Bristol city council and local NHS have made HIV prevention for people of African or Caribbean heritage a key priority.
- A four-year community project is under way to work with Black African and Caribbean communities on HIV prevention
- Outreach clinics are being held twice a month offering testing and PrEP
- It is part of a wider push on improving access to PrEP across the board.
Black ethnic groups make up just 4 per cent of the population, but more than 30 per cent of those receiving treatment for HIV in the UK are of Black African or Black Caribbean heritage.
As Bristol has historically had higher rates of HIV than the national average and a higher proportion of people of African or Caribbean heritage, the city council and local NHS has made HIV prevention in this group a key priority.
Working together, the council’s public health team, sexual health service and the University of Bristol has partnered with community organisations and the HIV charity Brigstowe to launch a programme called Common Ambition Bristol. The programme began in 2021 and runs until 2025 thanks to funding from the Health Foundation as well as the council.
It has four main aims:
- Increase HIV awareness
- Increase HIV testing
- Decrease late diagnosis of HIV
- Decrease HIV stigma.
Council Sexual Health and HIV Public Health Consultant Dr Joanna Copping said: “There’s lots of stigma in this community and so many are unaware they have HIV and are wary of using NHS services for all sorts of historical reasons. It is a real challenge for statutory services so we knew the answer lay in working with the community.”
At the heart of Common Ambition Bristol is co-production.
The lead community organisation is the African Voices Forum, which works with Brigstowe and partners to connect with community groups and support community researchers with the work overseen by a project advisory group and project delivery group.
‘We want to normalise HIV conversations’
A host of different projects have been run so far. These have included running HIV workshops at local community events, which Dr Copping said have proved incredibly popular.
“The workshops were run by our project co-ordinator. They were basically forums to provide information about HIV and why testing is so important and how you can protect yourself – including the use of PrEP. There has been a really good response. The workshops have helped open up a dialogue and inform the subsequent work that has been done.”
That has included the creation of two sexual health outreach clinics being run from local GP surgeries. Each one is held once a month allowing the community to access HIV testing and get PrEP prescriptions. Alongside this, the outreach workers have partnered with local businesses such as barbers to help increase awareness about HIV.
Dr Copping said: “The outreach team visit the barbers and encourage them to raise the topic with their customers as well as supplying flyers and condoms and other information about what is available. We want to try to normalise conversations about HIV.
“The challenge we always face is what happens when the funding ends. We have won trust and started to make a difference – but it has to be sustained.”
Early findings from the evaluation work being overseen by the University of Bristol suggest the outreach work has gained trust and helped to normalise conversations about HIV and signposting to testing options, while there has been “overwhelming positive” feedback from those that have attended the two clinics.
AVF Board Adviser Peninah Achieng-Kindberg is pleased with the impact it is having. “African heritage communities are subject of health inequalities therefore to have dedicated programmes such as the Common Ambition Bristol is key to addressing some of those issues and developing trust which helps to break down the stigma associated with HIV testing and treatment.”
Improving access to PrEP for everyone
In terms of PrEP there are plans in place to increase access more generally as well. Dr Copping said: “We were one of the first areas to starting offering PrEP and we’ve seen huge demand with 1,500 using it last year. In fact, it is taking up a huge amount of our staff power and resources so we are looking at ways to increase access and efficiency.
“It is quite labour intensive as you have to have an appointment with a doctor or nurse. We are re-commissioning our services this year so we plan to develop a digital service so that straightforward repeat prescriptions can be requested online, reviewed and then sent out by post. It will help us manage demand.”
Other options for the distribution of PrEP are also being explored. “We have received research funding to offer PrEP via pharmacies and GPs. There is still a bit of work to do – their knowledge and confidence needs building. But we are hoping to trial it and help make PrEP even more accessible.
There is also innovation going on with HIV testing. The public health team has supported funding for an HIV engagement support service, which is being provided by Brigstowe. An adviser has been taken on to provide one-to-one support to people who are struggling to keep to their HIV treatment.
Dr Copping said: “There may be other social factors – housing or poverty – that mean individuals struggle to attend appointments. The worker works with the hospital to identify those who are not turning up for appointments and need more support.”
And Bristol is one of the areas that is to start rolling out opt-out HIV testing in the city emergency departments later this year for HIV along with Hepatitis B and C.
“We have been advocating for opt out testing for everyone who has blood tests for several years,” added Dr Copping. “We know where it has been trialled so far it has picked up hundreds of new cases and we are delighted we have now got the funding to do it here.”