Health needs of Zimbabweans are poorly recognised in UK

Editor—In 2002 Zimbabweans were the second largest group of asylum seekers coming to the United Kingdom, 7695 asylum applications having been made,¹ and they constitute one of the largest migrant groups of English speaking peoples from a developing country for 25 years. The lack of language barriers may help this community to use the NHS more effectively than earlier migrants, but they may face discrimination nevertheless. What is known, and what needs to be known about the healthcare needs of Zimbabweans?

We found that most published work focuses on HIV and sexual health. The prevalence of HIV seropositivity in Zimbabwe is estimated to be 25%. The proportion of all reported HIV cases in the United Kingdom acquired in Africa (90% heterosexually) is over 20% and growing.² Several factors may pose problems when treating Zimbabweans with HIV: patients may present late³ and they are highly mobile (partly because of the government's policy of dispersal for asylum seekers), making follow up and contact tracing difficult. These problems are not confined to Zimbabweans. Coinfection with tuberculosis is a major concern, raising the question of whether Zimbabwean babies should be vaccinated with BCG.

In some towns the incidence of HIV has risen considerably. Many primary care trusts, local genitourinary services, and individual general practices are struggling to cope with increasing demand (our two practices in Luton together serve over a hundred HIV positive patients).

However, an inordinate focus on HIV may divert attention from other health needs of Zimbabweans. Anxiety, depression, and mental distress are to be expected among a population that has suffered rapid impoverishment and family separation. People have more mundane health problems, such as hypertension and diabetes. These have often been poorly controlled, and Zimbabweans may overlook these if health professionals are preoccupied with the risks of HIV. Only by integrating primary and specialist care can earlier diagnoses and improved access be delivered—and the public health interests of the whole population be addressed.