PRIME involved three phases. First, during 2015, three focus
groups attended by 24 women explored themes and helped researchers formulate the
questionnaire for the second phase, in which 869 women aged 45-60, approached at 21 HIV
clinics across England, took part. The questionnaire covered education, employment
and immigration status as well as socioeconomic and mental health needs.

Finally, 20 women out of the 869 were selected for in-depth
interviews to further explore themes.

For the purposes of the analysis presented at BHIVA, only
women of white British, black African, and black Caribbean ethnicity were selected,
for the purposes of isolating the clearest contrasts between them. So 115 women
of other and mixed ethnicity (12% of the
total) were excluded. This left 607 black African women (72%), 71 white British women (8.4%) and 46 black Caribbean women (5.4%).

Eighty five per cent were born outside the UK, and there
was a very wide range in the amount of time they had been in Britain. A quarter
of them had been here less than three years, while another quarter had been
here more than 43 years (in other words had moved to the UK aged 3-22).

African women were, on the whole, better educated: about
half of them had been to university compared with a quarter of both white and
Caribbean women. They were also slightly more likely to be employed. Despite
this, they were more likely to be living below the poverty line. Forty-two per
cent of African women said they did not have enough money for basic needs
compared with 36% of Caribbean women and 15% of white UK-born women.

Caribbean women were the most likely to say they felt socially isolated: 48% did, compared with 40% of African women and 25% of white
UK women.

There was striking inequality when it came to women’s mental
health needs. A quarter of all women had moderate to high levels of psychological
distress, i.e. they experienced depression, anxiety and other symptoms. Caribbean
women were more likely than average to experience these (38%) and white women
less likely (14%).

Despite this, white women were considerably more likely to
be taking anti-depressants (41% took them, compared with 28% of Caribbean women
and 26% of Africans); and white women were even more likely to have ever been diagnosed with depression: 72%,
compared with 47% of Caribbean women and only 25% of African women. This shows
pretty clearly how diagnoses of mental illness do not reflect actual mental
health needs.

Poor mental health had potential physical consequences. Women
with moderate to severe psychological distress were 2.3 times more likely to have
forgotten to take at least one dose of their antiretrovirals in the last week
(33% versus 18%) and were 75% more likely to have forgotten an HIV clinic appointment
in the last year. However, this had no effect on viral suppression; 13% of
women with moderate to severe distress had a detectable viral load versus 11%
with no or mild distress, and this difference was not statistically
significant.