There are estimated to be more than 8,000 African people living with diagnosed infection in the UK (HPA, 2003:46). In addition several thousand more African people living in the UK have undiagnosed HIV infection since studies have shown that roughly 2/3 of African people in the UK have never tested for HIV (Fenton et al. 2002). HIV prevalence is many times higher among African people in the UK than among the white British majority. Compared to UK born men and women attending GUM clinics (each of whom have an HIV prevalence of 0.2%), 7.7% of African born women and 4.8% of African born men who attend GUM clinics are infected with HIV.

African people with HIV have significant ongoing difficulties in the following areas: income, immigration status, housing and living conditions, and access to training, skills and job opportunities. Difficulties in meeting these basic needs clearly lead to reduced quality of life. They have significant and ongoing difficulties associated with anxiety and depression, their ability to sleep, their self-confidence and their personal relationships.

Social exclusion is undoubtedly exacerbated by factors associated with migration. It is likely that a significant proportion of African people with HIV in the UK are (or have been in the past) refugees or asylum seekers, a group already significantly socially excluded. Exclusion associated with being HIV positive may be significantly compounded by pre-existing social exclusion and social need associated with being an African refugee or asylum seeker.

In order to survive and thrive, refugees and asylum seekers need to draw on their own personal resources (their ability to work for example) and need to draw on a supportive social environment in their host country. This environment is created first by the support of expatriate communities in the host country as well as in their home country and second by the provision of supportive enabling legislation, policy and services by the host country. African people with HIV are likely to find all of these resources curtailed.

Despite a relatively long history of the epidemic in sub-Saharan Africa, HIV remains significantly stigmatised among African communities in the UK and globally. Expatriate, diasporic and global African networks play an important role in the survival of African migrants in the UK. However the disclosure of an HIV-positive identity often leads to the withdrawal of vital community support. Thus, African people with HIV in the UK are less able to disclose to and draw support from their family and expatriate communities. Stigma at a community level leads to difficulties in even the most intimate relationships. Sigma Research found that 15% of African people living with HIV had not disclosed their status to their partners and only a third of respondents had disclosed their HIV status to their children or their families.

The policy of dispersing asylum seekers away from large urban environments often means that those living with HIV are moved away from specialist HIV treatment and care centres as well as being moved to a setting where support and contact within expatriate groups is unlikely. Home Office changes to immigration policy and the recent decision by the Law Lords on May 5^th 2005 also mean that a person with HIV who is on treatment will be unlikely to be granted leave to remain on medical grounds under humanitarian protection provisions. If that person is granted discretionary leave to remain it will only be for three years.

In addition to this, changes made earlier this year to the provision of NHS services for overseas visitors impose strict limitations on access to hospital care for non-residents and those whose asylum applications have failed. Broadly speaking, this means that while short term visitors, including students, and failed asylum seekers will be allowed to access HIV testing and other STI screening, long-term treatment for infection will not be provided unless it is paid for privately or via A & E.

In short, the current social, legal and policy environment in the UK is not geared towards maximising the health and productivity of African people with HIV.