Who is the intervention for?
All sexual HIV transmissions occur during sex between partners who are infected with HIV and those who are not. That is, for sexual HIV transmission to occur, someone with HIV (diagnosed or undiagnosed) must have penetrative sex with someone without HIV.
Targeting HIV prevention interventions requires that we identify and prioritise those groups that are most likely to participate in sero-discordant sex.
Target Group 1: People with HIV
The ﬁrst priority group for HIV prevention with African people living in England are people with diagnosed HIV. Since they are in the minority, people with HIV have much more opportunity for HIV sero-discordant sex than do people without HIV. Given that HIV infection cannot be cured and that NAHIP agencies agree that it is unethical to try to stop people with HIV from having sex, it is vital that the HIV prevention needs of people with diagnosed HIV are met.
This does not mean that NAHIP agencies think people with HIV have more responsibility for HIV transmission than other people, but simply that they have more opportunity for involvement in transmission. As a result, unmet prevention need in people with HIV is more likely to result in new infections than unmet needs in people without HIV.
To address the needs of people with diagnosed HIV we need all Africans to know whether or not they have HIV. NAHIP agencies aim to inﬂuence Africans so that they know whether they have HIV or not through testing for the virus. HIV testing is a behaviour that has its own associated needs, and these are described here.
Target Group 2: Partners of people with HIV
The second priority group for HIV prevention with African people living in England are people in sexual relationships with people with diagnosed HIV. People in relationships with someone of a different HIV status to themselves have much more opportunity for sero-discordant sex than people not in such relationships.
Many of the 24,000 black Africans with HIV in the UK are in sexual relationships with people without HIV. For example, among African people with diagnosed HIV attending services in North East London, 20% of the heterosexual men were in a relationship with an HIV negative woman and another 14% were in a relationship with a woman whose HIV status they did not know. Similarly, among the heterosexual women with diagnosed HIV, 22% were in a relationship with an HIV negative man and another 18% were in a relationship with a man whose status they did not know (Elford et al. 2007).
NAHIP agencies agree that it is unethical to attempt to break up relationships where one partner has HIV and the other does not, in order to reduce sero-discordant sex. Similarly, NAHIP agencies are not trying to reduce the frequency of sex in HIV sero-discordant relationships. Therefore it is essential that people in sexual relationships with people with HIV have their HIV prevention needs met.
Target Group 3: People with multiple partners
The third priority group for HIV prevention with African people living in England are people with multiple sexual partners. Compared to other ethnic groups, African men have been found to have the highest median number of lifetime sexual partners (Fenton et al. 2005). Compared to African women, African men are more likely to maintain more than one sexual relationship at the same time (Mayisha II Collaborative Group 2005) and to have new sexual partners when travelling abroad (Fenton et al. 2005) .
The more sexual partners someone has, the more likely one of their partners will have a different HIV status to them. So people with multiple sexual partners, including homosexually active men, commercial sex workers, and people in (formal or informal) polygamous relationships, are more likely to have sero-discordant sex than those with fewer partners. Furthermore, participation in unprotected intercourse while travelling (for instance, on return visits to African countries with high HIV prevalence) may increase the likelihood of transmission (Health Protection Agency 2006). NAHIP agencies think it is feasible and ethical to inﬂuence people to reduce the frequency with which they have intercourse with new partners, particularly if they are already in a sexual relationship.
Target Group 4: Partners of people with multiple partners
The fourth priority group for HIV prevention with African people living in England are the sexual partners of people with multiple partners. People who have unprotected sexual intercourse with a man or woman who has multiple sexual partners (either concurrently or not) need to be aware that their partner has an increased likelihood of having HIV. This will particularly apply to homosexually active men whose male partners have multiple sexual partners, clients and other partners of commercial sex workers and those in relationships who know or think that their partner may be having sex with others.
Target Group 5: All other sexually active Africans
The ﬁfth priority group for HIV prevention with African people living in England are all other African people who are sexually active, or who will be in the future. It is possible for people to choose to reduce their risk of HIV transmission by having sex only with someone they know has the same HIV status as themselves. HIV testing allows people to know their own HIV status. However, establishing the HIV status of a prospective sexual partner is more difﬁcult and requires a great degree of trust. Although people can ask, high levels of undiagnosed infection means there are several thousand Africans in England who have undiagnosed HIV and are therefore unable to tell a prospective partner of their infection.
NAHIP agencies are not trying to inﬂuence HIV negative Africans so that they are better able to detect and reject potential sexual partners who may have HIV. However, NAHIP agenices do think it is possible to inﬂuence Africans so that they know whether or not they and their partner have HIV. The needs associated with talking to a sexual partner about their HIV status and testing for HIV are described here.
Page last updated: 3 October 2010