HIV in the United Kingdom: 2013 Report Public Health England

1. African MSM and HIV New Pathways for Engagement and PreventionPresented by Khalil West (National Online Worker for African MSM) at the HIV Prevention England Conference: London, 20 February 2014

2. HIV in the United Kingdom: 2013 Report Public Health England • At end 2012, men who have sex with men (MSM) remain the group with highest prevalence of HIV with 47 per 1,000 living with the infection. New diagnoses among MSM continued to rise and reached an all-time high of 3,250 in 2012. • Black-African men and women were the second largest group with highest prevalence of HIV with 38 per 1,000 living with the infection. Over the past five years, an estimated 1,000 Black-African men and women probably acquired HIV in the UK annually.

3. Within Europe, there are very significant differences between different European countries with regard to sexual education, accepted practice, sexuality-related legislation and mores, and so on. The same applies to Africa – so why do sexual health practitioners and agencies continue to subscribe to a monolithic understanding of ‘Africanness’? • Many Black-Africans do not only identify as ‘African’, but as citizens of their distinct country and culture of origin. For example: Ugandan, South African, Nigerian, Kenyan, etc. • Many Black-African (or, as above, Ugandan, South African, Nigerian, Kenyan, etc.) men who have or have had sexual contact with other men do not self-identify as “gay”, “bisexual” or even as “MSM” and may predominately identify as heterosexual, thus further complicating the traditional interpretations of MSM and Black-African HIV statistics. • These issues highlight a lack of understanding of significantly distinct sexual AND cultural self-definitions in HIV prevention and statistical analysis. • They also highlight a need for new non-monolithic frameworks for analysis, outreach, and prevention work.

4. Some of the reasons for high levels of HIV infection in different UK-based African communities • HIV myths and misinformation • Lack of education regarding risk behaviours, safer sex, and testing centres/procedures • Language barriers • Poverty • Sexual exploitation and abuse • Concerns about stigma and fear of discrimination • Fear of immigration and deportation

5. Some of the factors that affect many African-identifying MSM in their lives, and which may encourage risk behaviours • Multiple systems of oppression (racism and homophobia, for example) acting upon them simultaneously • Difficulty in identifying with and integrating into Western gender/sexual constructs • Fear of losing family and community support • Feelings of isolation, depression, and anxiety • Fear of outing

6. Some of the factors that may inhibit successful HIV prevention outreach for different African-identifying MSM • Lack of culturally-relevant/sensitive engagement practices • Lack of culturally-sensitive and appropriate materials (leaflets, flyers, etc.) • Lack of ‘safe spaces’ in which to receive sexual health information and testing • Concerns regarding confidentiality • Lack of resources and spaces in which lived experiences that mirror their own are seen • Lack of activities extending from an understanding of the breadth of different African cultures, MSM experiences and perspectives

7. Considering a focus on identity, representation, and lived experiences, how do sexual health professionals and agencies better address the unique concerns of (differently) African-identifying MSM, defuse fears and preconceptions around HIV and testing, and increase testing and sexual health awareness amongst African-identifying MSM nationally?

8. Possible frameworks for more effective interventions and outreach work • Involvement: Involving African-identifying MSM from various African countries and cultures in EVERY STEP of engagement/outreach design and intervention development. • Intersectionality: Understanding that HIV infection can be linked to different experiences of oppression and developing holistic approaches to sexual health in the lives of African-identifying MSM • Dynamic Models: Rethinking ‘one size fits all’ design of online and printed materials for MSM – e.g. bare white chests with ‘KNOW YOUR STATUS’ emblazoned across may not be acceptable materials for certain individuals to access and/or carry around • Social Networking: Moving with and influencing the use of evolving social media platforms for interventions and education • Sexual(ity) Diversity: Empowering by ‘seeing’ and dis-labelling – i.e. recognizing the complexities of sexual self-identification and inserting information regarding male-to-male sexual activity and risk behaviours into broader sexual health messages • Recognizing the Power of Personal Testimony: Seeking, commissioning and utilizing the personal stories of African-identifying MSM across a spectrum of lived experiences, backgrounds, politics, and HIV statuses

9. Questions to consider… • How do we better utilise social networking and mobile technology to provide safe virtual spaces and confidential access to HIV information? • How can agencies work together to create national physical and real spaces for African-identifying MSM to connect and share experiences? • How do we ensure that African-identifying MSM see themselves and their experiences in the resources we direct them to?

10. Thank You