Beliefs and Perceptions in the construction of HIV stigma and sexual health seeking behaviour among Black sub-Sahara African (BSSA) communities in Birmingham, UK.

Abstract

There is ample academic evidence indicating high levels of HIV stigma among BSSA communities. The research suggests that disadvantaged and marginalised social groups like the BSSA communities experience high levels of HIV and sexually transmitted infections. There is a significant amount of quantitative research in the public domain on HIV and stigma. Quantitative research has shown that BSSA communities present late with HIV and sexually transmitted infections often owing to HIV stigma. Currently there is limited published qualitative information on the factors influencing HIV stigma and sexual health seeking behaviour among BSSA communities, particularly from the perspective of the communities themselves. This research study explored beliefs and perceptions in the construction of HIV stigma and sexual health seeking behaviour among Black sub-Sahara African (BSSA) communities in one city in the UK. The Silences Framework, which sits within aspects of feminism, criticalist and ethnicity-based approaches, provided the theoretical underpinning for this study. An exploratory qualitative study methodology was used to identify and explore the key factors influencing the construction of HIV stigma and sexual health seeking behaviour among BSSA communities. Five focus groups and fifteen one-to-one semi-structured follow-up interviews were conducted to collect the data. The institution of Marriage, Religion, Reported HIV statistics, Politics and Immigration, HIV as a Sensitive subject, sexual health professionals Cultural competence, gender stereotyping, Sexual Orientation and Social Media emerged as key pillars underpinning the social scripts associated with the construction of HIV stigma and sexual health seeking behaviour. The experiences emanating from the pillars of HIV stigma, identified in this study, showed the impact of social, political and personal contexts associated with specific sexual scripts among the participants impacting on the construction of HIV stigma and sexual health seeking behaviour. The 'silences' contained in the socially determined scripts were important in understanding the phenomenon under investigation. The findings from this study were reviewed in light of current sexual health policies and strategies to consider how sexual health professionals and services can best meet the health care needs of BSSA communities. This thesis contributes to current knowledge of HIV stigma and ethnicity, by concluding that the construction of HIV stigma and sexual health seeking behaviour among BSSA communities takes place during different contexts of socialization, in a bid to conform to the perceived expectations of society which may be real or imagined. Furthermore, conformity is also influenced by commonly shared and personal appraisal of socially determined relevant issues. These contexts form the bases on which sexual scripts are given meaning and HIV stigma is constructed alongside a socially sanctioned pattern of sexual health seeking behaviour. This study makes an additional contribution in that it is the first time that The Silences Framework has been used to research HIV and stigma among BSSA communities. This research study compliments the currently available pool of quantitative data linking issues of HIV stigma and ethnicity in the United Kingdom. The findings from this exploratory qualitative research study reveal a wide range of critical issues to encourage further qualitative research in the area, while indicating new issues to consider in developing UK based interventions to address HIV stigma and sexual health seeking behaviour among BSSA communities.