Who is at risk?

The short answer is anyone who comes into contact with infected body fluids.  HIV is a virus and it doesn’t discriminate. But there are some communities in the UK where the number of people living with HIV is higher.

Does this mean if your patients or clients aren’t in one of the groups at higher risk, HIV isn’t something you need to consider? Not at all – the infection rate for people in the UK who don’t belong in a higher risk group is rising each year. Talking about groups at risk shouldn’t be considered to mean that 'only' these groups are at risk or that other groups have little risk. Anyone who adopts unsafe behaviour is at risk. It is helpful, however, to be aware of the demographics of HIV so that education and prevention messages are appropriate and cultural or other issues regarding treatment or counselling are considered.

Communities at greatest risk

In the UK most people with HIV come from two groups: gay and bisexual men, and black African heterosexuals. In 2010, over three-quarters of people diagnosed with HIV came from these two groups (Health Protection Agency, 2011). In the UK, the communities at greatest risk for HIV are:

• gay or bisexual men
• black African women and men, many of whom are migrants to the UK
• black Caribbean men and women
• prisoners - the HIV rate for male prisoners is 15 times higher than the rate in the general population
• injecting drug users - it is estimated that 1 in 250 IDUs in the UK is living with HIV
• an increased risk of HIV transmission should also be considered for people who have been sexually assaulted, particularly if anal or vaginal trauma occurred.

In 2010, in the UK:

• there were 6,658 new HIV diagnoses
• 45% were among men who have sex with men. This is the highest number recorded in a year
• 50% were among heterosexuals, with more than two-thirds of these infections occurring abroad.

In 2010, the National Institute for Health and Clinical Excellence (NICE) published guidance for increasing the uptake of HIV testing for men who have sex with men and black African communities. This is a key issue for both populations as we know that testing save lives.

Men who have sex with men

The recent increase in new HIV infections among men who have sex with men means that your role on the frontline of health care is an ideal opportunity for you to promote education and prevention messages and encourage testing including:

• Highlighting that the reasons people practice unsafe sex are complicated for example, for the heterosexual community, suggesting the use of condoms can be difficult or embarrassing.
• Checking existing levels of information people have - many younger gay or bisexual men may not have been provided information, support or advice about protecting themselves from HIV or may not have thought it was relevant to them.
• Reinforcing key messages - older men who had access to the education messages in the past may become complacent so it is important to reinforce safer sex messages. Also, information received in the past may be out of date or forgotten.
• Creating an opportunitiy to discuss and encourage regular testing.
• Reminding patients and clients in non-monogamous relationships that safe sex needs to be practiced even between partners who are both HIV positive. Otherwise, they could expose themselves to other diseases and infections or possible drug resistance, compromising their health.

Black African communities

Two-thirds of people diagnosed with HIV as a result of heterosexual sex in the UK are from the black African community (Health Protection Agency 2011). The attitudes and approach to people with HIV is a critical factor in halting the spread of this condition. Follow Ashur - a forty-year-old black African migrant from Nigeria as his story unfolds to see the contrast in his experience of HIV care and the difference it makes to his life, health and wellbeing.

While the circumstances and needs of each client or patient are of course unique, there are some general issues found regarding HIV within this community including:

• Many black Africans don’t see themselves as being at risk for HIV infection.
• On the whole, they tend to get diagnosed late.
• Most are already accessing health care services – over three-quarters of those diagnosed with HIV had seen their general practioner within a year of receiving their diagnosis.  Yet only 17% reported that they had been spoken to about HIV testing (British Journal of Nursing 2009).
• Many do not disclose their HIV status to partners, family, friends, or employers.
• There are more same-sex relationships in the black African community in the UK than are reported.
• Many African women have less ability to control their risk of HIV exposure and less ability to access services than women in many other communities.
• Economic issues, such unemployment and the need to send money to family members in Africa, take precedence over health.
• Preventative health measures are typically not part of the culture and are unfamiliar.

Barriers to testing for this community include:

• cultural issues, such as testing being seen as stigmatising
• fear that testing positive for HIV will lead to deportation
• fear of isolation and exclusion if found to have HIV infection
• not knowing how or where to get tested
• stigma surrounding HIV.

Understanding these issues can help you more effectively communicate with black African clients or patients. You might want to take a moment and consider how you would approach clients or patients from this community. What steps could you take to help them feel more comfortable and able to speak openly with you? How could you make sure your messages were understood? You may wish to record your responses to these questions. You may find the templates for an 'action plan' and a 'reflective record' available in the 'Taking action' section useful for developing and documenting your ideas and reflections. You may wish to save these documents to your computer and upload them to your e-portfolio as evidence of your continuing professional development. You may also find it helpful to share your action plan with you colleagues or line manager.