by Natasha Dhumma

The Muslim community in the UK experiences a range of health inequalities compared with the wider population. This is especially true for older people, with over 24 per cent of Muslims aged 50 years and above reporting poor or very poor health which is double that of the population as a whole. A large number of the Muslim population also live in deprived areas, which recent research shows are disproportionately affected by cuts to public health funding. Before we even start to look at their experiences within the health system, being Muslim does not put you on an equal footing.

These inequalities are evident when looking at the experiences of Muslims living with HIV specifically. Public Health England (PHE) conducted a large-scale survey* of people living with HIV in 2017 which found Muslim respondents disproportionately experiencing indicators of deprivation when compared to respondents overall. This included higher levels of unemployment (24 per cent compared with 11 per cent of the sample as a whole); being more likely to live in rented or sheltered accommodation compared  with owning their own homes; and more likely to financially struggle. As an example, whereas 47 per cent of all respondents said they always had money to cover their basic needs, only 28 per cent of Muslims agreed, falling to 24 per cent for Muslim women.

The existence of Islamophobia in healthcare settings should not take us by surprise considering its prevalence in society. Data allowing us to measure the problem however is scant, often resulting in limited efforts to provide culturally competent care. Improving trust and comfort in healthcare settings is crucial to address health inequalities. We must talk about the barriers Muslims experience regarding effective HIV prevention, treatment and care and the risks these pose to public health. Considering a significant proportion of target populations for HIV prevention identify as Muslim there is an urgency to addressing them; in PHE’s research 54 per cent of Muslim respondents living with HIV were black African, and this rose to 79 per cent of Muslim women*.

Islamophobic stereotypes and fear of discrimination

We know Muslims’ concerns around clinicians’ or nurses’ views of them often influence their ability to fully engage and articulate their needs, especially where they relate to religious practice such as fasting or needing to remain covered up. Further, fearing they will be judged against representations of Muslims in the media adds an extra layer of anxiety. This is especially true for Muslim women who are often portrayed as oppressed and victimised. Research on Muslim women’s experiences in maternity services for example demonstrates how, anticipating health workers having a negative image of them, participants felt they either had to constantly explain themselves when discussing their needs or they would avoid it altogether. This includes white British women who had converted to Islam feeling pressured to explain it was their choice in case professionals assumed they had been forced to.

There are other examples of explicit discrimination manifesting in institutional practice, such as staff belittling Muslim women’s concerns by referring to it as “Asian woman syndrome”, and hospitals refusing to share their baby’s sex in case the baby is aborted if it’s a girl. Beyond damaging trust and inspiring disengagement these experiences can have a wider impact on wellbeing. For Muslim women living with HIV feelings of anxiety or depression, worthlessness, losing confidence, and an inability to face problems were more commonly reported compared with Muslim men and all respondents.

Beyond individual interactions, the wider socio-political context in which the Muslim community engage with healthcare administration cannot be ignored. The Prevent duty, which forms part of the Government’s counter terrorism strategy, has created a climate where Muslim’s are reluctant to engage with public bodies through fear of being considered a suspect. As it is Muslims struggle to access services. Muslim respondents living with HIV were more likely to need HIV and social/welfare services such as immigration or legal advice, while less likely to have these needs met compared with the wider cohort*. Adding Prevent into the mix only sees inequalities for these groups deepen, an issue we will explore further in our follow up blog later this week. 

These barriers highlight wide-ranging discrimination at a policy, institutional and individual level. They expose clear challenges for Muslim communities to feel safe in expressing their needs and sharing experiences in health environments. While the lack of data makes it difficult to assess specifically how this impacts HIV prevention and treatment within the Muslim community, there are important lessons to be learnt. Healthcare providers at all levels must challenge Islamophobia and create an effective and inclusive system as a cornerstone for a healthy society.

*Data collected from the Positive Voices survey run by Public Health England, NAT and Positive Voices in 2017 (unpublished). See https://changingperceptions.co.uk/ for more information.

Read the second part of this blog here.

Natasha Dhumma is Head of Policy and Campaigns at NAT (National AIDS Trust)