HIV knowledge, sexual health and sexual behaviour among Black and minority ethnic men who have sex with men in the UK: a cross-sectional study
Rusi Jaspal A B E , Barbara Lopes C , Zahra Jamal D , Carmen Yap D , Ivana Paccoud D and Parminder Sekhon D
+ Author Affiliations
- Author Affiliations
A Trinity House, De Montfort University, Leicester, LE2 7BY, UK.
B Faculty of Arts, Psychology & Theology, Åbo Akademi University, 20500 Turku, Finland.
C Center for Research in Neuropsychology and Cognitive Behavioural Intervention, Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra, Rua do Colégio Novo, P-301-802 Coimbra, Portugal.
D NAZ Project London, 30 Black’s Road, London, W6 9DT, UK.
E Corresponding author. Email: rusi.jaspal@cantab.net
Sexual Health 16(1) 25-31 https://doi.org/10.1071/SH18032
Submitted: 2 March 2018 Accepted: 1 August 2018 Published: 27 November 2018
Abstract
Background: Black and minority ethnic (BME) men who have sex with men (MSM) face a major burden in relation to HIV infection. Using a cross-sectional correlational survey design, the present study explored the relationships between HIV knowledge and reported sexual health and sexual behaviour in this population. Methods: A convenience sample of 538 BME MSM was recruited in London, Leicester and Leeds: 346 (64%) self-identified as South Asian, 88 (16%) self-identified as Latin American, 76 (14%) self-identified as Black, 13 (2%) self-identified as mixed, and 15 (3%) self-identified as other. Results: HIV knowledge was low across the board, and South Asian MSM manifested the lowest scores. Respondents who perceived their HIV risk to be low possessed the least HIV knowledge. There were interethnic differences in the frequency of gay sauna visits, sex-seeking on mobile applications, drug use and attendance at sex parties. Respondents reported a high frequency of racism and discrimination, with Black MSM reporting highest frequency. Conclusions: There is an urgent need to raise awareness of HIV in BME MSM, and a culturally competent approach to HIV awareness-raising in BME MSM is required. These findings shed light on the contexts in which HIV prevention efforts should be targeted to reach specific ethnic groups, as well as some of the potential syndemics that can increase HIV risk or undermine HIV outcomes in BME MSM patients.
Additional keywords: drug use, homophobia, racism, risk.
References
[1] Dougan S, Elford J, Rice B, Brown AE, Sinka K, Evans BG, Gill ON, Fenton KA. Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales. Sex Transm Infect 2005; 81 345–50.| Epidemiology of HIV among black and minority ethnic men who have sex with men in England and Wales.Crossref | GoogleScholarGoogle Scholar |
[2] Millett GA, Peterson JL, Flores SA, Hart TA, Jeffries WL 4th, Wilson PA, Rourke SB, Heilig CM, Elford J, Fenton KA, Remis RS. Comparisons of disparities and risks of HIV infection in Black and other men who have sex with men in Canada, UK, and USA: a meta-analysis. Lancet 2012; 380 341–8.
| Comparisons of disparities and risks of HIV infection in Black and other men who have sex with men in Canada, UK, and USA: a meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[3] Public Health England. National HIV surveillance data tables. London, UK: Public Health England; 2015. Available online at: https://www.gov.uk/government/statistics/hiv-annual-data-tables [verified 20 December 2017].
[4] Letamo G. Does correct knowledge about HIV and AIDS lead to safer sexual behaviour? The case of young people in Botswana. African Population Studies 2011; 25 44–62.
[5] Public Health England. HIV in the UK: 2016 report. London, UK: Public Health England; 2016. Available online at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/602942/HIV_in_the_UK_report.pdf [verified 24 September 2018].
[6] Weston HJ. Public honour, private shame and HIV: issues affecting sexual health service delivery in London’s South Asian communities. Health Place 2003; 9 109–17.
| Public honour, private shame and HIV: issues affecting sexual health service delivery in London’s South Asian communities.Crossref | GoogleScholarGoogle Scholar |
[7] Soni S, Bond K, Fox E, Grieve AP, Sethi G. Black and minority ethnic men who have sex with men: a London genitourinary medicine clinic experience. Int J STD AIDS 2008; 19 617–9.
| Black and minority ethnic men who have sex with men: a London genitourinary medicine clinic experience.Crossref | GoogleScholarGoogle Scholar |
[8] Mohammed H, Furegato M, Hughes G. Inequalities in sexually transmitted infection risk among black and minority ethnic men who have sex with men in England. Sex Transm Infect 2016; 92 A42
| Inequalities in sexually transmitted infection risk among black and minority ethnic men who have sex with men in England.Crossref | GoogleScholarGoogle Scholar |
[9] Hickson F, Melendez-Torres GJ, Reid DH, Weatherburn P. HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities. Sex Transm Infect 2017; 93 508–13.
| HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities.Crossref | GoogleScholarGoogle Scholar |
[10] United Kingdom Collaborative HIV Cohort Study Group. Uptake and outcome of combination antiretroviral therapy in men who have sex with men according to ethnic group: the UK CHIC Study. J Acquir Immune Defic Syndr 2012; 59 523–9.
[11] Pence BW, Thielman NM, Whetten K, Ostermann J, Kumar V, Mugavero MJ. Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast. AIDS Patient Care STDS 2008; 22 869–77.
| Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the United States Southeast.Crossref | GoogleScholarGoogle Scholar |
[12] Melendez-Torres GJ, Bourne A. Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers? Curr Opin Infect Dis 2016; 29 58–63.
| Illicit drug use and its association with sexual risk behaviour among MSM: more questions than answers?Crossref | GoogleScholarGoogle Scholar |
[13] Daskalopoulou M, Rodger A, Phillips AN, Sherr L, Speakman A, Collins S, Elford J, Johnson MA, Gilson R, Fisher M, Wilkins E, Anderson J, McDonnell J, Edwards S, Perry N, O’Connell R, Lascar M, Jones M, Johnson AM, Hart G, et al Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study. Lancet HIV 2014; 1 e22–31.
| Recreational drug use, polydrug use, and sexual behaviour in HIV-diagnosed men who have sex with men in the UK: results from the cross-sectional ASTRA study.Crossref | GoogleScholarGoogle Scholar |
[14] Amaro H, Raj A, Vega RR, Mangione TW, Norville Perez L. Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need. Public Health Rep 2001; 116 434–48.
| Racial/ethnic disparities in the HIV and substance abuse epidemics: communities responding to the need.Crossref | GoogleScholarGoogle Scholar |
[15] Dhar J, Griffiths CA, Cassell JA, Sutcliffe L, Brook GM. How and why do South Asians attend GUM clinics? Evidence from contrasting GUM clinics across England? Sex Transm Infect 2010; 86 366–70.
| How and why do South Asians attend GUM clinics? Evidence from contrasting GUM clinics across England?Crossref | GoogleScholarGoogle Scholar |
[16] Yang X, Derlega VJ, Luo H. Migration, behaviour change and HIV/STD risks in China. AIDS Care 2007; 19 282–8.
| Migration, behaviour change and HIV/STD risks in China.Crossref | GoogleScholarGoogle Scholar |
[17] Jaspal R. The construction and management of national and ethnic identities among British South Asians: an identity process theory approach. Ph.D. Thesis, Royal Holloway, University of London; 2011.
[18] Díaz RM, Ayala G, Bein E. Sexual risk as an outcome of social oppression: data from a probability sample of Latino gay men in three U.S. cities. Cultur Divers Ethnic Minor Psychol 2004; 10 255–67.
| Sexual risk as an outcome of social oppression: data from a probability sample of Latino gay men in three U.S. cities.Crossref | GoogleScholarGoogle Scholar |
[19] Ayala G, Bingham T, Kim J, Wheeler DP, Millett GA. Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men. Am J Public Health 2012; 102 S242–9.
| Modeling the impact of social discrimination and financial hardship on the sexual risk of HIV among Latino and Black men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[20] Mizuno Y, Borkowf C, Millett GA, Bingham T, Ayala G, Stueve A. Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors. AIDS Behav 2012; 16 724–35.
| Homophobia and racism experienced by Latino men who have sex with men in the United States: correlates of exposure and associations with HIV risk behaviors.Crossref | GoogleScholarGoogle Scholar |
[21] O’Donnell L, Agronick G, Doval AS, Duran R, Myint-U A, Stueve A. Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men. AIDS Educ Prev 2002; 14 457–71.
| Ethnic and gay community attachments and sexual risk behaviors among urban Latino young men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[22] Jaspal R, Siraj A. Perceptions of ‘coming out’ among British Muslim gay men. Psychol Sex 2011; 2 183–97.
| Perceptions of ‘coming out’ among British Muslim gay men.Crossref | GoogleScholarGoogle Scholar |
[23] Jaspal R. Enhancing sexual health, self-identity and wellbeing among men who have sex with men: a guide for practitioners. London: Jessica Kingsley Publishers; 2018.
[24] Fish J, Papaloukas P, Jaspal R, Williamson I. Equality in sexual health promotion: a systematic review of effective interventions for black and minority ethnic men who have sex with men. BMC Public Health 2016; 16 810
| Equality in sexual health promotion: a systematic review of effective interventions for black and minority ethnic men who have sex with men.Crossref | GoogleScholarGoogle Scholar |
[25] Carey MP, Schroder KE. Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Educ Prev 2002; 14 172–82.
| Development and psychometric evaluation of the brief HIV Knowledge Questionnaire.Crossref | GoogleScholarGoogle Scholar |
[26] Brown AE, Mohammed H, Ogaz D, Kirwan PD, Yung M, Nash SG, Furegato M, Hughes G, Connor N, Delpech VC, Gill ON. Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)? Euro Surveill 2017; 22 30553
| Fall in new HIV diagnoses among men who have sex with men (MSM) at selected London sexual health clinics since early 2015: testing or treatment or pre-exposure prophylaxis (PrEP)?Crossref | GoogleScholarGoogle Scholar |
[27] Stephenson R, White D, Darbes L, Hoff C, Sullivan P. HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners. AIDS Behav 2015; 19 553–60.
| HIV testing behaviors and perceptions of risk of HIV infection among MSM with main partners.Crossref | GoogleScholarGoogle Scholar |
[28] Jaspal R, Williamson I. Identity management strategies among HIV-positive Colombian gay men in London. Cult Health Sex 2017; 19 1374–88.
| Identity management strategies among HIV-positive Colombian gay men in London.Crossref | GoogleScholarGoogle Scholar |
[29] Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull 2003; 129 674–97.
| Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence.Crossref | GoogleScholarGoogle Scholar |
[30] Jaspal R. Gay men’s construction and management of identity on Grindr. Cult Health Sex 2017; 21 187–204.
| Gay men’s construction and management of identity on Grindr.Crossref | GoogleScholarGoogle Scholar |
[31] Hinkin CH, Hardy DJ, Mason KI, Castellon SA, Durvasula RS, Lam MN, Stefaniak M. Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse. AIDS 2004; 18 19–25.
| Medication adherence in HIV-infected adults: effect of patient age, cognitive status, and substance abuse.Crossref | GoogleScholarGoogle Scholar |
