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African Health survey reveals need for flexible sexual health services

Survey results from Waverley Care have revealed the need for flexible sexual health services to meet the diverse聽needs of African communities in Glasgow.

The analysis, prepared for NHS Greater Glasgow and Clyde, asked participants about their preferences on accessing sexual health information, alongside their views on issues like HIV and STI testing, access to condoms and PrEP, and talking to partners about their sexual health. 

The interim report is part of a wider survey of sexual health needs of African communities across Scotland, due to be published later in the year.

The findings will be used both to improve our own services, and to support improvements to partner services so that they can better meet the needs of people from African communities.

They will also help us to identify gaps where further research is needed to ensure that the diverse needs of African communities are identified and addressed.

Some of the key findings are presented below, and you can read the full interim report here.

Preferences in accessing sexual health services

Among its key findings, the survey highlighted that people from African communities in Glasgow:

  • continue to place significant trust in healthcare professionals as the main source of sexual health information
  • prefer to access information from dedicated services, including sexual health clinics, GP surgeries, pharmacies and hospitals
  • are open to accessing support in-person and via a range of remote options including phone, email and instant messaging. 

Views were split among participants, regarding staffing of services, with some exhibiting a preference to be supported by staff of the same ethnicity, sexuality or gender identity as them, while others believed this was unimportant.

The findings demonstrate the broad range of preferences and opinions found among participants, reinforcing the need for providers to offer flexible support based on the needs of individual service users. This feeds into wider concerns about guarding against the tendency to view African communities as a homogenous bloc.

Developing such a person-centred, and culturally sensitive approach will require providers to invest in resources and training. 

HIV and STI testing

Feedback from the survey revealed wide disparities in frequency of sexual health testing:

  • A third of participants had taken an HIV test in the past year, while a further one in five had not tested in at least five years
  • Over 40% of participants had not tested for other STIs in at least five years

As with sexual health services more generally, participants highlighted a preference for accessing testing within dedicated services including sexual health clinics and GPs. 

With Covid restrictions having significantly impeded face-to-face services in the past 18 months, the survey attempted to measure the acceptability of HIV self-tests among people from African communities. These tests allow individual to provide their own blood sample at home and get results in as little as 15 minutes.

  • A majority of respondents had heard of HIV self testing and, when asked, said they would be likely to use them - citing ease of use, practicality due to Covid restrictions, and confidentiality.
  • Roughly a third of respondents (32%) said they would prefer to order self-test kits online and receive them through the post 

Respondents would expect different levels of support alongside self-testing, including online information and advice, as well as phone and in-person support though the likes of sexual health services. Again, this reinforces the need for flexible, person-centred and culturally appropriate services, that respond to individual needs,

HIV and STI Prevention

African communities in Scotland remain disproportionately affected by HIV, so the survey asked respondents about two of the most prominent prevention options - PrEP and condoms.

PrEP is a daily pill that can prevent the person taking it from getting HIV. It has been available on the NHS in Scotland since 2017, with eligibility focused on those at the greatest risk of HIV. 

  • Awareness of PrEP among respondents prior to the survey was roughly 50:50, though only one participant had actually accessed the HIV prevention option
  • A significant proportion of respondents (40%) believed that they would benefit from accessing PrEP
  • Those who didn't believe they would benefit justified this by saying they were either: in monogamous relationshipsweren't sexually active, or were living with HIV.

In the first two years of Scotland's HIV PrEP programme, 0.4% of those who accessed it identified as African or African Scottish - just 14 people out of over 3,350.

In recognition of the disproportionate impact of HIV on African communities, work is needed both to provide targetted and culturally sensitive information, and to widen access to more people from African communities.

This should not take away from the need to continue making the measure available to gay bisexual men, and all men who have sex with men, who have been issued the vast majority of PrEP prescriptions to date.

Feedback from participants provided interesting information regarding condom use:

  • Almost three quarters of participants said they'd accessed free condoms in the past
  • A small majority of respondents said they'd refuse to have sex if their partner refused to wear a condom
  • However, more than four out of five participants reported having condomless sex in the past two years
  • The most popular options for accessing condoms was through NHS services including sexual health services, pharmacies and GP practices
  • While a high proportion of respondents said they'd be comfortable talking about issues around sexual health (including condom use), with their partner, this was far from universal. 

It is clear that there is still a need to develop and deliver clear and culturally sensitive information about the importance of condom use for the prevention of HIV and other STIs. At the same time, there is a clear demand for condoms to be made available in a range of healthcare and community venues.

Sexual Health and Faith

As part of the survey work, researchers held a focus group with a group of African Pastors in recognition of the central role of religion for many people from Scotland's African communities,

  • Pastors acknowledged that they could play a key role in supporting the sexual health and wellbeing of their congregants 
  • Particular emphasis was placed on building strong working relationships with local services so that congregants could be signposted on for support
  • Ongoing concern was highlighted about the tension between sexual health messages and the teachings of the church
  • While the importance of promoting good sexual health was acknowledged, the general view was that churches were not appropriate venues for the delivery of services like free condoms

We welcome the acknowledgement of pastors of the role that they can play in supporting improved sexual health for their congregants. Over recent years, Waverley Care's Health in Faith programme has worked to develop strong relationships with pastors across Scotland, and to frame key messages around sexual health in a way that is consistent with faith beliefs.

An understanding of the dynamics of faith and health can assist service providers to provide culturally sensitive, inclusive services while improving sexual health.

Overall, while the survey identified a number of areas for improving sexual health services, including HIV testing, the findings are limited by the make up of respondents. Most respondents identified as women, meaning the data cannot be considered wholly representative of the community. We are working to address this limitation in the final report.

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