Source: Gender Links
While HIV prevalence rates are dropping in many parts of Africa they are on the rise within African communities in other parts of the world and experts think gender roles and harmful cultural practices are to blame.

In the United Kingdom, Africans have the highest HIV prevalence. In 2009 an alarming 33% of all new cases were of African descent. According to the UK Health Protection Agency, 70% of HIV-positive women in Britain were born in Africa.

The Public Health Agency of Canada estimated in 2005 that the HIV infection rate among Canada's black population was 12.6 times greater than among other groups, noting that black women are four times more likely to have HIV than white women.

Antoinette Andze* was diagnosed with HIV after she arrived in the UK from Cameroon. Even though she is on antiretroviral treatments, she is pale, weary and in bed in her London flat. At 40-years-old she lives with four of her children and has another in Cameroon. Her youngest child is also infected with HIV. Andze thinks she was infected by her husband, who abandoned her after she was diagnosed.

"I am deeply worried about my kids, even now I spend most of my time in the hospital, it is as if things are not getting any better and I have no one to run to in this difficult situation," she said.

Andze's friends and family do not know she is HIV-positive and she fears they would abandon her if they did. She attends a clinic far from her community so no one will find out.

"Many people still believe that having HIV is a form of punishment or witchcraft," says Fola Rogers-Saliu, a doctor and manager of the African Emotional Support Service at the UK's Terrence Higgins Trust. "People still live in fear, with stigma and discrimination rife."

She said Africans in the UK carry their culture with them. Many don't want to get tested because of the stigma, which is why the disease is spreading so quickly.

Within the African community gender norms strongly influence HIV vulnerability and how women respond to being diagnosed as HIV-positive. Most African women keep it a secret for fear of being blamed or ostracised. Some are scared about the repercussions of not breastfeeding their young children, which is regarded as an abomination in parts of Africa. Such secrets mean partners and children are put at greater risk of infection.

Rogers-Saliu notes that polygamy and the common practice of multiple sexual partnerships also contributes to more women becoming infected. "It is not uncommon that some men who live here in UK with their wives or partners still keep and maintain other women as wives or partners back home in Africa with the knowledge and approval of their extended family members," she said.

She said religious beliefs around condom use and the inability of women to negotiate safer sex also pose a challenge to curbing the spread of HIV.

Reducing gender imbalances, rape, trafficking and enforced marriage must be prioritised in order to provide a level playing field for women like Andze. Violence against women undermines HIV prevention and care efforts and Rogers-Saliu said her organisation spends a lot of time helping women get the support they need when they have been put at risk.

But fear and lack of education means most women are still not taking advantage of these services.

"Only about 11% of African women who live with HIV in the UK are accessing services that would prevent mother to child transmission, which is something we need to improve to reduce the onward transmission of HIV," she said, noting that there has, however, been progress in promoting the use of female condoms and Post Exposure Prophylaxes if women have been at risk of infection.

She said Terrence Higgins Trust encourages testing so that it can reduce the high number of Africans who don't realise they are living with HIV.

For Andze, an earlier diagnosis would have prevented her from becoming as sick as she is and it may have meant her youngest child was born HIV-negative.

Now that she is ill and unable to work, poverty is her greatest concern. She depends on benefits and has twice lost a job because she was taking too much sick leave. Most of what she owns has been donated by members of her church.

Stories like Andze's demonstrate that holding onto some aspects of African culture might be comforting for Africans living abroad, but increasing HIV prevalence rates in places like the UK proves this can also be deadly.

*Real names have not been used.

Mariama Kandeh is a Sierra Leonean journalist currently living in the UK. This article is part of the Gender Links Opinion and Commentary Service.