African HIV epidemic in the UK examined in study

The impact of the HIV epidemic in Africa on the epidemiology of HIV in the UK is explored in a study in the July 15^th edition of AIDS.

Publication of this study coincides with that of a report by the All Party Parliamentary Group on AIDS reported here on aidsmap.

Epidemiologists and public health officials used UK HIV surveillance data to review the epidemiology of African HIV in the UK and to see what trends could be established.

By the end of 2001, a total of 48,226 cases of HIV had been diagnosed in the UK. Of these, 13,451 had been acquired through heterosexual sex, with 67% (8,960) probably acquired in Africa. Sex between men is the main mode of HIV transmission in the UK.

Amongst black Africans, 88% of HIV infections (5,865 of 6,699) were acquired through heterosexual contact. Mother-to-baby transmission was the next most common mode of HIV transmission amongst Africans, accounting for a little under 10% of cases (571). Sex between men was the cause of HIV in 292 black Africans.

The investigators noted that new diagnoses of heterosexually acquired HIV have been increasingly steadily, with steep rises in the mid-1990s and again in the late 1990s. Between 60% - 70% of these cases were acquired in Africa. Sexual contact with a person infected with HIV in Africa also accounts for many of the 10% of heterosexual cases of HIV each year that did not involve sexual contact with a person from a known high risk group.

Since 2000 data has been collected on the year of arrival in the UK for all new HIV infections where HIV was acquired overseas. These data suggest that many people with HIV acquired in Africa have arrived in the UK recently. Of the 1,448 cases of HIV diagnosed amongst Africans in 2000, 366 cases, 25% of the total, had arrived since the beginning of 1999.

Anonymous unlinked HIV testing of heterosexuals attending sexual health clinics in London suggests that one in 16 women and one in 33 men born in sub-Saharan Africa are HIV-positive, with 39% unaware of their health status.

However, the proportion of black Africans with HIV in London fell over the course of the late 1990s. In 1998, 87% of Africans with HIV lived in the UK’s capital, but this had fallen to 81% by 2000.

Investigators also found that there are many more African women with HIV than men. Among the 3,653 new cases of heterosexual HIV diagnosed in 2000, 1,199 were in black Africans and 800 of these (67%) were in women. This is a greater female to male ratio than any other group. In addition, 18% (142) of black African women were pregnant at the time of their HIV diagnosis compared to 12% of white women (16 of 134) and 14% of black Caribbean women (6 0f 43).

Late diagnosis of HIV was also found to be more common amongst Africans than other ethnic groups. An HIV diagnosis was made within three months of an AIDS diagnosis in 133 of 244 Africans in 1995, rising to 239 of 275 in 2000. The equivalent figures for people of white ethnic origin were 320 of 1,261 in 1995 and 155 of 398 in 2000.

Investigators also looked at the prevalence of certain AIDS-defining illnesses in the African community. Tuberculosis was found to be significantly more likely to affect Africans than white people. In 2000, 72 (26%) of the 275 AIDS diagnoses in Africans involved tuberculosis, making it the most common AIDS-defining illness in this ethnic group. However, in the same period only 17 of the 398 AIDS cases in white people involved tuberculosis, making it the sixth most common opportunistic infection reported in this ethnic group.

Investigators highlight a reduction in late diagnoses, better prevention efforts, and a reduction in mother-to-baby transmission of HIV as public health priorities. HIV information should be integrated with other health messages the investigators suggest, given the high prevalence of tuberculosis and sexually transmitted infections amongst African communities.

The study concludes that “the future of HIV infection among Africans living in the United Kingdom is unpredictable, and continued surveillance of the situation is essential.”

Further information on this website

HIV information needs of Africans in UK revealed by new study - news story

Sexual attitudes and practices of Africans in UK: Padare study findings released - news story