By Juliette Chantitch

HIV testing and medication have grandly improved over the past few years. In the 1990s the treatment was very limited, so people were dying at quite a significant scale.

When Aids Care Education and Training Ireland (Acet) was created in 1992, its goal was to provide support to those with the virus and their families.

Today’s treatments, however, can allow people with HIV to live a normal life, which has redefined Acet’s role. Their new mission is to spread and explain the message that U=U — meaning that if the virus is undetectable, then it is unstransmittable.

In 2016, Ireland could count over 500 new HIV diagnoses, according to the HIV in Ireland 2016 Report. There are still many obstacles towards achieving a significant drop of new infections in this country.

One of the major problems identified by the HSE two years ago was that the black African community in Ireland wasn’t testing enough, or later than needed.

“The problem is that there are probably hundreds of black Africans and black Irish people leaving with HIV in Ireland who don’t know it, and their only way to find out is to test,” says Acet chief executive Richard Carson.

Acet had to learn what barriers to this particular community faced compared to other groups in Ireland. A study conducted by Ifedinma Dimbo, a researcher at Acet and a native from Nigeria, sought responses from professionals and volunteers working in HIV testing protocol and community testing centres, pastors of faith-led migrant communities, and a panel of 15 black immigrants from sub-Saharan Africa, and reveals what some of these barriers are.

“When you come from Africa, you know about HIV because a lot of people died from it there. But when an African migrant arrives in Ireland, there is no advertisement about HIV and you hardly hear people and the Government talking about it. So, they assume it’s not there,” she says.

“It also depends from which African region you come from. People from east Africa, where HIV caused the most devastation, would be more aware than people from west Africa.”

There is also a lack of awareness in the black African migrant community concerning the progress made in HIV treatment. Some could still think having the virus equals death.

“They have seen it happening back home. So as far as they are not sick, they don’t want to know, because it would mean death and nothing to do about it, because they don’t know about the treatment,” Dimbo says.

Some cultural beliefs in this community that only “someone living a terrible life”, such as a prostitute or a drug addict, would be infected by HIV is another barrier to testing.

There is a fear of isolation, Dimbo says, particularly from faith communities that provide a key social support in Ireland for sub-Saharan Africans. In fear of being rejected by their community or their friends if they are diagnosed HIV positive, they just don’t take the test.

“To do the test, they can go to the hospital, community health centres, even in bars and pubs. But African people don’t like people knowing their business, there is a culture of secrecy, so they won’t go test there,” Dimbo adds.

“We realised that they like it to be done away from the public eye. The public could be your neighbour, could be your friend.”

Dimbo and Carson believe that these numerous barriers can be erased by creating awareness. However, the stigmatisation of this particular community could be a risk in and of itself.

For Richard, the work of creating awareness has to be done at different levels. First, a message needs to be communicated that U=U and that the test is rapid — around 30 seconds — and free. Secondly, it needs to be spread directly within faith communities, especially to migrants and multicultural communities.

“People talk about the language barrier, but it is deeper than your language — it’s awareness in your cultural connections,” Carson adds.

At the same time, there is a lack of leadership in making a two-way, mutual integration happen. “Integration in Ireland now tends to only be unidirectional,” Carson says. “We should help black Africans to integrate better into our Irish health system. [At present] Irishness is the centre, and all the others are out, and they need to come closer to us. We think that whole model is wrong, because it is not international.”

Carson believes this could be resolved by getting closer to church and faith leaders, talking with them, encouraging them to test for HIV and communicate that testing to their congregations.

While one of the challenges of tomorrow for Acet is the rapid reality of HIV, work also needs to be done in the long term, at a generational scale.

“How do you remain both urgent to the testing need, and patient to the new Ireland story? Because this is going to take patience, there is lots to do, lots to do,” Carson says.