Worst of all worlds.

    Being HIV-positive isn’t easy for anyone. But for women from
    ethnic minorities it can be especially challenging, as the first
    national conference on the subject was told this month. The event,
    organised by ethnic minority HIV and Aids charity Naz Project
    London, revealed that women from these communities face significant
    hurdles when dealing with the disease.

    Naz’s director Bryan Teixeira says it is important for ethnic
    minority groups to take HIV seriously because the infection rate
    among women in London’s African communities is twice that of men.
    “There is still a lot of denial that HIV is in their communities
    or, if it is, it’s seen as a gay issue,” he says. And some women
    come from cultures where they have a low social status so
    negotiating for safer sex is particularly complicated, he

    For others, religion plays a strong role and this can hinder women
    coming forward. Sharron Keightley, Terrence Higgins Trust
    Lighthouse south London regional manager, says: “They can take so
    long to be tested for HIV because of the views that come from the
    church: that they are to blame and it is in God’s hands.”

    Of the 700 clients a year THT Lighthouse King’s Centre in south
    London sees, 85 per cent are from ethnic minorities and most of
    these are women. Women tell the service they cannot disclose their
    status, or even store their medication in their fridge, for fear of
    their family back home finding out.

    Being black, female and HIV-positive can be “a triple bind”, agrees
    Kusum Gopal, senior research fellow at the London School of
    Economics’ gender institute. She says: “It depends on their culture
    and social background. This conditioning reflects how they react to
    HIV. The disease is looked on as a sin and it brings shame to a

    It is not just women from ethnic minorities settled in the UK who
    may be reluctant to reveal their HIV status. Asylum seekers fear an
    admission of their condition will count against them during the
    asylum process. Teixeira says: “They think ‘can I trust that my
    medical information will not cross the boundary and become
    available to the Home Office?’.”

    HIV-positive Kenyan asylum seeker Salima Jivani (see facing page)
    has received disappointing responses from some medical
    professionals. “When I’ve been to clinics they ask me where I’m
    from first rather than anything about my health,” she says. “I am
    asking them for help and they are judging me by the colour of my

    So what sort of support should social care services offer this
    client group? They could follow the example of THT Lighthouse,
    which has operated an African emotional support group for three
    years. Here, African men and women talk individually to someone
    else from their culture who is also HIV-positive, so it differs
    from traditional counselling methods absent from some African

    Keightley says social care professionals should undertake specific
    training to ensure they are meeting their ethnic minority clients’
    needs and be able to signpost them on to appropriate help.

    Providing gender- and culture-specific groups for women from ethnic
    minorities may also be helpful if service users request them. Until
    recently both Naz and women’s HIV charity Positively Women did this
    but each has amalgamated these groups so they include both sexes
    from other cultures. Teixeira says this was a fascinating,
    unforeseen development which had come about because of clients’

    Reducing the stigma of HIV among women from ethnic minorities needs
    to start in school, says Gopal. A greater focus should be given,
    for boys and girls alike, to the teaching of good sexual health
    practices. “Ghettoising women is wrong. They should be seen in
    relation to men and boys.”

    Another way to reduce stigma is to build women’s confidence and
    skills. Positively Women encourages women to take part in local and
    national HIV strategies. And 18 months ago Naz convinced an
    HIV-positive black woman to address its AGM for the first time.
    Teixeira says: “We’re trying to identify these women to talk about
    their experiences but it is a slow process.”

    Perhaps the most powerful challengers of stigma and discrimination
    are the women themselves.

    ‘hiv is taboo in our culture’    Salima
    Jivani is 34 and from Kenya. She first came to the UK three years
    ago on holiday. During her week’s stay she developed a fever and
    went to the doctor, who tested her for HIV. The result was
    positive. From that moment Salima knew she could never tell her
    Muslim family or friends: “HIV is taboo in our culture and you only
    get it if you are gay or a prostitute.”  She flew home and told her
    boyfriend of one year the news. He did not respond well and this
    was compounded when his HIV test came back negative: “He threatened
    to tell my family and was abusive and violent towards me. He didn’t
    understand HIV, he thought it would go away like a cold and
    demanded we have sex. I felt dirty and ill and couldn’t bear the
    thought of anyone near me.” Her boyfriend regularly turned up at
    the airline office where she worked and shouted abuse at her. After
    two months she felt she had to leave before her family found out. 
    Salima believes she contracted the virus from the husband she
    married as a 26-year-old virgin. The marriage ended after a year
    because of his violence – he attacked her when she was pregnant and
    she lost their baby. Salima believes her ex-husband knew he was
    HIV-positive. After they separated he moved to Tanzania and she has
    had no contact with him.  In May 2001 Salima returned to the UK and
    claimed asylum after seeing a solicitor. When she told him she was
    HIV-positive he questioned her morals as a Muslim. She is still
    waiting for her asylum claim on human rights grounds to be
    assessed. Initially, Salima was afraid people in the street stared
    at her because they knew she had HIV. Accessing community support
    groups increased her confidence and last summer she co-founded
    Naz’s monsoon group to help other people from ethnic minorities. 
    Getting support from social services has been a long process for
    Salima, especially as she is now six months pregnant. The baby is
    the result of a relationship with an HIV-positive man Salima is no
    longer with. “Not only am I Muslim but I am single and a woman. It
    has been difficult to get anyone to listen to me or to help me.”
    She is worried about affording milk for her baby as she does not
    work and is not on benefits. “It is not a good enough excuse for
    social care professionals to be ‘over-worked’ and not respond.”

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