{
  "abstract": "Objectives African and Caribbean heritage (ACH) communities in the UK face disproportionately high rates of HIV and often experience delayed diagnoses, worsening health inequities. Increasing HIV testing in these communities is essential to address these disparities and support the UK’s HIV reduction targets. This study examines barriers and facilitators to HIV testing among Bristol’s ACH community, a high-prevalence area with significant rates of late diagnoses, filling a critical gap in context-specific data.Methods Using a mixed-methods approach, this study combined 29 in-depth interviews and 41 online surveys, capturing ACH community members’ views on HIV stigma, healthcare trust and testing experiences. Data were thematically analysed and mapped to the Social Ecological Model (SEM) framework, with community researchers conducting data collection and analysis to enhance participants’ engagement and trust and contribute to a deeper contextual analytical understanding.Results Findings highlight significant barriers across SEM levels: individual-level knowledge gaps and stigma, interpersonal confidentiality concerns within tight knit communities, community-level taboos and distrust and organisational barriers, such as discriminatory healthcare experiences. Effective facilitators included culturally specific services, flexible testing options, community-driven outreach and increased healthcare representation, all of which fostered greater trust and engagement in testing.Conclusion The study underscores the importance of culturally aligned interventions, including representation within and training in cultural competence for healthcare providers and community co-production in service design. Implementing such strategies could reduce late diagnoses and support the normalisation of routine HIV testing in ACH communities, ultimately contributing to health equity. Future research should explore gender and age-specific barriers, while assessing the long-term impact of community-led interventions to inform national HIV policy and public health strategies for marginalised communities in the UK.",
  "authors": [
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK"
      ],
      "name": "Temilola Adeniyi"
    },
    {
      "affiliations": [
        "University of Bristol Centre for Academic Primary Care, Bristol, UK",
        "NIHR Applied Research Collaboration West, Bristol, England, UK"
      ],
      "name": "Jeremy Horwood"
    },
    {
      "affiliations": [
        "Brigstowe Charity, Bristol, UK"
      ],
      "name": "Marsha Doran"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK"
      ],
      "name": "Khabo Piggott"
    },
    {
      "affiliations": [
        "Brigstowe Charity, Bristol, UK"
      ],
      "name": "Aisha-Monic Namurach"
    },
    {
      "affiliations": [
        "University Hospitals NHS Foundation Trust, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Lindsey Harryman"
    },
    {
      "affiliations": [
        "University Hospitals NHS Foundation Trust, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Emmy Oldenbourg"
    },
    {
      "affiliations": [
        "University Hospitals NHS Foundation Trust, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Miryam Kiflu"
    },
    {
      "affiliations": [
        "University Hospitals NHS Foundation Trust, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Nathan Speare"
    },
    {
      "affiliations": [
        "University Hospitals NHS Foundation Trust, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK"
      ],
      "name": "Mary Griffin"
    },
    {
      "affiliations": [
        "Brook, Bristol, UK"
      ],
      "name": "Matthew Wilson"
    },
    {
      "affiliations": [
        "Terrence Higgins Trust, London, UK"
      ],
      "name": "Mark Febrache"
    },
    {
      "affiliations": [
        "Bristol Health Partners, Academic Health Science Centre, Bristol, UK"
      ],
      "name": "Rachel Allbless"
    },
    {
      "affiliations": [
        "African Voices Forum Ltd, Bristol, UK"
      ],
      "name": "David Dravie-John"
    },
    {
      "affiliations": [
        "Bristol City Council, Bristol, UK"
      ],
      "name": "Joanna Copping"
    },
    {
      "affiliations": [
        "Population Health Sciences, University of Bristol, Bristol, UK",
        "NIHR Applied Research Collaboration West, Bristol, England, UK"
      ],
      "name": "Frank De Vocht"
    },
    {
      "affiliations": [
        "NIHR Applied Research Collaboration West, Bristol, England, UK"
      ],
      "name": "Scott Walter"
    },
    {
      "affiliations": [
        "NIHR Applied Research Collaboration West, Bristol, England, UK"
      ],
      "name": "Fiona Fox"
    }
  ],
  "title": "Barriers and facilitators to HIV testing among African and Caribbean heritage communities: a mixed methods study",
  "uid": "b7ab83b3-8eec-5e4a-a56a-7c0cf4736386"
}