Knowledge, Attitude and Practice Regarding HIV/AIDS among students in United Kingdom; A Systematic Review

All included studies were descriptive or observational and included both quantitative and qualitative research. Sexual knowledge and behaviour Research exploring the sexual health knowledge and behaviour of students in the UK is mostly focused on unmarried, young people (aged 13–25 years) in defined geographical areas. These studies, including both survey and/or qualitative data, have consistently demonstrated relatively poor sexual health knowledge among young students. (Testa and Coleman, 2006) Testa and Coleman found poor knowledge in terms of STI name, symptom recognition and means of prevention and identified particular gaps among males and females. French et al. also identified particular knowledge gaps among Bangladeshi and Indian young people and found that school was often the only source of sex and relationships education available as sex was almost never discussed at home. (de Visser, 2010) However, sex and relationships information provided in schools has been found to take little account of faith or cultural issues relevant to these young people and is seldom considered to be a useful source of information. (Griffiths et al. , 2008b). This may be prominent in South Asian people’s responses where behaviour considered culturally unacceptable may be underreported for fear of adverse judgement. (Ramanathan et al. , 2013) That two of the large surveys were conducted in London only also needs consideration. The consistency of some findings across geographical areas (e. g. Glasgow, Greater London, Birmingham, Manchester) is somewhat reassuring. However, we need to consider possible differences between young people of the same ethnic/cultural background who live in different geographical regions in the UK. Communities often evolve differently in different places and where local ethnic population profiles/compositions vary, friendship group formation and sexual mixing may vary with implications for sexual behavioural risk. STIs and HIV Though increasing data are available on the sexual behaviour of students in the UK, there are limited data reporting sexual health outcomes such as STIs. Ethnic origin is not routinely collected in genitourinary medicine (GUM) clinics and there are the aforementioned limitations of definitions and categorisations of ethnicity. Existing data have generally shown lower rates (actual and reported) of STIs in South Asian groups compared to white groups. (Griffiths et al. , 2008a) One GUM clinic study found similar rates of STIs in Bangladeshi attendees as non-Bangladeshi attendees, though this was mainly among individuals born in Bangladesh. Sexual dysfunction and premature ejaculation among some South Asian and Muslim men has been found elsewhere. The reasons behind the sexual dysfunction remain unclear, though possible influences include psychosocial, familial and genetic factors. ‘Dhat syndrome’ or semen loss has also been widely reported as a sexual concern among Indian men. In 2005 in England, Wales and Northern Ireland, 1. 4% (321/22 324) of heterosexuals living with diagnosed HIV were of Indian, Pakistani or Bangladeshi ethnicity. (Dougan et al. , 2005) This rate is low relative to some other population groups, however some suggest that increasing HIV incidence in South Asia combined with migration due to strong familial, social and business links between South Asians in the UK and those of the South Asian region may be cause for concern. (Weston, 2003) Contraceptive Behaviour Improving contraceptive uptake and access to services and information among all students and minority ethnic women is part of a national initiative to reduce unintended pregnancy. (Baxter et al. , 2011) There is also a need to ensure individuals have equitable access to a full range of contraceptive methods. Contraceptive surveys conducted in the 1970s and 1980s did not provide data on ethnic background and, in the few studies where ethnicity was referred to, South Asians constituted less than 5% of the study population. (Baxter et al. , 2011) Other studies conducted in the 1980s have involved small, select populations from family planning clinics or ante/postnatal departments and found varying degrees of contraceptive use and variation in the type used. More recent studies have also shown varying levels of contraceptive use among South Asian women but usage has consistently been shown to be lower than for their white counterparts. (McAvoy and Raza, 1988) Some of this survey data does, however, rely on pooled data over several years because of small sample sizes and may therefore have underestimated contraceptive use due to a lack of information about sexual activity. South Asian women, particularly Bangladeshi and Pakistani women, have higher parity than white women and often continue childbearing to older ages. (McAvoy and Raza, 1988) One study found that about a third of married women and half of women over 30 years of age who said that they had completed their families were not using contraception and were therefore at risk of unplanned pregnancy. (Saxena et al. , 2002) In contrast, in the same study, unmarried women (mainly teenagers) were more likely to be using contraception than married women, which indicates that despite cultural expectations of no premarital sex, some young women are sexually active and able to access contraception. However, the sample in this study is small and taken from a general practice and therefore excludes women unable to access health services altogether, including contraception Access to Services Although there is Department of Health guidance for developing contraception and sexual health advice services for young people, (Robinson, 2005) there is little research exploring sexual health service use specifically among South Asians in the UK. National routine data collected in family planning and GUM clinics does not include ethnic origin of attendees. The work that has been conducted is qualitative and in the main explores awareness, preference and barriers to service access. Poor awareness of specialist sexual health services (i. e. GUM) is a common theme across studies (Griffiths et al. , 2008a) and many South Asians have expressed the need for more accessible information about services. 4 A case-control study in two London GUM clinics found that South Asians were significantly more likely than controls to have been referred by other medical services rather than self-referred, perhaps reflecting the lack of awareness of services or barriers to access. (Ross et al. , 2006) In terms of service preference, one study found general practice to be the most preferred setting for sexual health care among Indians, Pakistanis and Bangladeshis. Some South Asians have been found to prefer GUM services because they are specialised, however stigma and anxiety of being seen remain consistent themes. In general, for many South Asian communities, faith and cultural values prohibit premarital sex and therefore dialogues around sexual health are deemed unnecessary and irrelevant. (Hennink et al. , 1998)