  • None 1.9%
  • Primary, elementary 4.8%
  • Secondary, high school 26.3%
  • University, college 52.7%
  • Other 14.6%

Employment status

  • Employed 44.4%
  • Unemployed 16.7%
  • Home, family, caring 3.0%
  • Education 32.4%
  • Other 3.5%

Relationship Status

  • Married 40.0%
  • Widowed, seperated, divorced 5.7%
  • Living with partner 8.1%
  • In relationship (not living with partner) 13.8%
  • Single 38.4%

Religious Affiliation

  • Roman Catholic 26.7%
  • Protestant 34.3%
  • Muslim 13.5%
  • Other religion 13.8%
  • No religion 8.8%
Box 2. Mayisha II Recommendations
Sexual Health Needs
  • Immigration status is a barrier to HIV Testing
  • Access to HIV Testing and care (especially for undocumented migrants)
  • Raise awareness and provide health education about HIV and sexually transmitted diseases
  • Education around sexual orientation and sexual preference
  • More sexual health/HIV campaigns
Stigma and discrimination
  • Targeted awareess and education (dispelling myths)
  • Self esteem/empowerment training
  • HIV+ve involvement in health promotion and inclusiveness with other issues
  • Language diversity
  • Lobby government regarding policies (immigration, housing, charging for treatment)
HIV Testing
  • Promotion of community-based rapid HIV testing/outreach
  • Targeted sexual health prevention awareness & campaigns (faith groups, men and women)
  • Promotion of condom use and publication of sexual health materials
  • Adequate resources for sexual health provision in primary care settings
  • Promotion of partnership working/immigration
Risk Factors
  • Large scale national campaigns around awareness
  • Policies that encourage people to test
  • Negotiation of safer sex/ risk reduction campaign (targeted)
  • Working with positive people around prevention
  • Promote/encourage HIV-testing that is community based.
Impact of research
  • African communities need to engage with researchers
  • African HIV Policy Network needs to be proactive in managing results and potential impact
  • Need to maintain links
  • MAYISHA II survey needs to be repeated regularly
  • Engage with spiritual leaders
People living with HIV
  • Find ways to involve faith leaders
  • Engage more peer educators and people to educate health care workers about the plight of African communities
  • Engage voluntary sector outside London
  • Strategically distribute results
  • Lobby government to treat HIV like any other STI