Search

'Black Africans' in England are disproportionately and highly affected by the heterosexually contracted HIV epidemic. Policy and practice frameworks have advocated ethnic matching in HIV prevention. We explore how self-identifying 'black African' workers in London were co-producers of 'black African' identities to target in preventative HIV interventions. Drawing on a focused literature review and 12 in-depth interviews with workers, the paper identifies themes associated with co-production of an African identify by workers. The historical inclusion of the category 'black African' in the 1991 census coincided with the emergence of Africans as at higher HIV 'risk'. In co-producing an African public, the workers projected their heterosexual and Christian affiliations on to the targeted population, perceiving themselves as 'insiders' knowledgeable about rumours that had historically co-produced African identities. Fear of those in authority galvanised the formation of African-led agencies, offering entry points for HIV prevention to Africans. By projecting aspects of their complex 'selves' on to the 'other', encounters in public spaces were deemed 'opportunities' for outreach interventions. The ethics of 'cold calling', confidentiality and informed consent were taken as 'given' in these socially produced 'private' spaces located in 'public' venues. In following HIV prevention frameworks as advocated by Pulle et al (2004), the workers endorsed yet problematised the notion of ethnic matching. [ABSTRACT FROM AUTHOR]

Health equity audit (HEA), a pragmatic policy tool to ensure that services and resources are focused on issues that have the highest impact on health inequalities, has now become embedded in the national strategy to tackle these inequalities through a new mandatory requirement that primary care trusts (PCTs) conduct one such audit annually. This study aimed to assess their experience through a national baseline survey in 2004, all PCTs (n = 303) being electronically mailed a questionnaire with non-respondent follow-up. Replies were received from 132 PCTs (44%), a representative sample of PCT diversity, most of whom had completed only a few steps in the audit cycle. Audit topics (most frequently coronary heart disease, smoking cessation, and access issues) and dimensions of inequity (mainly area and deprivation) were agreed through only limited engagement with local strategic partnerships. Local public health networks and multiagency teams were infrequent partners in undertaking the HEA. Most PCTs wanted comparator data, good practice examples, and specific methodological expertise. While significant progress has been made, this survey shows only limited use of HEA as a tool for multisectoral use by PCTs in partnership with others and a focus on intra-PCT comparisons at the expense of those with a wider pool of 'look-a-likes'.