Studies that have explored the psychological concerns of sexual health clinic attenders from black African groups in London show that despite the higher levels of subjective psychological distress reported by African clinic attenders (26%) and the significant proportion who said they would like to see a psychologist (36%), no referrals to psychology services were made. This evidence substantiates existing arguments concerning a general reluctance to refer black people to ‘talking therapies’.

Reports also indicate that for black African people the fear of stigma leads to a lack of disclosure, and in turn lack of disclosure seems to be linked to a lack of social support and social isolation. Many describe a distinct lack of social support and report a lack of opportunity to talk about their HIV status and that the fear of meeting people from the community is a barrier to using self-help groups. Thus, because status disclosure is difficult, social isolation and lack of social support are exacerbated. Weatherburn et al. found a lack of social support in practical areas such as doing household chores, mobility and getting enough money to live on. Almost half of those living with children had difficulties looking after them. Although problems with practical needs were the experience of a minority of HIV-positive people, the impact could be considerable.

Relationship problems were experienced by nearly one- third of respondents, although whether problems would have emerged regardless of HIV status was unclear. Sexual problems were also experienced.

Active involvement with a religious group has been linked to increased social support and a sense of belonging as well as spiritual support among older HIV-infected adults. The majority of respondents in all studies stated that religion was important, and religious faith was found to be a major source of support for African women in coping with their difficulties.