Elsevier

Social Science & Medicine

Volume 57, Issue 9, November 2003, Pages 1573-1592
Social Science & Medicine

An agenda for future research on HIV and sexual behaviour among African migrant communities in the UK

https://doi.org/10.1016/S0277-9536(02)00551-8Get rights and content

Abstract

The epidemiology of the recent rise in HIV cases in Britain highlights the need for more research among the heterosexual African migrant population. New research should not, however, only extend the limited number of studies that describe observable patterns in sexual health but should also seek to determine their underlying social causation. To achieve this, both methodological and ontological shifts are necessary in the existing research paradigm; we advocate that a broad range of qualitative techniques be deployed both to uncover the empirical details of specifically African sexual behaviours and to highlight and explore the ‘relational’ nature of sexual decision-making. Rather than fixing on individuals, analysis must situate them within the broader discursive and material frames that structure the boundaries of decision-making. In addition, researchers need to utilise the parallel literature on the social embeddedness of HIV in Africa to inform analysis of the British context. It would then be possible to address the crucial question of whether the social conditions known to cause high-risk behaviours and facilitate transmission in Africa persist, or are transformed, after migration to the UK. A key, and neglected, dimension of this is the role of spatial context in relational sexual decision-making and the constitution of social relationships in particular arenas. This needs further thought, particularly in relation to domestic space and gender identities. We believe that the research agenda proposed herein has much to contribute to interventions and service provision. Nevertheless, we are mindful of the need for self-reflexivity about our role in the production of powerful knowledges about sex. Our final proposal is that researchers seek ways to work with, not on, African communities in order to facilitate their own informed management of sexual health.

Section snippets

Introduction: ‘black Africans’ and rising HIV rates in the UK

The success of combination anti-retroviral therapy in delaying AIDS among those with HIV disease may be making the western public complacent about the continuing threat of infection and dismissive of the huge personal and public costs that the disease continues to exact. In Africa, by comparison, complacency is impossible. While the price of desperately needed pharmaceuticals now seems set to fall (PHLS (2001a), PHLS (2001b), BBC Online (2001c)), drugs will remain beyond the reach of most

Weaknesses in the existing literature on ‘ethnicity’ and sexual health in the UK

Most of the limited work that has been conducted in the British context on HIV/sexual health and ethnicity has been quantitative and more strongly influenced by biomedical than social health perspectives. Valuable though this work is, it rarely displays an appreciation of the socially produced nature of the categories utilised in the measurement of health. A consequence of ‘objective’ taxonomic classification and measurement is that it can produce a ‘black box epidemiology’ in which ‘ethnicity’

The need for methodological and ontological shifts in sexual health research

Elam, Fenton, Johnson, Nazroo, & Ritchie (1999), Chinouya, Fenton, and Davidson (1999 (2000) are among those who have begun the process of addressing the dearth in empirical data on sexual behaviour among ethnic minorities and are following up this work with a larger longitudinal quantitative survey of sexual behaviour among ‘black Africans’ across London. In addition to simply filling in gaps in knowledge this work and that of Elam, Fenton, Johnson, Nazroo, and Ritchie (1999) is also

Conclusion

This paper has reiterated the point made by others that more work addressing the health needs and HIV related sexual behaviours of Britain's ‘black Africans’ is urgently needed. Although people in this heterogeneous community face the greatest risk of HIV infection via the rapidly expanding heterosexual route, they remain a remarkably under-researched population subgroup. Nevertheless, we argue that simply increasing the number of studies describing the unequal epidemiology of HIV in the UK

Acknowledgements

Thanks to colleagues at St Andrews and UCL for their comments on drafts of this paper and associated research proposals. Thanks also to Hannah Weston for her useful insights based on her doctoral work among Britain's Asian community. We also wish to thank our two unnamed referees for the constructive and insightful criticism that challenged us to clarify our thinking in several important areas of the paper. Crown copyright material is reproduced with the permission of the Controller of HMSO and

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