There's Been a Huge Surge of HIV Cases in the UK's Hispanic Community
What's to blame? Attitudes brought over from Latin America, or the UK's healthcare system? Or a little bit of both?
On the other end of the phone, Pablo is exceptionally polite. He speaks softly and enthusiastically, his English lilting in a Colombian accent. "I'm so lucky," he says, happily. "Life has treated me like a king."
Pablo is one of an estimated 110,000 people living with HIV in the UK. Arriving from his native Colombia in September of 2000, he expected to study English for six months and head off in search of something new. Then he got sick. "My whole life was suddenly in limbo," he recalls. "I felt incredibly lonely."
Nonetheless, his timing was fortunate. By the late 1990s, antiretroviral drug treatment had HIV on the backfoot and survival rates had spiked dramatically. With support from sexual health charity Naz Latina, Pablo was able to adapt and accept his new condition. His story is one that thousands of Latin Americans living in London can still relate to.
Recent research has found a worryingly high rate of HIV within the diaspora. While 59 South Americans in the UK were diagnosed with the virus in 2005, the figure hit 136 in 2009, a 130 percent rise. Unreleased data from 2014 by Public Health England also shows the rate of new STI diagnoses in Londoners born in Latin America was 2.3 times that of the average in the city. The vast majority of cases were among gay men or "MSM" (a term for men who have sex with other men, regardless of how they identify themselves). A 2013 report for London provides further backing, suggesting that 1 in 8 diagnoses of HIV among MSM in 2011 were in men born in Latin America.
To understand why the HIV rate has peaked in this community – and what needs to happen to combat it – we have to understand two distinct stories: a migrant's journey from South America to the UK, and the failure of the UK's public services to take responsibility for these people.
In part, the recent spike in HIV is a reflection of the Latin American population's growth in London; it's quadrupled since 2001, with estimates from 2008 putting the figure at 113,500, nearly as large as London's Polish presence. However, the emergence of this new community and its needs have been overlooked by both London's councils and health services until remarkably recently.
"Since the economic crisis started in 2008, many Latin Americans have come to London from Spain, Portugal and Italy to find work," explains Lucila Granada, Advocacy and Campaigns Co-ordinator for the Coalition of Latin Americans in the UK (CLAUK). "These are Latin Americans in the second phase of their migration. Many have secured EU citizenship in a different country, but when job cuts start they are still the most vulnerable."
That same level of vulnerability holds true when it comes to their health. The rise of HIV infection among London's Latin Americans is intrinsically linked to a lack of healthcare access. For a patchwork of reasons, a large number of Latinos in the capital simply aren't using NHS services. A 2011 survey identified that one in five had never been to a GP, and the consensus within CLAUK is that healthcare access is worryingly low.
Within some areas of the Latin American community, combatting HIV means addressing a complicated tangle of taboos and ignorance. But the inertia of the UK's response to newly arrived communities is also a key stumbling block.
"There has been a failure by the authorities to recognise a substantial new community, and to cater to them," argues Carlos Corredor, Project Co-ordinator for sexual health charity Naz Latina. "One of the big problems is the language barrier; most of the information about HIV and AIDS is in English, and many new arrivals don't speak it."
This lack of information, coupled with a poor understanding of NHS support, means a large proportion of the community simply don't engage with the health services. Instead, many first generation arrivals fall back on the support available within their own networks.
"In many cases, community organisations are the ones who end up taking responsibility for public services work," confirms Lucila. "Groups like CLAUK are catering to an invisible community in the context of an anti-immigration agenda."
For most migrants, staying in touch with the original identity of your homeland is hugely important. The South American diaspora in the UK is no different, and churches and community groups often play a critical role in helping new arrivals adjust while still honouring deep-rooted cultural values and traditions.
As Carlos explains, these networks are vital sources of support. However, the powerful influence of a traditional identity can clash with newfound freedoms. To avoid conflict, a culture of silence and secrecy blooms, especially when it comes to sex. According to CLAUK's research, homophobic attitudes – in tandem with the idea that sexuality is taboo and shouldn't be discussed – stifles open conversation among some groups of new arrivals.
It's a lucid example of how painful and complicated adapting to a new culture can be. On the one hand, gay men from Latin America may find they're able to express themselves with a freedom unrealised back home; on the other, they may have to hide in plain sight from the friends and family they arrived with.
It's a paradox Pablo understands only too well. "In many ways it was really good for me that I was diagnosed in London and not Colombia," he says. "But old stigmas die hard. I had come to live with a friend, and telling my housemates I had HIV was very difficult.
"My family back home still have no idea about it. I know some cases where people have told their families and it's caused problems. People still struggle to accept it."
Dr Justin Varney, National Lead for Adult Health and Wellbeing at Public Health England, rejects the idea that Britain's healthcare services have been too slow to react to this problem. "It's hugely variable across the country," he argues. "In areas where there's a large population of Latin Americans the local authorities and health services have done a lot of work."
Dr Varney explains that the Office for National Statistics (ONS) is responsible for ethnic categorisation based on its surveys and analysis. Once a new ethnic grouping is established, Public Health England can develop healthcare guidance. It's then up to councils to recognise new ethnic groups and support them at a local level.
As the ONS categories are based on the national picture the data shows, it's perhaps no surprise the Latino community hasn't been categorised; too many are irregularly documented (19 percent) and off the radar.
However, the question of where responsibility lies cannot be ducked. "Unless the government recognises there are people who don't have access to these services, things won't get better for them," Lucila argues. "But if you're not in the statistics no one cares; it's no one's responsibility."
Meanwhile, there seems to be a major disconnect between local authorities and the NHS. For example, despite large Latin American communities in Lambeth and Southwark being acknowledged by the councils, the health services still aren't carrying out ethnic monitoring of the group in these areas.
"Could more be done? Yes, quite possibly. That's true for a range of emerging communities," admits Dr Varney. "If you fall into the 'other' category in the statistics, that's a catch-all. It becomes hard to get the specific information you need."
The fallout from not being recognised is clearly a lack of engagement to address sexual health risks – a key reason why HIV rates have spiked among this group. Mind you, things are changing for the better – slowly. Four London councils have so far recognised the Latin American community living in their boroughs; Southwark in 2012, Lambeth in 2013 and Hackney and Islington in 2014.
Public Health England and Naz Latina have also been partnering to pilot new workshops in support of those affected by HIV in minority communities. It's part of the broader work Naz carries out against the background of public sector cuts and sweeping changes within the NHS.
According to Pablo, these changes have been felt directly by those living with HIV, many of whom have noticed a dramatic drop-off in the quality of healthcare they're receiving.
From the top-down sluggishness of the authorities, you can follow a twisted path all the way to the human impact of new HIV diagnoses. And between bureaucratic labyrinths of data, the vagaries of political responsibility and the government's retreat from the public sector, we come back to the crux of countless migrant stories; the battle for a better life in an unfamiliar new world.
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