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'Straight men left behind in HIV fight'

REAL TALK: From left, The panel at the NAZ event in discussion

THE LATE diagnosis of HIV remains a persisting inequality in black African heterosexual communities, according to recent Public Health England data.

Last year, of the black Africans who tested positive for HIV, 69 per cent of heterosexual men and 52 per cent of heterosexual women received a late diagnosis.

A late diagnosis means the virus has already caused significant damage to the immune system and greatly increases the likelihood of death within the first year of diagnosis.

In fact, even for people diagnosed promptly, black African and other non-white ethnicities are more likely to die within a year of diagnosis.

While a number of programmes are currently running concerned with addressing HIV among black heterosexual women in the UK, there appears to be a dearth of messaging designed to reach black heterosexual men.

NAZ, a charity delivering sexual health services to BAME communities across London, is trying to fix this.

At the annual British HIV Association conference in Bournemouth this month, NAZ convened a panel of straight black men to discuss the barriers facing them when trying to access healthcare services, with a view to opening the eyes of clinicians and funding bodies who consistently describe this particular demographic as “hard to reach”.


BARRIERS: Bilal Khan, one of the panellists, spoke about the reluctance of BAME men to engage with sexual health services

The panel, which included chief executive of Pak’s Hair and Cosmetics, Peter Mudahy; Dr Charles Mazhude, an HIV clinician; Dr Henry Mumbi, a professor at De Montfort University; Bilal Harry Khan, an activist working with disadvantaged youth across the UK and Ben Hurst, lead facilitator at the Good Lad Initiative, explored the systemic and mental barriers facing black heterosexual men when it comes to accessing health services. Bilal Khan, who studied theology at Cambridge and hosts a podcast exploring black masculinity and mental health, suggests that well-entrenched suspicions of racist institutions is an important factor to consider when examining this issue.

“As black men, we’ve been brought up knowing that we are vulnerable to institutionalised racism, that we’re vulnerable at the hands of the police, that our lives are not valued,” he said. “We need to remember that healthcare is just another one of those institutions. The history of medicalised racism and the disregard for black lives has a very real impact on whether or not we engage with health services. Many of us, myself included, just won’t go to the doctor until we can’t avoid it anymore.”

Dr Charles Mazhude, an HIV clinician who serves predominantly black patients in Lewisham, south east London, said that competing priorities for migrants and those from low socioeconomic backgrounds meant that healthcare often gets bumped down the list.


SHARING KNOWLEDGE: Dr Charles Mazhude, an HIV clinician, offers his thoughts during the event

“When you’re a migrant to this county, you won’t go to the doctor until you have to, until your health is in crisis,” he said. “You’re trying to provide for your family, trying to get on your feet and you often have to choose putting food on the table over seeing a doctor.”

PRIORITIES
Competing priorities is a recurrent theme in minority communities, regardless of gender.

Christabel Kunda, who leads on women’s and faith services at NAZ, echoed the sentiments of Dr Mazhude.

She said: “We see so many women who don’t have a choice. They can’t get childcare, they can’t take time off from work and so they make a decision to put their health at the back of their mind, but we need our people going to the doctor and demanding services. Our lives are on the line.”

But funding cuts across the board are also disproportionately impacting black people, adding another barrier to good sexual health.

The National AIDS Trust, a lobbying and advocacy organisation, suggested in their 2018 report that “delivering public health functions is now unsustainable with current funding”.

However, the UK is one of the first countries in the world to reach the targets set out by the UN and World Health Organisation as part of their 90/90/90 campaign, which seeks to ensure that 90 per cent of people living with HIV are tested and know their status; 90 per cent of those living with HIV are on effective antiretroviral treatment; and 90 per cent of those on antiretroviral treatment have a suppressed viral load.

It is now widely accepted that once a person living with HIV has a suppressed viral load (also known as an “undetectable” viral load), they cannot pass on the HIV virus (it’s “untransmittable”).

Like many countries, the UK has signed up to the goal to end all new HIV transmissions by 2030, but if black African communities are still disproportionately impacted by late diagnosis and funding cuts that prevent effective interventions, it calls into question the viability of the 90/90/90 targets.

“People tend to look at black people as one homogenous group,” said Ben Hurst, of the Good Lad Initiative. “But we’re all so different and this messaging isn’t reaching those of us who need to hear it most.”


PICTURED: Ben Hurst of the Good Lad Initiative

His work teaching young boys about gender equality and masculinity is particularly important – as earlier interventions and better sex education have demonstrable results in preventing the transmission of HIV and other sexually transmitted infections.

“I work with youth across the country and I have not seen any campaigns that seek to educate our youth about their vulnerability to HIV and sexual health.

“I’m in my late 20s and I’ve only recently started doing research into sexual health and HIV because I have to teach it. Many of my friends, who do not work in this particular space, do not know that they are vulnerable to HIV.”

At the event, the panellists suggested sexual health agencies and funding bodies are asking the wrong questions.

“Black communities are not hard to reach; we are reached all the time by people who put thought and effort into how to reach us. The question we should all be asking is, ‘Why are these interventions not working?’” asked Khan.

NAZ believes that galvanising organisations outside of sexual health, and that also serve BAME communities, is key to ending the disparities.

The charity recently hosted Black And Brilliant, a dinner convening black leaders from across London to connect, network and plan action around key sexual health disparities facing black communities.

Edem Ntumy, who leads interventions with BAME women at NAZ, was surprised at how many of these leaders were unaware of the disparities. He said: “These are people who are doing real and measurable work in social justice, media and education and they have not been reached by public health organisations with vital information about their vulnerability to HIV and other sexually transmitted infections. It’s remarkable, but unsurprising. As ever, it would appear the responsibility for saving our lives lies firmly with us.”

To reach BAME communities at scale, the charity is calling upon funding bodies to take seriously the challenges facing black communities across the UK, but is also exploring how to work with trusted institutions in black communities to find new ways of delivering sexual health and HIV education and interventions.


PICTURED: Dr Henry Mumbi, a professor at De Montfort University

The charity has begun working closely with Peter Mudahy and the team at Pak’s Hair and Cosmetics, who serve 67,000 people a week across the UK.

Mudahy sees an opportunity to intervene at the intersection of hair care, beauty and sexual health. He said: “When I heard about the late HIV diagnosis rates in black communities, I was speechless. It’s insane that our people don’t know about this and that there isn’t more being done to help address this. Pak’s serves 67,000 customers a week and we feel we have a responsibility to respond to this health crisis in our communities by encouraging regular HIV testing among those who come to our stores.”

He continued: “Alongside offering up-to-date information in our stores about how HIV is acquired, we are exploring how we begin to offer self-testing kits in-store to ensure our customers can take their sexual health into their own hands (if they are uncomfortable going to their local clinic or GP).

“Our community is facing a serious problem and we are ready to do our part to help.”

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