Jane Elliott BBC News Health Reporter

African men think they will be ostracised

When the doctor told DJ he was HIV positive, he was sure they had made a mistake.

"It did not cross my mind that I could be HIV positive. It was the last thing I had ever thought of," DJ, not his real name, said.

"I was not expecting this diagnosis. I was respectably married. I had not gone with prostitutes. I was quite hostile when the doctor told me and I said that I was sure he was making a mistake.

"When my GP got the results of my test he said that I had left it very late to come for treatment."

Test

But experts say that DJ's story is not unusual and that many men from the African community, like him, are refusing to heed the HIV message or get tested.

Dr Jane Anderson, HIV consultant at the Homerton Hospital, in North London, explained that in her clinic double the number of African women come in for testing than men.

My life literally fell apart. I was ostracised and my wife and children would not talk to me. I was really isolated. DJ

She said this was not because more women were infected, but because men feared they would be stigmatised in their community.

She said the challenge facing experts was how to get the male African community to engage in the HIV debate and get tested.

Dr Anderson said that because men often leave it so late to get tested their conditions are worse when they do seek help.

But said the earlier the men get diagnosed, the more effective the treatments can be.

"There are more men coming forward for testing when they are very sick. As they come much later when they are much sicker they are harder to treat.

"In general we see a high proportion of men coming with very advanced infection and needing very intensive care very early after their diagnosis.

"There is treatment and it does work, but if they come before they are very sick it will work better."

She said many of the men were worried about losing their anonymity and being stigmatised by their community, but stressed that all testing was confidential.

Bombshell

Ten years later on, DJ is still rebuilding his life.

His wife, who had not been infected, left DJ, who admitted to her that he had a couple of affairs during their marriage. Although he could also have been infected following a blood transfusion.

"It came as a bombshell to me. My life literally fell apart. I was ostracised and my wife and children would not talk to me. I was really isolated.

"When I told my wife she would not look at me or talk to me. She told people that I had Aids and that I could have given it to her.

"Everything fell apart. I managed to rebuild my relationship with my children but my wife left me."

He now counsels newly diagnosed men, encouraging them to face their condition and get help and to wear condoms to cut the risks of them infecting others.

But he said many African men were still refusing to listen to the safe sex warnings.

"Some just can't accept the message. I try to give them condoms and they say that they do not need them. The stigma is the biggest problem."

He says that because he left it so long to get help he was very sick when he first saw his doctor.

Now DJ is responding well to combination therapy. When first diagnosed his CD4 count was just 18. Now it is up to over 300.

To test the health of the immune system, doctors measure the number of specialist CD4 cells in a cubic millimetre of blood.

A normal count in a healthy, HIV negative adult can vary, but is usually between 600 and 1200.

Target

DJ says he is now coming to terms with his condition.

But he admits that because in the African community HIV has a particular stigma attached to it, he can not be openly positive.

"It is a big, big thing. There is a lot of stigma and people don't want to talk about it. It is the biggest problem especially among West African men. I tell very few people about it, although I think one or two people do know."

Clement Musonda, of the Organisation of Positive African Men (OPAM), agreed that African men were notoriously slow to get tested and that they needed to be targeted.

He said that part of this was because women got routinely tested during pregnancy, but said the problem could be blamed on the attitudes and culture of the African male.

"Men are not open, they tend to come out when they can't cope.

"African men have a number of issues, they feel marginalised and there are also some cultural issues.

"Most African men who have come out have found it difficult to integrate. The stigma problem is huge."

But he said that, despite the problems, the men would face that it was still better to get a test.

"I think that the message is that it is better to know than not.