Barriers to uptake of HIV/AIDS testing services - Research Paper Example

WORD COUNT: 5529) Research paper Barriers to Uptake of HIV/AIDS Testing Services in Health and Non-Health Care Settings amongst Black Africans Abstract This study will be conducted to investigate some of the underlying factors that influence the late diagnosis of HIV/AIDS among the black Africans who live in the United Kingdom. The specific objectives of this study will include; exploring the prioritization of other activities at the expense of one’s health; lack of tradition of preventive medicine and stigmatization. Other areas include the knowledge on HIV test, cultural and social beliefs about HIV by the black Africans living in the U.K among other discussed factors Introduction and Rationale The late HIV infection diagnosis among the black Africans in the UK is a gap that needs to be corrected. The proposal aims at correcting the situation by suggesting various alternatives towards ensuring early HIV infection diagnosis among the Africans in UK. There is a need to access the various barriers that hinder. The research paper will also contain some research questions that the researcher will use in the field to come up with concrete findings in the study. The methodological chapter reviews some of the research techniques and designs that the researcher will use in addressing the qualitative and quantitative studies in developing the research. The section also gives the prelude on how data will be collected in the field as well as the sampling procedures that will be used in obtaining the desired population for the study. A detailed technique of raw data analysis and presentation is also indicated in the chapter. Search Strategy A literature search refers to an explicit and systematic approach to identifying, retrieving and managing bibliography of independent studies. The independent sources are obtained from published from sources, and the search aims at synthesizing conclusions, singling out future areas of research as well as locating information on particular topics. Today, a lot of technological advances are seen in the field of medicine as well as nursing. For instance, there are epidemics and new cases of diagnosis of some diseases worldwide. The current trends in the late diagnosis of HIV infection among the black Africans is a matter of concern in UK (Health Protection Agency, 2007). The issue poses a great concern to the government of UK to find out the primary cause of the late HIV infection diagnosis. Late HIV infection diagnosis among Africans in UK is a serious problem in the region. The problem of late HIV infection defines a situation where the CD4 cells count way below the minimum level of 350 cells/mm3 (Fenton, 2007, p.14). The late diagnosis hinders early access to antiretroviral treatment, increasing the chances of shortened life expectancy and severe illness in the population. The project focuses on the various factors that result in the problem of late HIV infection diagnosis among the Black Africans in UK. In analyzing the factors, the research cover areas of concern including immigration, childcare and employment, beliefs and stigmatization and other related areas of study. Inclusion and Exclusion criteria The search engine Google was used to carry out the extensive research. In order to obtain the precise information, the primary search terms used during the study included ‘Black African’, ‘UK’ and ‘HIV’. Various agencies were used including Sigma Research in an attempt to find more elaborate information and data in analyzing the problem. In order to obtain the precise information sources, the actual topic is identified for a detailed systematic search. For best evidence available, the research employed databases such as Cochrane. Apart from defining the central question, the database also highlights the relevant terms that direct the researcher to the required information or data. PICCO tool is used to establish the evidence for the information sources as shown in (Table 1) below Table 1: Adaption of the PICCO tool Research Question ‘Why are Black-Africans in the UK more likely to present to healthcare services with a late diagnosis of HIV?’ Patient/Population Moreover,/or Problem Intervention/Exposure Comparison (Not Applicable) Outcome Black-African United Kingdom HIV Late Diagnosis of HIV Barriers to healthcare Risk Awareness Alternative Words Africa Migrant Immigrant England Britain HIV-positive HIV infection AIDS Adults HIV testing HIV Services Opportunities Access to healthcare Knowledge/Attitudes Practices Healthcare professionals Healthcare services Utilization Key terms were combined and entered into the Google search engine in health related fields. Such combinations produced 1110 hits as shown in (Table 2). Table 2: Data Bases, Search Terms, and Results Databases Number of hits prior to exclusion criteria Number of Hits after exclusion criteria Cochrane 0 0 BNI via EBSCO 311 19 CINAHL 452 25 PubMed 105 5 Medline 242 10 Total 1110 59 At some intervals, the search was repeated using more specific terms depending on the topic of discussion. The aim of more concrete terms was to help identify the respective sources of information to the area of study. The relevant identified sources are further subjected to critical search so as to obtain the required and other articles for the research. Six items were identified as shown in (Appendix 1) and will be reviewed in the assignment later. Critique of the Literature Six studies (Forsyth et al., 2009); (Camden et al., 2010); (Chinouya et al. 2007); (Gordon, 2009); (Green, 2007); (Chinouya, 2006); (Burns et al., 2007) obtained through the above process will be critiqued. Other relevant information on the articles such as study aims, findings, evaluation, methods and full reference are found in Appendix 1. Certain tools such as CASP have been used in critiquing the above six articles. (Forsyth et al., 2009) carried out research to establish the association between immigration and the late HIV infection diagnosis among the black Africans in UK. Quantitative method analysis was employed so as to obtain descriptive data and conclude on any crucial link between immigration and the topic of concern. In the study, a high proportion of South East London residents was found to be African migrants. The participatory approach was also used to involve the black African sample selected in the study. The extensive research carried out by (Forsyth et al., 2009) revealed the face and content validity in the methods used. South East London in UK was one of the places with the highest HIV prevalence. Despite the fact that HIV infection cases among the black Africans was decreasing, late diagnosis risk remained high among the black Africans in the region. Most of the HIV infections were acquired from the home countries including Nigeria, Somali, and Ghana. However, the rate of transmission was high within the UK as well as through the cross-border sexual relationships. (Forsyth et al., 2009), adopted an adequate sampling size and method that gave reasonable results in the study. For instance, the samples used in the study were recruited uniformly from all areas of residence of the black Africans. Such recruitment prevented challenges that could arise such as that of generalization that always give a biased result. Migration was considered a critical factor in the high-risk sexual behavior among the Africans in UK. Migration was therefore considered a significant contribution in HIV infection. The mode of study was also supported by (Burns et al. 2007). Here the study identified the other aspect of immigration (heterogeneity) as a cause of the late diagnosis among the black Africans. The study employed quantitative descriptive methods in data collection. In addition, the qualitative method was used to analyze critically and interpret the information. The qualitative approach boosted on clarity and avoided bias information. The heterogeneity of a number of features among the black Africans was identified as a barrier to accessing the HIV test in the UK. Hence, the origin country proved to be a right proxy indicator or evidence of HIV risk than ethnicity. In both the UK and the home countries, the HIV risk critical transmission factors included migration history, country of origin and poverty. Other factors considered critical in the transmission of HIV were higher educational attainment and the female gender (Camden et al., 2010), also carried out a study aimed at establishing the significant influence of African beliefs in the late HIV infection diagnosis among the black Africans. The paper adopted a qualitative framework to explore the issue. HIV/AIDS was found to a manageable disease in UK contrary to the African case. In most African countries, citizens only had a few accesses to the services. Therefore, Africans had shorter survival and treatment times to HIV compared to UK. For a long time, black Africans in UK thought that HIV infection could not be manageable. Such belief has seen many Africans remain reluctant never to seek health care services in UK. As in the case of the home countries where HIV always proved harsh and deadly, black Africans in the UK, did not see the possibility of staying or living longer with the infection. The study stated the key issues deductively in order to suit the interactive and explanatory ambitions of researchers. For instance, the religious beliefs among the black Africans in UK might as well contribute to the late HIV diagnosis. The study showed that most African communities valued religious beliefs, for instance, the ideas pertaining to sexual relationships as well as having unprotected sex. While some religious beliefs supported unprotected sex, such feelings increased the chances of HIV transmission among the black Africans in UK. According to (Camden et al., 2010), out of 246 patients tested and diagnosed with HIV/AIDs during the period 2004-2006, almost 99% had strong religious beliefs. The study also used extensive and understandable explanations for the findings. This is an advantage as it allows natural synthesis of the information and data of the study. Simple explanations such as how the Black Africans perceived the use of condoms as lack of trust between the partners avoids the complications in the study. Majority practiced unprotected sex over time with the belief that it instilled trust in the relationship. Unfortunately, unprotected sex was a haven for new HIV infections among the Africans. However (Chinouya et al., 2007); stated that religious beliefs did not result in the late HIV diagnosis among the black Africans in UK. The study adopted qualitative and quantitative methods in data collection and analysis. The findings of the study identified the knowledge gap in (Camden et al., 2010). According to the study beliefs, had no close links with the late HIV diagnosis among the black Africans. There were no certainties in the link between late HIV diagnosis and religious beliefs. Today it is still not clear whether religious beliefs contribute in the high proportion of the late diagnosis. The existing factor is that most African communities value their religious beliefs regardless of the location country. Therefore, some studies suggested that it could be true that religious beliefs influenced HIV diagnosis among the Africans. The primary cause of the uncertainty was due to the very little undertaken UK-based research examining the effects of religious beliefs on antiretroviral therapy and HIV testing. According to (Camden et al., p. 49), the link between religious beliefs and the late HIV infection diagnosis among the black Africans in UK exists. The participatory research selected samples uniformly in the region and majority preferred to be identified with religion. 56 % identified themselves as Protestants while 35 % were Catholics. On the other side, Muslims had an identity of 6 % while only 1% did not belong to a religious group (Camden et al., p. 49). Only single individuals said that religion had no essential meaning attached to their lives. Moreover, some black Africans did not take the HIV test in the belief that they have God’s protection against the infection. According to this group who had faith in God, those who accepted the HIV test did not believe in God and that their faith was weak. To this group, taking the test and disclosing their status would result in isolation by their faith community. In studying and analyzing the impacts of stigmatization in HIV diagnosis, (Chinouya et al., 2007) adopted a more elaborate quantitative method analysis. The method was used to collect data throughout the region to ensure no black African community was left out. Again such uniform data collection promotes adequate research information. Many European Countries including UK showed overwhelming evidence of discrimination against those who are HIV positive. The discrimination was even more rampant among the Africans. Such discrimination together with stigma deterred people from disclosing their HIV status. Majority feared falling victims of discrimination in UK thus they rather remain silent on their status until some other times. The effects of HIV/AIDs-related stigma of the black African people infected with HIV/ AIDs is multi-faceted. Sigma research reported many instances or experiences of discrimination and racism among the black Africans living in UK. The study also revealed the stigmatizing attitudes from the health staff and the doctors especially in the black Africans communities. The fear of stigma causes the HIV positive individuals to refrain from informing his or her close associates with regards to his or her HIV status. Such fear due to stigma has seen many black Africans diagnosed with late HIV infection. Positive black Africans find it difficult, almost impossible the disclosure of their status especially in the close-knit communities. In such areas one always feels he or she has no control over who knows his or her HIV status. However, there are also some instances of forced labor where one stores the drugs at home and takes the antiretroviral drugs at fixed times. The fear of unintentional disclosure results to the isolation of black Africans from support networks that are very potential. Moreover, stigma within communities can also facilitate the worsening of economic challenges. Many African immigrants who had just arrived in UK from Africa had to move out from their relatives’ homes (Chinouya et al., 2007,p.59). The reason for such movement is either because the family is experiencing a precarious financial situation or the family suspects their guest of HIV infection, maybe because they found evidence of some ARVs. Risky sexual behaviors also have a close association with HIV infection diagnosis. (Gordon, 2009), adopts quantitative study method. Furthermore, the study employs simple stratified to synthesize the information. An extensive survey of the research promoted efficient data collection. The study showed that a big proportion of black Africans both in the UK and at home practiced risky sexual behaviors. The cultural practices among the Africans influenced the number of partners one should have. The religion and region of the African patients are also not left out. Africans both at home and in UK had maintained some of their cultural practices including wife inheritance and polygamy. Unfortunately, a study by the North London PADARE have found out that the HIV prevalence is high among the African women who once had more than two sexual partners (Health Protection Agency, 2007, p25). The study reveals that young black Africans frequently engage in casual relationships in UK. Such inculcated culture results in late HIV infection diagnosis. The majority maintain the culture throughout their entire stay in UK. In addition, there is high number of sexual contact between African partners of the same-sex. For instance, 5.8 % of African men living in UK have reported same-sex partners (Health Protection Agency, 2007, p.45). The outcome is that of increased homosexuals without the knowledge or caution on the likelihood of contracting HIV. Such Africans only realize the impact later when already the infection has evolved through many stages. Fear of HIV and its consequences was also identified as a factor that influenced the late HIV infection among the black Africans in UK. (Green, 2007), uses both quantitative and quantitative methods in the research. In analyzing the collected data, the methods further adopts a cross-sectional design to facilitate efficiency during the study. The fear of HIV and the related consequences among the Africans in UK is due to the home experiences. In most African countries, people perceive HIV infection to be very dangerous and deadly. Citizens from such countries do not access affordable treatment for the disease, and the majority has developed an attitude to avoid testing. Many perceive HIV testing to be rather useless. The argument is that eventually an HIV positive person dies whether tested or not. Such perceptions are not wise as the condition is now manageable in countries such as UK. It is due to such attitudes and perceptions that prevent Africans from going for early HIV tests in UK only to be diagnosed later with HIV infection. Research by (Chinouya et al., 2007), showed that the inadequate targeted health promotion perpetuates fear among Africans. Notably, many Africans living in UK often reli on the word of mouth and informal networks for information, especially on HIV infection. The fear of discrimination for disclosure of positive HIV results further deters the Africans from accessing the early testing. The problem of discrimination is much greater amongst the Africans in London compared to the non-black UK residents. The primary concern is that disclosing positive HIV status results in one risking his or her social status. Gender is the other issue identified behind the late HIV infection among the black Africans. A study by (Chinouya, 2006) uses appropriate methods to address the issue of gender among the black Africans in UK. Focusing on the African men for HIV test has been difficult, and the same men prove difficult to reach in the UK. Indeed, the need for efforts in reaching the black African men in the communities in UK and put the men in the prevention picture is widely documented. Statistics in UK demonstrate that more African men are still not aware of their positive status compared to women (Chinouya, 2006, p.67). The antenatal testing contributes a lot to the HIV testing among the black African women while the male counterparts are left out. This is the reason for the difference level in the HIV status awareness among the black men and the black women in UK. The African men are difficult to contact since they hardly reach health services in UK. The low perceptions of attitudes and risks towards HIV also make it difficult to reach the black African men. In addition, most men perceive the gatherings of HIV prevention as primarily directed at women’s needs, relationships, children, and contraception. While such gatherings are as well intended for men, majority act foolishly and end up refusing to go for early HIV test in UK. Themes Immigration Personal choice and migration history and culture drove the complex sexual behaviors. Such practices resulted in same-sex HIV transmission as well as heterosexual. The HIV transmission risk among the immigrants was even made worse by the low condom usage and inadequate sexual knowledge and information as well as the little awareness of HIV. Beliefs Beliefs and attitudes promoted the gradual spread of HIV among the Africans in UK. However, the majority failed to realize that the cultural practices and beliefs increased HIV prevalence amongst them. Research shows that many of the Africans only came to understand of their status after serious stages of the infections (Health Protection Agency, 2007, p25). Again a high percentage later linked the HIV infection to some of their cultural practices and beliefs. Stigmatization Fear of stigma may make an individual to hide health information or status to people such as friends, children and community as a whole. Many black Africans in UK, therefore, suppress their needs for emotional support and social needs. In general, the victims are not open to visiting the public medical treatments for the fear of being stigmatized. In the broader community, stigma is usually compounded with by the stigma arising from the family and more immediate social networks (Gordon, 2009, p. 197). Notably, many black Africans in UK feel they are not able to access the social and community support groups since they are unwilling to disclose their HIV status. Risky sexual behavior The fear comes about due to HIV transmission with inappropriate and ‘promiscuity’ sexual behavior. Moreover, many Africans fear being viewed by others as threats of new infections. Studies have shown that the male Africans in UK prioritize fear for criminalization when it comes to HIV testing. On the other side, women reported fear in domestic violence while responding to the fear of disclosing their HIV status. Fear of HIV/AIDS and its consequences Patients of HIVAIDS in UK face much discrimination especially the black Africans. Notably, the discrimination also impedes many Africans from accessing social care, health care as well as applying for work. The effect of such discrimination and stigma is that of social exclusion of the HIV positive people. Gender Black African men consider HIV to be a problem that is only associated with the women and men. Therefore, men only seek the HIV testing once their partners are tested positive. Men believe that they should always remain strong and healthy as the head of the family. Therefore, early diagnosis of HIV infection undermines their status in both the family and community. Objectives To explore the prioritization of other activities at the expense of one’s health To find out if there was lack of traditional preventive medicine and stigmatization. To test the knowledge of black Africans on HIV early diagnosis. To investigate the cultural and social beliefs about HIV by the black Africans living in the U.K. Research questions The study will attempt to obtain answers to questions like; whether the black Africans had other priorities other than their health; whether they were aware of HIV test and their social beliefs about having HIV. Other relevant questions include: their emotional impacts on positive diagnosis of HIV; their perception at the right stage to use the conventional medicine; whether these population were aware of the benefits of HIV testing among others included in the questionnaires. From the research questions the researcher will test the hypothesis by determining whether there could be an association between late HIV diagnosis with the HIV prevalence among the Africans in the U.K. the researcher will also test for the absence of relationship between the late HIV diagnosis and HIV infections among the Africans in the U.K. Methodology The study will apply both the quantitative and the qualitative approaches in analyzing the data. The quantitative approach will employ the use of stratified sampling technique to determine the proportionate sample of the size used in population estimation from the hospitals where data will be obtained (Pope, 2009, p.115). Convenience sampling method will further be used in getting the number of the black Africans who visits heath facilities for HIV testing. Since the variable that the researcher has interest in, which is the due uptake of HIV test by the Africans is not evenly distributed in the population, the use of convenient sampling technique will allow the available clients to take part in the research study as they will be enrolled in the HIV testing program (Lacey, 2006, p.97). Quantitative approaches are based on theories and fictions that have to be further tested to ascertain their reliability and validity (Pope, 2009, p.173). In the qualitative approach, the research will pick the study samples through simple random selection from the HIV testing registers to take part in the focused group discussions. This will be after strategically identifying two large clinics in the U.K concerned with the voluntary counseling and testing services for focused group discussions. For the purpose of in-depth interviews, all the heads of voluntary counseling and testing from the two large identified clinics will be used. This helps in providing a high degree of control over the direction and nature of the discussion as well as aiding in the dissemination of more valuable information to the respondents (Krueger, 2009, p.53). Sampling strategy Research design To come up with the desirable population which will be required for the study, the research will employ qualitative and quantitative research design where a descriptive, cross-sectional and analytical study designs will be adopted for sampling owing to the fact that it provides the magnitude of the data based on morbidity and mortality and adding to the fact that it is time saving and provides clues to disease etiology, helps the researcher to generate hypothesis which can be further tested using analytical studies to give data for planning, organizing as well as evaluating preventive and curative services (Pope, 2009, p.114).This will contribute to the research in terms of occurrence of a disease by the person; place and time of disease occurrence.It will, therefore, provide the researcher with extensive, elaborate and realistic information from the actual respondents as well as presented both qualitative and quantitative data (Pope, 2009, p.116). Target population The study will target all the black African population who lives in the United Kingdom. All the individuals who have lived in the U.K for more than one month and visit the voluntary counseling and testing centers will be included in the study area. The exclusion criteria will include all the black Africans who will not have lived in the U.K for more than one month and also those Africans who will not consent to take part in the study. Sample SizeDetermination The desired sample size for the study will be calculated using the Fishers’ formula (Environmental Health, 2006, p.37). d2 N-desired minimal sample population Z- standard reasonable deviation that is 1.96 at 95 % confidence level P-proportion of the target population estimated to have a particular characteristic being measured. d- Level of statistical significance Q= 1-P. P= 52196/156416 Q= 1-0.3 0.3 0.7 Z= 1.96 D = 0.05 =323 As determined below, a total of 323participants will be enrolled in the quantitative category of this study. The sample size will be calculated as 323.This formula will be adopted since it had been used in other previous assessments dealing with similar studies. Pilot Study A pilot study involving 32 participants (10% of the total sample size) will be carried out in one clinic not sampled for the main study within the region of study.The results of the pilot study will be used to review the questionnaire and corrections will be made before data collection. Validity Validity refers to the meaningfulness of inferences and accuracy that are based on the research results.To check on content validity, any blank spaces, inaccurate responses or lack of clarity and items found to elicit this kind of reactions from the pilot study will be modified or removed altogether after piloting (Gibb et at., 2007, p. 112).In order to ensure that the measure covers a broad range of areas within the concept under study, items will be sampled from all of the domains. In addition, the areas will be completed with the help of the supervisors as a panel of experts who will make sure the content area is adequately sampled. Reliability Reliability referred to as a measure of the degree to which a research instrument yields consistent and accurate results or data after repeated trial. To establish the reliability of the instrument, the researcher will use Test-Retest Method (Dougan et al. 2007, p.234)). A similar test will be given to a group of subjects on two separate occasions during pre-testing at one clinic with similar characteristics as the target population. The test aims at assisting in establishing the coefficient for this type of reliability.In order to test reliability, the responses that will be given by each respondent on the first administration will be compared to those given by the same respondent in the second administration. In a Test-Re-test method, it is maintained that the response to the same question by one respondent should be similar in both first and second administration (high positive correlation). The researcher with the help of the supervisor will critically assess the consistency of the responses on the pilot questionnaires and make a judgment on their reliability. Study items which will elicit inconsistent responses (small negative correlation) in the two administrations will be deemed unreliable and will be re-modified to make them more reliable while those that will exhibit high negative correlation will be omitted from the final questionnaire(Lacey, 2006, p.101). Data collection tools, apparatus, and materials The study will use mixed methods in data collection that is, the use of questionnaire tools will be supplemented with the use of focused grouped discussions and interviews to offer enriched data, more generalized and valid data (Lacey, 2006, p.152). Questionnaire Questionnaires that will have both closed and open-ended questions will be used to obtain data from the sampled 323 black Africans representing the entire population. The questionnaire will cover aspects of factors influencing the duly diagnosis of HIV among the Africans living in the United Kingdom leading to probable high prevalence HIV rate and information pertaining to the objectives that this study will focus on. Questionnaires would be preferred in data collection because it is easier to administer to a good number of respondents who respond in private settings (Chinouya, 2007, p.108).A questionnaire is a way of getting data about persons by asking them rather than watching them behaves. These questionnaires will contain detailed queries and will provide multiple answers option in order to cover all the aspects relevant to the study. Key informant interviews A key source is one who is at a reliable position to know the ideal reflection of the data which the researcher is interested in a particular area (Fenton, 2007, p. 23)). The informant is presumed to be in a position of expressing the emotions, feelings and the opinions of the group of individuals under study and their perspectives on the topic under study. In this study, key informants would be the voluntary counseling and testing specialists, nurses and the disease surveillance coordinators in the selected clinics.The researcher will ask them questions in relation to the stage at which the population under study always go for HIV testing and at the same time when specifically during the prognosis of the disease when the usually diagnose HIV among this population under study. Focus Group Discussion Focus group discussion is a group interview or discussion (Fenton, 2oo8, p. 37)). It consists of a small group of individuals, usually numbering between 6-10 people, which meet to air their opinions on a particular topic defined by the researcher. The facilitator or moderator leads the group and guides the discussion between the participants. A high- level moderation will be adopted. This moderation type will assume a high degree of control over the direction and nature of the discussion. Questions will be asked in an orderly, and there will be little opportunity for the respondents to deviate from the topic of discussions. It will be tape- recorded for the purpose of transcription. It will be used to examine people’s knowledge about a subject as well as test topics and the phrasing of questionnaires (Krueger, 2009, p.52). Its content is also broader though data from FGD lacks the depth of information that could be obtained from individuals. Three groups of FGD consisting of 20 respondents from different regions will be used. In this study, the FGDs will provide information to complement information from the questionnaires about the Africans’ level of knowledge. Data collection procedure A research permit will be sought from the institution of affiliation before embarking on the study. In order to administer the questionnaire efficiently, a personal visit to all the selected voluntary counseling and testing centers will be made. The researcher will avail an introduction letter to the respondent and then explain the purpose of the research; the researcher will also clarify the issues that would be arising from the questionnaires. The questionnaires will then be left with the respondents to have enough time for filling them. After one week, the researcher will go back and collect the filled questionnaire. Data Analysis Data analysis will be done using the statistical package for social sciences (SPSS) (Fotsyth et al., 2009, p. 68)). Descriptive summary statistics such as frequencies, mean, median and standard deviation will be used to describe the characteristics of these black African population e.g. sex, age, etc. The guiding principle in data interpretation will be done on charts, tables and graphs and will be based on the theoretical framework for the study. The primary data will be integrated with secondary data in order to derive conclusions from collated and triangulated information. Ethical and Cultural Considerations The authority to carry out the research will be given from the institution of affiliation where an introductory letter will be obtained and presented to responsible persons, Medical Officer of Health/medical superintendent of the sampled clinics. Informed consent will be sought from the study participants who will be strictly the black Africans. The assent of the target population who will be under 18years will be obtained from their parents to be including them in the study. Confidentiality will be maintained throughout the study. Respondents will not receive any incentives to participate in this study, and no participant will be forced to answer questions they will not wish to answer. Conclusion From research that ought to be conducted, the researcher will systematically apply the various methods as discussed in the methodology to address some of the factors illustrated in the literature review which may be responsible for the disparities identified. The findings that will be realized from the study will be further used in data analysis for the purpose of future planning as well as aiding in other evaluation of different programs. APPENDIX I: QUESTIONNAIRE Questionnaire for Study of factors influencing late diagnosis of HIV/AIDS among the black Africans in the U.K Request for participation I hereby ask you to participate in this survey of the assessment of factors influencing late diagnosis of HIV/AIDS among the black Africans in the U.KThis survey aims at generating information which will be used by the healthcare stakeholders to manage and reduce the prevalence of HIV to ensure longer healthier life for the general population and the society in general. You were randomly chosen from among many African communities, and everything that you tell us will be kept confidential. Your participation is voluntary. Instructions Please feel free to share to share this information in a sincere and a realistic way. We ascertain you that this information will be treated confidentially. Mark the box corresponding to your response in the bracket provided. Socio-demographic data How old are you? 15-20 [ ] 21-25 [ ] 26-30 [ ] Sex Male [ ] female [ ] Marital status Married [ ] Separated [ ] Single [ ] Divorced [ ] Widowed [ ] Religion Christian [ ] Muslim [ ] Hindu [ ] others (specify) …………… Level of education None [ ] Primary [ ] Secondary [ ] Tertiary [ ] Others (Specify)………………. Occupation Formally employed [ ] Self-employed [ ] Unemployed [ ] Influence of cultural and religious beliefs on HIV prevalence Does your culture allow the utilization of health services like testing when one is ill? Yes [ ] No [ ] Do your culture and society stigmatize the people living with HIV? Yes [ ] No [ ] Does your religion believe that having HIV/AIDS could lead to one’s deportation from the U.K? Yes [ ] No [ ] Knowledge level of HIV prevalence Have you ever heard of HIV test? Yes [ ] No [ ] Where did you first get information on HIV/AIDS testing? School [ ] Health facility [ ] Worship place [ ] At home [ ] on the media [ ] Health campaigns [ ] others (specify) …………………………… Do you think HIV can be prevented? Yes [ ] No [ ] If the answer above is yes, highlight the methods you know which can help prevent HIV? ………………………………………………………………………….. ……………………………………………………………………………….. What is the distance from the VCT Centre to your home? 0.5km [ ] 1 km [ ] 2 km [ ] more than 2 Km [ ] How much do you think VCT costs? Free [ ] More than 1000 shillings [ ] others (specify)………….. If you realize you are HIV-positive today from the test result, how would you take it? Stressed [ ] Normally [ ] Others (specify)………………. Is there a possibility of cross HIV transmission? Yes [ ] No [ ] If the answer above is yes, state HIV modes of transmission ……………………………………………………………………… ……………………………………………………………………… Influence of health care providers on HIV prevalence Do health facilities in your area offer confidential results of voluntary counseling and testing? Yes [ ] No [ ] don’t know [ ] Have you ever received any HIV/AIDS education from the health care provider? Yes [ ] No [ ] When you went for voluntary counseling and testing, how did the health worker handle you? Very well [ ] Well [ ] Poor [ ] Very poorly [ ] How long did counseling and testing take you to receive the results? Immediately [ ] between 1-2 hours [ ] 1 day [ ] others (specify) Did you like the quality of care you received in the hospital or the VCT Centre? Yes [ ] No [ ] When you went to VCT services, were you given information about HIV and prevention? Yes [ ] No [ ] Highlight information given……………………………… Bibliography Arendt, G. &Giesen, H-J.(2011). HIV-active female migrants in Northrhine-Westphalia - relevant but unfocused problem?European An Update: November (2009). London: Health Protection Agency, Centre for Infections Bhatt, C. (2009). Positive Responses: A Local HIV Action Strategy for African Communities. London, Enfield, and Haringey. Bhatt, C., Phellas, C. &Pozniak, A. (2007).National African HIV Prevention Projects: Evaluation Report. London, Enfield and Haringey Health. Bibliography Blair, T. (2007).London Health Promotion Work and African Communities Affected by HIV Strategic Development Day. London, Brown, P. (2009). The rate of HIV transmission among Africans in UK ‘underestimated’ British Medical Journal 320 (7237), 735. Burns, F. (2007) Study of newly diagnosed HIV infection amongst Africans in London (SOPHIA). 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(2006).The decline in mortality among Children with HIV in UK. British Medical Journal 328: 524. Gibb et al. (2007). Factors affecting uptake of antenatal HIV testing in London: results of a multi-centre study. British Medical Journal316: 259-261. Gordon, B., Hudson, M., Mansour, J. (2009).Getting Message Out Centre for Health Education. Green, G., Smith, R., (2007).The health care and psychological needs of HIV-positive people. United Kingdom: HAART Guiard-Schmid, J-B.et al. (2004).Prospective cohort study to compare HIV care for French and foreign patients treated in France. Hamers, F.F., Downs, A.M., (2006).Changing the face of HIV epidemic in Europe.New York Haour-Knipe, M, (2009) Migration and HIV/AIDS in Europe. AIDS Infotheque 4-14. Health First: Chinouya, M., Ssanyu-Sseruma, W., Kwok, A, (2012). The SHIBAH Report. Health Protection Agency,(2007). Focus on Prevention HUNTER, S. S, (2006).AIDS in America. New York, Palgrave Macmillan. Ibrahim F, Anderson J, Bukutu C, Elford J, (2008).Social and economic hardship among people living with HIV in London. HIV Med Oct; 9 (8):616-24. Ikambere (2007).Rapport 2007. Paris. MacLeish, J. (2008). Mothers in Exile.London Moreover, ethnic minority ethnic men who have sex with men in England and Wales. Sexually Transmitted Infections 81: 345-350. NSHPC. MRC Centre of Epidemiology for Child health, UCL Institute of Child Health London. Available at: www.ucl.ac.uk/NH PC ROBERTSON, G. L, (2006). Not in the family: AIDS in African-American communities Chicago, Agate. The era of highly active antiretroviral therapy. AIDS 15(18): 2453-5. Tookey P, (2013).Obstetric and pediatric HIV surveillance data from the UK and Ireland. APPENDIX I Questionnaire for Study of factors influencing late diagnosis of HIV/AIDS among the black Africans in the U.K Request for participation I hereby ask you to participate in this survey of the assessment of factors influencing late diagnosis of HIV/AIDS among the black Africans in the U.KThis survey aims at generating information which will be used by the healthcare stakeholders to manage and reduce the prevalence of HIV to ensure longer healthier life for the general population and the society in general. You were randomly chosen from among many African communities, and everything that you tell us will be kept confidential. Your participation is voluntary. Instructions Please feel free to share to share this information in a sincere and a realistic way. We ascertain you that this information will be treated confidentially. Mark the box corresponding to your response in the bracket provided. Socio-demographic data How old are you? 15-20 [ ] 21-25 [ ] 26-30 [ ] Sex Male [ ] female [ ] Marital status Married [ ] Separated [ ] Single [ ] Divorced [ ] Widowed [ ] Religion Christian [ ] Muslim [ ] Hindu [ ] others (specify) …………… Level of education None [ ] Primary [ ] Secondary [ ] Tertiary [ ] Others (Specify)………………. Occupation Formally employed [ ] Self-employed [ ] Unemployed [ ] Influence of cultural and religious beliefs on HIV prevalence Does your culture allow the utilization of health services like testing when one is ill? Yes [ ] No [ ] Do your culture and society stigmatize the people living with HIV? Yes [ ] No [ ] Does your religion believe that having HIV/AIDS could lead to one’s deportation from the U.K? Yes [ ] No [ ] Knowledge level of HIV prevalence Have you ever heard of HIV test? Yes [ ] No [ ] Where did you get information on HIV/AIDS first? School [ ] Health facility [ ] Worship place [ ] At home [ ] on the media [ ] Health campaigns [ ] others (specify) …………………………… Do you think HIV can be prevented? Yes [ ] No [ ] If the answer above is yes, highlight the methods you know which can help prevent HIV? ………………………………………………………………………….. ……………………………………………………………………………….. What is the distance from a public VCT Centre to your home? 0.5km [ ] 1 km [ ] 2 km [ ] more than 2 Km [ ] How much do you think VCT costs? Free [ ] More than 1000 shillings [ ] others (specify)………….. If you realize you are HIV-positive today from the test result, how would you take it? Stressed [ ] Normally [ ] Others (specify)………………. Is there a possibility of horizontal HIV transmission? Yes [ ] No [ ] If the answer above is yes, state HIV modes of transmission ……………………………………………………………………… ……………………………………………………………………… Influence of health care providers on HIV prevalence Do health facilities in your area offer confidential results of voluntary counseling and testing? Yes [ ] No [ ] don’t know [ ] Have you ever received any HIV/AIDS education from the health care provider? Yes [ ] No [ ] When you went for voluntary counseling and testing, how did the health worker handle you? Very well [ ] Well [ ] Poor [ ] Very poorly [ ] How long did counseling and testing take you to receive the results? Immediately [ ] between 1-2 hours [ ] 1 day [ ] others (specify) Did you like the quality of care you received in the hospital or the VCT Centre? Yes [ ] No [ ] When you went to VCT services, were you given information about HIV and prevention? Yes [ ] No [ ] Highlight information given………………………………………………………… May 2015 June 2015 July-Sep 2015 October 2015 Nov-Dec 2015 Ethical approval to conduct the research Sampling the population for the study Collection of data Analysis of data Report writing and draft submission Appendix 3 Appendix 2 Title Author/s Aims Methods Findings Evaluation Immigration Forsyth, S., Burns, F., French, P To get a rough estimation of the African immigrants distribution and their HIV prevalence rate Simple stratified study Fair number of Africans distributed in the U.K and are accessing early test Consistency noted in research procedure – sample size might have affected the generalizability of the findings Beliefs Camden, Islington Health Authority, to diagnose the differential views and cultural factors linked to late HIV diagnosis among the black Africans Convenience surveys -in-depth interviews Low number accessing early diagnosis due to the cultural views Rigor prominent through research process – tough to generalize to wider African population Stigmatization Chinouya, M Gordon, B., Hudson, M., Mansour, J., To ascertain if there are some underlying segregations based on ones’ status of HIV Simple random sampling High early diagnosis because there were no cases of stigmatization There was no consistency in the research study Risky sexual behaviors Gordon, B., Hudson, M., Mansour, J -to estimate the risk of sexual behavior as well as sexual health services used. -cross-sectional survey Several cases fear early test due to their unhealthy sexual behaviors No identified reflexivity on the researchers’ part. It was appropriate to apply frameworks Fear of HIV/AIDS consequences among the Africans Green, G., Smith, R To find out if some emotional factors kept the black Africans from knowing their HIV status earlier -A cross-sectional study design No credible figures obtained in relation to fears Rigor noted through the research procedure. It was hard to generalize to wider African population Gender Chinouya, M., Musoro, L.& O’Keefe, E To explore the existing stereotypes in the society based on gender that could lead to health disparity. Qualitative study Diminishing rate of discrimination based on gender Lack of rigor was found in this study Study of factors influencing late diagnosis of HIV/AIDS among the black Africans in the U.K Institution Research paper Name Date Tutor Course Read More