HIV treatment

Two thirds of all people accessing HIV care in the UK in 2008 were black African.¹ Of the 22,282 black Africans diagnosed with HIV and accessing care in 2008:

• 74% were receiving a combination of at least three antiretroviral drugs (ARVs).
• 3% were receiving monotherapy or dual therapy.
• 23% were not receiving any ARVs, of whom 24% had a CD4 count below 350 cells/mm³ (at which point starting treatment is recommended).

There are problems around awareness of HIV treatment, both amongst African people with HIV and in the wider African community. According to the most recent BASS Line survey of Africans in England, roughly one-in-six respondents did not know of the existence of treatments that can improve the health of people living with HIV, while one-in-three did not that know such treatments are more effective the earlier they are taken in the course of the disease. The survey showed that African people are very eager to learn about treatments for HIV – when presented with a list of HIV-related topics, this was the second-most common topic that people would like to know more about.²

This gap between knowledge and desire to know is a persistent issue, with the 2003 Project Nasah study revealing that over a third of African people living with HIV in the UK were not satisfied with their knowledge about HIV treatments. People of African origin were eight times more likely than white British people to report encountering problems in relation to knowledge of antiretroviral therapy. This suggests a disparity in the accessibility of treatment information.

Nonetheless it should be mentioned that in this study most African people had sought treatment information from a range of sources – nearly all had spoken to healthcare workers about treatment or had read some treatment literature in the previous year.³

An important barrier for Africans in the UK in accessing HIV treatment is government restrictions on the use of the NHS by foreign nationals. While asylum seekers and those granted leave to remain in the UK can access free treatment, unsuccessful applicants as well as undocumented migrants often receive substantial hospital bills or are refused treatment. Registering with a GP is also a problem, resulting in people seeking emergency care when they become seriously ill.

One in-depth study conducted with 70 Zambian, Zimbabwean and South African HIV-positive migrants living in London showed that these regulations had led to individuals delaying HIV testing, only accessing health care when they were sick enough to be admitted to an accident and emergency department, and sending for medication from abroad. Regulations had contributed to individuals avoiding the formal health sector, with subsequent low antiretroviral treatment uptake. Many instead resorted to potentially harmful alternative or herbal remedies.⁴

Returning to people’s information needs, a quarter of respondents in the BASS Line survey said they would like to know more about who is eligible for free HIV treatment, reflecting competing anxieties over personal finance, health and immigration status.²