Race and Health Inequalities: We Should All Be Advocates

For Black History Month, we explore why minority ethnic communities are disproportionately affected by HIV and STIs. 

Minority Ethnic communities are disproportionately affected by HIV and STIs. The reasons for this are often misunderstood, resulting in people not receiving the treatment they need, prevention campaigns being mistargeted and rates continuing to rise.  

But understanding the reasons for these disparities are complex and need to be unpicked if we are going to solve some of the health inequalities that exist in Scotland. Alongside socio-economic factors, it is important to look at how race and health have been connected historically to understand why racial inequalities continue in sexual and wider healthcare in the twenty-first century. 

Modern medicine has always been deeply connected to issues of race. 
During the Enlightenment, advances in science developed alongside the expansion of European colonialism. This meant that the project to scientifically categorise the natural world extended to different cultures, as settlers travelled the globe and attempted to build theories of racial difference to justify colonial expansion and slavery. Defined as the ‘other’ within colonising European cultures, indigenous populations were categorised as biologically inferior to their White counterparts. 

In the nineteenth century, J. Marion Sims became known as the “father of modern gynaecology” for inventing the Sims’ speculum, still a fundamental tool in sexual and reproductive health. At the time, research into gynaecological health was relatively new and Sims wowed the scientific community with his findings and solutions to women’s painful health problems. But working in the USA in the early nineteenth century, Sims conducted his research on Black slave women without the use of newly developed anaesthetic because he believed that Black people did not feel pain, a notion that can still be found today. 

By the twentieth century, the eugenics movement emerged. Based on Charles Darwin’s ‘survival of the fittest’ theory, eugenicists believed that by proving the biological inferiority of social groups perceived as ‘different,’ it would be possible to build a better and more highly functioning society. 

Eugenics is most widely known for underpinning the racist policies of the Nazi regime, leading to the death of millions of Jewish, Roma, disabled and LGBT people during the Holocaust. But in the UK in the early twentieth century, eugenicist ideas and policy could be found in all parts of society, not least in the field of reproductive rights.  

Activists like Marie Stopes fought for a woman’s right to birth control in Britain and made great progress in creating access to sexual and reproductive healthcare across the UK. But Stopes was a member of the Eugenics Society, a popular organisation in pre-war Britain that aimed to develop “reproductive technology” to further the goals of social engineering. Stopes advocated for compulsive sterilisation for those who were ‘unfit for parenthood’, a group which, to Stopes, included non-white people and the poor. 

The legacy of colonisation. 
These beliefs in the biological inferiority of non-white races have not come to an end with scientific and political advances. The legacy of these views and practices are still playing out in healthcare policy today. There are cases of women with HIV being forcibly sterilised in some countries; in the UK, Black women are five times more likely to die during pregnancy or childbirth than white women, and Black men are four times more likely to be detained under the Mental Health Act than White men, despite having similar levels of mental health problems.  

It is only by looking at the historical origins of the belief in a biological difference between races that we can understand how it affects the institutional makeup and medical practices of the present day. In the UK, although NHS provision means that quality of care outcomes are the same for ethnic minority and white populations, minority ethnic people have a poorer experience of care, experiencing longer wait times and higher levels of dissatisfaction.

How can we counter these legacies in sexual health services?  
Minority ethnic service users need to feel safe when accessing healthcare, free from any markers of a hostile environment. When implicit bias around race is so hidden within everyday practice, healthcare providers need to explicitly state their support for transforming services with the aim of real inclusivity. This is not just marketing campaigns or snappy slogans, but requires asking the people themselves what they need, bringing community representatives into the heart of decision-making in sexual healthcare services. 

To this end, in 2021 we investigated the sexual health needs of people from African communities in Scotland by consulting with members of the community themselves. From this research, We All Have A Different Consciousness About It, we created bespoke resources to better reach people from these communities. This has included, 

  • Establishing independent liaison roles with the most frequently accessed community spaces such as churches and businesses. 
  • Identifying spaces to facilitate peer-led community discussion centred on destigmatising sexual healthcare and HIV.
  • Increasing the provision of free condoms in frequently accessed community venues such as churches and businesses. 

To learn more about our work with people from African communities living in Scotland click here.