HIV and African M S M in England: A new wave of Challenge. Presented by Adebisi Alimi

Thematic Issue Statistical information on infections Statistical information on infections Reasons for high HIV infection in African MSM community Reasons for high HIV infection in African MSM community Factors leading to late diagnosis in African MSM community Factors leading to late diagnosis in African MSM community Treatment options Treatment options Care and support Care and support

Introduction Sex between men occurs in every culture and society Sex between men occurs in every culture and society Estimates of the proportion of men who have had sex with another men at least once vary between 3% and 20% worldwide Estimates of the proportion of men who have had sex with another men at least once vary between 3% and 20% worldwide In many countries, social stigma and discrimination means that many MSM who would otherwise be exclusively homosexual are having heterosexual relationships, thereby potentially exposing their female as well as male partners to HIV & STIs when they have unsafe sex In many countries, social stigma and discrimination means that many MSM who would otherwise be exclusively homosexual are having heterosexual relationships, thereby potentially exposing their female as well as male partners to HIV & STIs when they have unsafe sex

Setting the scene Although disproportionately white and mainly British, the gay community in London is as multi-ethnic and multi-cultural as the broader population (Sigma Research, 2004) Although disproportionately white and mainly British, the gay community in London is as multi-ethnic and multi-cultural as the broader population (Sigma Research, 2004) Bass Line survey (2008) approx 5% black Africans men report sex between men Bass Line survey (2008) approx 5% black Africans men report sex between men Sexual health survey (UCL) Up to 10% of MSM surveys identify themselves as BME Sexual health survey (UCL) Up to 10% of MSM surveys identify themselves as BME

Statistical information on infections among African MSM in England an estimated 60% of the 33 million people living with HIV worldwide reside in sub Sahara African an estimated 60% of the 33 million people living with HIV worldwide reside in sub Sahara African In the UK there have been over 39,000 new diagnoses of HIV among men who have sex with men (MSM) of which 1.3% are from the African MSM community ? In the UK there have been over 39,000 new diagnoses of HIV among men who have sex with men (MSM) of which 1.3% are from the African MSM community ? Within the African community, African MSM accounts for the second highest HIV prevalence after African women. Within the African community, African MSM accounts for the second highest HIV prevalence after African women. There are not enough data to show the uptake of HIV testing within the African MSM community and these is due to many reasons. There are not enough data to show the uptake of HIV testing within the African MSM community and these is due to many reasons. Between 1999 and 2009, the HPA statistic shows that 527 African MSM has tested positive compared to over 24,000 from the white gay men and over 2,000 from mix heritage. Between 1999 and 2009, the HPA statistic shows that 527 African MSM has tested positive compared to over 24,000 from the white gay men and over 2,000 from mix heritage.

Reasons for high HIV infection in African MSM community Unprotected sex anal sex Unprotected sex anal sex Drug use Drug use Lack of information on HIV/ Condom use Lack of information on HIV/ Condom use Lack of capacity to negotiate safer sex Lack of capacity to negotiate safer sex Poverty Poverty Immigration Immigration Stigma and Discrimination. Stigma and Discrimination.

Factors leading to late diagnosis in African MSM community Knowledge of the need to test Knowledge of the need to test Availability of testing centres outside of GUM clinics and GPs Availability of testing centres outside of GUM clinics and GPs Confidentiality Confidentiality Fear of immigration Fear of immigration Type of questions asked Type of questions asked Stigma and Discrimination Stigma and Discrimination Poverty Poverty

Treatment options Many people do not know treatment is free Many people do not know treatment is free Provision of treatments based on Immigration status Provision of treatments based on Immigration status Side effects Side effects Treatment demands Treatment demands Adherence to treatments Adherence to treatments Alternative medicine Alternative medicine

Care and support Where to get care and support Where to get care and support What type of supports are available What type of supports are available How long they can have access to those supports How long they can have access to those supports

Monya Project The first project for African Men who have sex with Men in London The first project for African Men who have sex with Men in London Funded by the Newham PCT Funded by the Newham PCT Executed by Naz Project London Executed by Naz Project London Started in Started in Have a membership based of over 50 Self identified African MSM Have a membership based of over 50 Self identified African MSM Been the base for support for many Africa gay men. Been the base for support for many Africa gay men.

Services Provided Referral for testing Referral for testing Support group meeting Support group meeting Advice session Advice session Condom demonstration and distribution Condom demonstration and distribution Social events Social events Outreach Outreach Training/workshop Training/workshop

Recommendations More research into the sexual and identity behaviour of African MSM More research into the sexual and identity behaviour of African MSM Develop a specific intervention package for the community Develop a specific intervention package for the community Redesign pre-test discussion questions to get the right answers Redesign pre-test discussion questions to get the right answers More funding for Prevention work for the African MSM More funding for Prevention work for the African MSM Develop a campaign strategy that understands the identity, Language and needs of the community Develop a campaign strategy that understands the identity, Language and needs of the community Provide testing areas away from the conventional. Provide testing areas away from the conventional.

THANK YOU