In this sample of black African men and women attending social and commercial venues in London, Luton and the West Midlands, 14.0% were infected with HIV. HIV prevalence varied between sub‐groups, and was high in respondents with a previous STI diagnosis, in men born in East Africa or recruited in pubs, bars, restaurants or nightclubs and in women aged over 25 years, born in East or Southern Africa or who had had two or more new sexual partners in the past 12 months. Of note was the high percentage who reported a previous HIV test (46.7%). Despite this, we identified a substantial proportion of participants (nearly 1 in 10) with undiagnosed HIV infection; about two‐thirds of the infections identified were undiagnosed.
The HIV prevalence within this study demonstrates the disproportionate burden of infection among black Africans in Britain,1,2
with most respondents having been born in East and Southern Africa, representing the demographic of Africans living in the UK13
and where the HIV epidemic is most intense.16
As found in other studies of Africans in Britain, our respondents were more likely to be young, highly educated and single than the UK's general population.5,17,18
However, for the first time, our study documents the sexual diversity of the population, with 5.8% of men and 5.4% of women reporting same‐sex partners only. In addition, we found evidence of substantial sexual health need within this community: nearly 1 in 5 reported having had a previous STI diagnosis and 1 in 2 a previous HIV test. Despite this need, a substantial proportion of respondents were unaware of their HIV infection. That more respondents perceived their HIV status to be positive than those reporting a positive test result suggests a lack of testing and/or result collection among those who may be worried about their status. These findings support targeted prevention strategies aimed at intensifying efforts to promote repeat HIV testing and collection of test results. Other studies have confirmed the delays in healthcare access and late diagnosis of HIV infection among Africans in Britain.2,19,20,21
This study represents one of the largest community recruited samples of Africans in Britain, doubling the numbers recruited in the initial 1999 survey,5
and for the first time community‐survey and HIV seroprevalence data on Africans resident inside and outside London has been collected. We successfully built on the participatory model of research; trained African field workers were used to recruit participants, facilitated tremendously by a community consultant (WS‐S) who greatly improved linkages with the African communities.
As with similar studies of this nature, it is acknowledged that sampling and selection bias might have affected the estimates of HIV infection and risk behaviours.22,23,24
The response rate could be an overestimate if refusals were not accurately logged, although we are confident that field workers were conscientious in recording this information. Respondents recruited from bars, football matches and community events are potentially more likely to be young, single and educated. As well, only English‐ and French‐speaking Africans were sampled, and so the study findings might not generalise to those who do not speak these languages. It is also unclear as to the degree to which the experiences of these respondents can be generalised to Africans residing in less ethnically dense areas. The 74% participation rate for the provision of a sufficient oral fluid sample compares favourably with those reported by other venue‐based HIV prevalence studies.10
However, HIV prevalence and related risk behaviours might have differed between participants and refusals, and because we have no data to document this, it is not possible to determine whether our results might be over‐ or underestimates.
Despite the above limitations, the information derived from this study provides useful information for targeting health promotion activities, informs future research, and provides a continued comparator to behavioural surveys. Comparison of our data with other unlinked anonymous seroprevalence data from sexual health and antenatal clinic attendees will provide improved HIV prevalence estimates among African communities in England.25
A key element of future analyses will be to understand the changing patterns of behaviour between the two Mayisha surveys (1999 and 2004), taking into consideration the different sample populations and locations.5,6
Comparison of our data with data derived from Natsal 20007,8
will also help to estimate how representative the Mayisha II findings are of the UK black African population.26
Well into the third decade of the epidemic, interventions designed to prevent HIV infection must take into account the enormous heterogeneity of black African communities living in the UK. Our study confirms relatively high HIV prevalence among black Africans, many of whom have migrated from high‐prevalence areas of sub‐Saharan Africa, and yet are often unaware of their HIV serostatus. Our findings indicate that current efforts to promote HIV testing and awareness of HIV serostatus among black Africans living in the UK should be further strengthened and culturally competent education programmes promoting risk reduction strategies must continue. They are important tools in promoting early diagnosis, preventing onward transmission and reducing HIV‐associated morbidity and mortality within this population.