Adeniyi Temilola, Horwood Jeremy, Doran Marsha, Piggott Khabo, Namurach Aisha-Monic, Harryman Lindsey, Oldenbourg Emmy, Kiflu Miryam, Speare Nathan, Griffin Mary, Wilson Matthew, Febrache Mark, Allbless Rachel, Dravie-John David, Copping Joanna, De Vocht Frank, Walter Scott, Fox Fiona
Population Health Sciences, University of Bristol, Bristol, UK
University of Bristol Centre for Academic Primary Care, Bristol, UK.
Sex Transm Infect. 2025 May 13. doi: 10.1136/sextrans-2025-056491.
African and Caribbean heritage (ACH) communities in the UK face disproportionately high rates of HIV and often experience delayed diagnoses, worsening health inequities. Increasing HIV testing in these communities is essential to address these disparities and support the UK's HIV reduction targets. This study examines barriers and facilitators to HIV testing among Bristol's ACH community, a high-prevalence area with significant rates of late diagnoses, filling a critical gap in context-specific data.
Using a mixed-methods approach, this study combined 29 in-depth interviews and 41 online surveys, capturing ACH community members' views on HIV stigma, healthcare trust and testing experiences. Data were thematically analysed and mapped to the Social Ecological Model (SEM) framework, with community researchers conducting data collection and analysis to enhance participants' engagement and trust and contribute to a deeper contextual analytical understanding.
Findings highlight significant barriers across SEM levels: individual-level knowledge gaps and stigma, interpersonal confidentiality concerns within tight knit communities, community-level taboos and distrust and organisational barriers, such as discriminatory healthcare experiences. Effective facilitators included culturally specific services, flexible testing options, community-driven outreach and increased healthcare representation, all of which fostered greater trust and engagement in testing.
The study underscores the importance of culturally aligned interventions, including representation within and training in cultural competence for healthcare providers and community co-production in service design. Implementing such strategies could reduce late diagnoses and support the normalisation of routine HIV testing in ACH communities, ultimately contributing to health equity. Future research should explore gender and age-specific barriers, while assessing the long-term impact of community-led interventions to inform national HIV policy and public health strategies for marginalised communities in the UK.
英国的非洲和加勒比裔社区面临着不成比例的高艾滋病毒感染率，而且诊断往往延迟，这加剧了健康不平等。在这些社区增加艾滋病毒检测对于解决这些差异并支持英国的艾滋病毒减少目标至关重要。本研究调查了布里斯托尔非洲和加勒比裔社区（一个晚期诊断率很高的高流行地区）艾滋病毒检测的障碍和促进因素，填补了特定背景数据方面的关键空白。
本研究采用混合方法，结合了29次深入访谈和41次在线调查，收集非洲和加勒比裔社区成员对艾滋病毒污名化、医疗保健信任和检测经历的看法。对数据进行了主题分析，并映射到社会生态模型（SEM）框架，社区研究人员进行数据收集和分析，以提高参与者的参与度和信任度，并有助于更深入地理解背景分析。
研究结果突出了社会生态模型各层面的重大障碍：个人层面的知识差距和污名化、紧密社区内人际关系中的保密问题、社区层面的禁忌和不信任以及组织障碍，如歧视性的医疗保健经历。有效的促进因素包括具有文化特色的服务、灵活的检测选择、社区主导的外展活动以及增加医疗保健代表，所有这些都促进了对检测的更大信任和参与。
该研究强调了文化协调干预措施的重要性，包括医疗保健提供者的文化能力代表性和培训以及服务设计中的社区共同生产。实施这些策略可以减少晚期诊断，并支持非洲和加勒比裔社区常规艾滋病毒检测的常态化，最终促进健康公平。未来的研究应探索性别和年龄特定的障碍，同时评估社区主导干预措施的长期影响，以为英国边缘化社区的国家艾滋病毒政策和公共卫生战略提供信息。
