Martha J. Chinouya

A disease called stigma: the experience of stigma among African men with TB diagnosis in London

OBJECTIVES Tuberculosis (TB) is a highly stigmatised disease. This paper sought to explore the experiences and meanings of stigma among African men with a previous TB diagnosis. STUDY DESIGN Qualitative approach with ten men recruited from a community based organisation offering health support to the men. METHODS In-depth semi-structured interviews. RESULTS Men were unable to recognise TB symptoms and subsequently made late clinical presentation when they were also diagnosed with HIV. A few were diagnosed when in immigration detention centres. The experience of late diagnosis informed their understanding of the word stigma. The link between HIV and TB compounded experiences of stigma which led to depression and compromised HIV confidentiality. CONCLUSION TB late diagnosis among the men has implications for population health. Multidisciplinary teams supporting ongoing TB education programmes should include African mens organisations, due to the close supportive links such organisations have with African men.

Experiences and challenges of an interprofessional community of practice in HIV and AIDS in Tshwane district, South Africa

Abstract Collaboration amongst stakeholders remains a central tenet to achieving goals in planning, implementation, monitoring and evaluation of HIV and AIDS prevention and care strategies. This paper describes the experiences of members of a health care team who joined efforts to collaborate and form a community of practice (CoP) in HIV and AIDS. Qualitative, exploratory case study methods were used. Twenty-six participants were interviewed. Transcripts from the interviews were subjected to the thematic framework of data analysis. Based on the analysis, three themes emerged as impacting on collaboration and these were: the understanding and expectations of being a CoP member; professionalism and ethics within the CoP and collaboration in HIV and AIDS care. The key findings were that the understanding and expectations from the CoP varied. Ethical principles including respect, trust and confidentiality were identified as key tenets of collaboration and were expressed in various ways. The expectations of being a CoP member, the ethical principles within the CoP all impacted in differing ways on how they collaborated. The implication of this study suggests that consultation during inception and throughout the process, clarification of roles, transparency and respect are cardinal points in professional relationships.

‘This word volunteer is killing us’: Making sense of volunteering in social welfare provision for orphans and vulnerable children in rural Zimbabwe:

This qualitative study explored how volunteers delivering social welfare to orphans and vulnerable children through a community initiative supported by donors made sense of volunteering during a period of hyperinflation in Zimbabwe. Findings confirm that volunteering in Africa is influenced by a normative value system embedded in Ubuntu. Volunteering emerged as contradictory given the contextual prevalence of the social obligation discourse rather than individual choice as embedded in the European sense of voluntarism. Volunteering masked the cost of participation, thereby potentially making poverty worse for the poor in a context without a formal welfare system.

Implications for Policy and Practice

This final chapter attempts to draw out of the nine substantive chapters implications for policy and practice with respect to the Black African population. Firstly, we ask what kind of ethnicity data is needed for policy and practice, focusing on the limitations of current census categorisations. Quality issues concerning the reproducibility of the data, concealed heterogeneity under the hegemonic banner ‘Black African’, and concealment of the category in an aggregate ‘Black’ group all pose challenges in research and policy analysis. Legal and policy frameworks have not adequately addressed racism that has become embedded in British life and continues to be one of the major contributors to health and other social inequalities. The policy implications of racism and disadvantage in the labour market, housing market, health and healthcare, social care, and living in deprived neighbourhoods are explored. Secondly, the UK’s policy towards asylum seekers and the introduction of increasingly restrictive policies concerning migrants are assessed in the context of the increasing number of migrants from the Middle East and Africa making the journey across the Mediterranean and into Europe. Finally, the chapter addresses the diversity of preferences and needs associated with the Black African population that may be different from mainstream expectations and the need for respect for these differences.

African Communities in Britain

This chapter traces the long historical presence of ‘Black Africans’ in Britain going back to the Roman times. A new type of evidence, based on the study of Y-chromosome and mitochondrial DNA, is beginning to provide the first genetic trace of a long-lived African presence in Britain. The seventeenth, eighteenth, and early nineteenth centuries—from around the late 1620s to the early 1830s—are dominated not solely by the Black African presence in Britain but by Britain’s relationship with the peoples of Africa through the enslavement on an industrial scale of hundreds of thousands of Africans. From the late seventeenth century, there is archival evidence of Black Africans living in Central London that is mainly associated with slavery. In the eighteenth century, records of missionaries and ministers record conversions of Black Africans, living mainly in London, leading to many African kings sending their sons to London for a Christian education. African performers appeared through the nineteenth century in London theatres. Once again, Britain’s relationship with the peoples of Africa was dominated from the late nineteenth century by Britain’s colonial campaigns on the continent of Africa. An immediate impact of Britain’s establishment of colonies in Africa was a growing presence of Black Africans in Britain. Finally, the role played by Black Africans in the First and Second World Wars is described: the development of ‘colonies’ of seamen and their families in the major seaport towns of Cardiff, London, Liverpool, South Shields, and Glasgow, and the changing size of the Black African community following the mass migration of people to Britain from Britain’s former colonies in the post-Second World War years.

Socio-economic Position

This chapter provides a focus on the socio-economic position of Black Africans, with respect to their housing circumstances, education, and labour market. The section on housing circumstances considers housing tenure, dwelling type, whether the accommodation is self-contained, central heating, overcrowding (rooms and bedrooms), and the housing circumstances of Black African subgroups. The analysis of education encompasses an investigation of generic measures (degree level and no qualifications), variation in educational attainment by Census country of birth, linguistic, national origin, and religion subgroups, and reasons for variations in educational attainment. The final section on the labour market focuses on trends in labour market participation by ethnic group; economic activity by ethnic group; differences in labour market participation by gender, occupation, and industry (low-skilled jobs, nurses, doctors, and social work staff), self-employment and entrepreneurship, hours worked, young people in the labour market, and Black African subgroup variations in labour market participation.

Social, Cultural, and Civic Life

This chapter looks at associational contacts and informal social relationships. Amongst associational contacts, an attempt is made to examine the involvement of ‘Black Africans’ in home associations and other African voluntary organisations and ‘categoric’ contacts via volunteering and involvement in politics. The focus on casual, informal social relations includes friendship patterns and networks, interethnic relationships and unions, caring responsibilities, and group and community experiences (of conviviality and friendship). Intermarriage between Black Africans and other groups during the past several decades is investigated. The growing importance of globalisation and transnationalism, manifested through return visits to the migrant’s country of origin and remittances, is also investigated.

Where ‘Black Africans’ Live

This chapter focuses on where the Black African population lives in Britain. It looks at the spreading out of the Black African population and its reduced concentration in London between the 2001 and 2011 censuses. Variations in patterns of residence are examined for communities of descent, as measured by first language and country of birth. The segregation and mixing of the Black African population are explored using the concepts of evenness (Index of Dissimilarity [ID]), exposure, concentration, and clustering, as operationalised through the use of census data and Onomap Subgroups. The extent to which Black Africans live in deprived neighbourhood, a dimension frequently neglected in studies of place, draws on a recent analysis that utilises the Index of Multiple Deprivation (IMD). Finally, ‘ethnic density’ (or ‘group density’) effects, which may offset some of the drawbacks of living in deprived neighbourhoods, are examined and examples presented for the Black African group.

Long-Term Conditions and Infectious Diseases

This chapter focuses on a number of long-term conditions, notably circulatory disease, IHD, cerebrovascular disease, diabetes, cancers, mental illness, and sickle cell disease. It examines the behavioural and health risk factors for most of these conditions, including self-reported cigarette smoking, use of alcohol, overweight and obesity, blood pressure, participation in physical activity, eating habits, and use of complementary and alternative medicines. In addition, a significant fraction of the morbidity (but now to a lesser extent of mortality) amongst ‘Black Africans’ is related to infectious diseases, especially those acquired in their countries of origin. The epidemiology of the HIV/AIDS pandemic amongst ‘Black Africans’ is described, with respect to its impact on the community, its essentially heterosexual character, and disease acquisition prior to migration, differences in incidence by gender, and the literature on ‘Black Africans’ currently living with HIV/AIDS (notably, people seen for care). A range of issues are explored, including undiagnosed infections and late diagnosis, and the personal context of living with HIV/AIDS, including stigma attached to it and issues of disclosure. The chapter also examines other infectious diseases, including tuberculosis and sexually transmitted infections. Finally, the chapter discusses children’s health including the context of social and community care.

Patterns of Migration

This chapter focuses on Black Africans who have come to Britain to live here from sub-Saharan African countries (or as secondary migrants from European countries) over the last three decades or so. First, the age of arrival of the population born abroad is presented. Data are then shown on the year of arrival of migrants from African countries, followed by a detailed analysis of Black African migrants by period of arrival and countries of birth in Africa. Secondary migration from European countries, especially Somalis from the Netherlands and Sweden, is then explored. The main reasons for migration are investigated: asylum seeking (including the dispersal programme), migration for study, migration for work, family migration, undocumented/illegal migrants, and trafficked populations. The adverse consequences of what may happen when international migrants settle or remain in the country, including homelessness and destitution, are analysed. Finally, integration issues are discussed.