A new approach to improving sexual and reproductive health outcomes for African, Caribbean and other multi-ethnic communities in South London

In this month’s eFeature, Love Sex Life Partnership service manager, Ineala Theophilus, describes how the Partnership is driving a new approach which is responsive to barriers that impact the sexual and reproductive health of their local communities and which seeks to create more culturally sensitive sexual and reproductive health systems and services.

The Love Sex Life Partnership is a new service aimed at Black African and Caribbean communities in Lambeth, Southwark and Lewisham (LSL). We were commissioned in response to some of the largest sexual and reproductive health inequalities in England, including high rates of HIV, STIs, emergency contraception use and termination of pregnancy. The three boroughs all have young and diverse populations, but a number of the inequalities in sexual health disproportionately impact Black African and Caribbean people. For example, while new HIV diagnosis rates are falling across LSL, the rate of diagnosis among women of Black African heritage remains disproportionately high.

Specific sexual and reproductive health (SRH) challenges facing our community include a low uptake and knowledge of contraceptive options, reflected in high rates of user dependent methods such as the contraceptive pill and condoms, and lower use of Long-acting Reversible Contraception (LARC) in older Black African and Caribbean women of reproductive age. This is linked with higher use of emergency contraception

To better understand these inequalities and challenges, we take the view that we must look beyond sexual health, calling out injustices and racism in our health systems. A research report published by Love Sex Life last November - Transforming sexual and reproductive health for BAME communities in Lambeth, Southwark and Lewisham - outlines findings from an online survey and consultations undertaken with the local community, service users, providers and other key stakeholders. Our research reinforces how socio-economic factors can exacerbate health inequalities, and how factors such as culture, religion, housing and immigration can all affect attitudes to sexual health and access to SRH care.

 

Creating culturally sensitive SRH systems and services*

We know from our research that lack of cultural sensitivity and related stigma deters 45% of respondents from seeking SRH support. SRH providers also had concerns about the availability of appropriate, culturally specific provisions, indicating a desire to better support their patients and remove any possible barriers to access. So how do we create a more culturally sensitive patient experience? As a service, one of our core priorities is to train and upskill SRH clinicians and health workers to open up discussions on difficult topics using culturally appropriate training tools in order for them to best support Black and ethnic minority service users. Another recommendation from our research was the availability of translated key resources that can be accessed in waiting rooms and in all local settings, such as markets, supermarkets and hairdressers. Ensuring that accurate and standardised messages are available in languages spoken by our local communities was linked in our research to reducing misinformation and an over-reliance on informal sources of information.

 

Culturally sensitive campaigns, community champions and influencers

Our priority is responding to the needs of Black communities using a culturally specific approach. This is led within the  partnership by BAME sexual health charity NAZ and community inclusion charity Blueprint for All, both of whom have decades of experience and strong ties to Black and ethnic minority communities across South East London. In response to the key themes that emerged from our research, we have developed a communications strategy that produces monthly culturally sensitive campaigns on a variety of SRH topics. These will continue to be shared via a community distribution plan using social media, local media outlets and via local support services to educate our community with the right information and signpost to services.

 Working closely with faith leaders and other local influencers was a key recommendation from our research, which found that collaborations with trusted local influencers and peer support networks have been effective interventions with some multi-ethnic communities. Training and working with volunteer community champions, who cascade positive and appropriate sexual health messages to their communities is a key part of this. Finally, we will be mobilising our community by collaborating with local BAME groups and activating relevant stakeholders to create a network of organisations that are ready to support our communities.

 

Need for bold and targeted HIV health promotion

As a sector, we recognise that it’s time to be bolder and more targeted in our HIV health promotion efforts to reduce existing inequalities, by highlighting the advancement and availability of medicines including pre-exposure prophylaxis (PrEP). In Lambeth, Southwark and Lewisham, there are an estimated 1,000 people living with HIV who are unaware of their status, with the highest levels of late diagnosis among women of Black African ethnicity in their 50s and 60s. Our research found that almost 50% of respondents felt that people from their community are scared to get an HIV test, reinforcing the fact that stigma is directly related to people not getting tested out of fear of a positive result.

To de-stigmatise HIV and inform local communities, our HIV communications have piggybacked on messaging around #NormalisingHIV. Normalising the conversation and bringing it into community spaces may require a multi-pronged approach of media and communications, as well as community outreach. As one panellist said in a recent Love Sex Life panel, Normalising HIV testing, treatment and prevention in BAME communities: “Ultimately, we need a cultural revolution about the way we talk about sexual health. We're missing out on key moments to really give that HIV education.”

Although there are real challenges, there are also some exciting opportunities ahead. The Love Sex Life Partnership will continue to work with all members of the local Lambeth, Southwark and Lewisham community to tackle stigma and taboos which prevent people from seeking support, and to advocate for safe, accessible and culturally sensitive services. We want a future where equity in sexual and reproductive health is realised for all members of the LSL community and for Black and ethnic minority communities more widely, and for them to be empowered to engage and proactively access services that meet their needs and are right for them.

* Culturally sensitive healthcare has been defined as reflecting the “the ability to be appropriately responsive to the attitudes, feelings, or circumstances of groups of people that share a common and distinctive racial, national, religious, linguistic, or cultural heritage"

For further information:

Transforming sexual and reproductive health for BAME communities in Lambeth, Southwark and Lewisham, Love Sex Life LSL Partnership, Nov 2020

Love Sex Life website

 

Published in the March 2021 edition of the Sexual Health, Reproductive Health and HIV Policy eBulletin. The content of all eFeatures represents the views and opinions of the authors. FSRH and coalition partners do not necessarily share or endorse the views expressed within them.