Background Black Africans comprise 5.5% of the London population, but account for 1/3^rd of newly diagnosed HIV cases and 1/3^rd of diagnosed people accessing care. Current policy encourages targeted interventions to raise HIV awareness and promote uptake of testing in this group. ‘Love Safely’ is a 10-year West London community outreach partnership promoting HIV awareness and behaviour change. It deploys outreach workers working with a toolkit to engage people.

Methods The study was conducted in 2012. A mixed-methods approach involved analysis of data on 1078 clients and interviews/focus groups with 54 informants - partner organisations, outreach workers, clients, and referral services. Behaviour change was measured through three indicators: (a) recommending family members/friends for a similar visit, (b) exhibiting more careful sexual behaviour (consistent/correct condom use), and (c) accessing HIV testing. Process measures were explored to understand pathways of change.

Results The service was effective in penetrating some hard-to-reach groups (men) but less so with others (older people, Muslim faith). Several aspects of knowledge, attitudes and behaviour were influenced by gender, length of UK residency and HIV prevalence in country of origin. Sexual healthcare was accessed from fixed settings but access through mobile units had increased. A high level of HIV knowledge and willingness to discuss HIV issues within social networks was demonstrated, but despite some evidence of behaviour change, awareness of personal risk was low. The main reasons for not attending HIV testing highlighted multi-level (individual, community and service) barriers and had remained unchanged compared to findings from a 2004 evaluation.

Conclusion Behaviour patterns are hard to shift and require persistent, robust action to bridge the knowledge-motivation-behaviour gap. Targeted intervention, while necessary, is insufficient. Emphasis on pluralistic, multi-level, joined up approaches may be more effective. Notwithstanding prevailing HIV stigma, people’s social networks offer a potentially supportive role in prevention.