Africans
in the UK
are a diverse group. In the course of my work, I
have met service users originally from 15 different sub-Saharan African countries
ranging from South Africa to
Somalia and Nigeria.
My work has highlighted some similarities in issues in both Kenya and the UK.
Living
with HIV is a challenge in both places, not only in terms of living with a
long-term condition, but also overcoming socioeconomic barriers. These Africans
are faced with a myriad of issues and challenges. The similarities that stand
out include late diagnosis of HIV (often when HIV
is already causing illness) and late treatment uptake. Africans in both
countries are faced with high unemployment, housing problems and poverty, and
experience fear of disclosure, stigma, discrimination and isolation.
Although, to a
certain extent, there is still a strong support system from families and
communities, both still hold the same cultural and religious
beliefs, values, myths and misconceptions about HIV. During a discussion I
attended with an HIV specialist and people living with HIV, one lady said: “I
still believe that I was cursed by God, because since my husband died I had
never had sex with another man.” Some Africans pass blame to others when it
comes to HIV and do not want to be associated directly with it. Over there and
over here, people still find speaking openly about sexuality with children and
peers shameful and taboo.
There are similar
attitudes towards people in authority too. People in authority are regarded as
godlike, and their decisions and actions never questioned. During one forum a
lady commented: “Whenever I visit my HIV specialist I never ask questions or
interrupt him. I know that everything that he says is true, so I don’t need to
read up on his decisions. After all, he is very educated and knows what he is
doing. I just listen and comply.”
The
differences between Kenya
and the UK
were eye-opening though. I was amazed at the services offered in London by African
community organisations: drop-ins, lunches, complementary therapies,
transport reimbursement, social and outdoor activities, volunteering, IT
training, dancing, yoga… all geared towards getting the HIV-positive person
moving forward with their lives and becoming more self-reliant. Community
organisations here take people with HIV on as volunteers, in some cases
enabling them to become permanent members of staff. One service user told me: “Because
of the training I have received, such as power speaking and advocating for
positive people, I am now a fully-fledged positive speaker attending parliament
sessions; I’ve addressed MPs on policy issues affecting HIV-positive Africans
living in London”.
I believe this is the way to move the HIV-positive African in from isolation
and help people give back to their own community. That’s how a community
develops and is able to tackle, as a community, its own issues.
I must applaud the treatment services here
in the UK.
Clearly the monitoring and regular care are superior to that in Kenya, but one
thing I was especially impressed by is that patients can also be referred to
mental health specialists and psychiatrists. This is something very rare in Kenya
because psychiatrists are far too expensive to be consulted. UK clinics even have home-delivery of
patients’ drugs. One support group participant told me it hadgiven her peace of mind because she was
afraid she would meet a friend or relative whilstcarrying her drugs.
Yes, in both countries
HIV services are under increasing pressure, and one issue facing both Kenyan
and London
clinics is trying to serve a large number of HIV-positive patients within a
limited period of time. One lady commented: “I used to get a lot of support from
my HIV specialist and sometimes could just call her when I was very sick and
ask for advice. But now you only get to see your HIV specialist every three
months.”
Despite all the HIV-related services available in London, a significant
number of Africans here are not able to fully benefit from them. Faced with
language difficulties, housing problems, joblessness and poverty, uncertain
immigration status and fear of stigma, many do not prioritise learning more
about HIV and their health options.
Some people end up with jobs that they do not like or
they are over-qualified for because qualifications obtained from their
countries of origin are not always recognised by the British system. During one
community support group I attended, a gentleman aired his frustrations. “I have
a Masters degree in administration back home in Nigeria,” he said, “but for the
last ten years I have had no job that tallies with my qualification. I have
been working in an old people’s home for the last seven years to be able to pay
my bills and send money home. I am just glad that my relatives back home do not
know the kind of work I am doing; it’s too shameful for a man of my status to
be washing people’s bodies.”
He also had constant fear about his HIV status being
revealed: “I have to make false excuses to be away from the office. I never say
I am seeing the doctor, for fear my employer might think I am not well enough
to work. He might ask me to do a medical examination, as he had done before
with other African employees who kept missing work. All these lies make me sick.”
Just under two-thirds of the half-a-million
Africans living in the UK
are first-generation migrants from Africa.1 They tend to have strong
attachment to values such as family dignity, honour, and respect for the
authority of men and of elders. Open discussion of sexuality in public, or in
mixed social settings is a taboo for most of them. For this reason, many
African parents tend not to offer information about sex to their children. This
responsibility passes (formally or informally) to others, including teachers.
As a result, second-generation Africans in the UK may be left feeling confused by
the silence at home regarding sex education, yet being taught in school about
sex and relationships. The confusion is worsened by the sexual freedom
displayed in the media – to which they have easy access – as well as in British
culture.