By Rianna Raymond-Williams and Uzochi Nwaosu
“The beauty of anti-racism is that you don’t have to pretend to be free of racism to be an anti-racist. Anti-racism is the commitment to fight racism wherever you find it, including in yourself. And it’s the only way forward.”
— Ijeoma Oluo
Just over a year ago, I (Rianna) was invited to give a talk at The Faculty of Sexual and Reproductive Healthcare’s (FRSH) one-day online conference – the leading conference for sexual and reproductive healthcare (SRH) professionals, showcasing the latest clinical developments across the UK and bringing together an impressive range of national speakers. After being approached on social media by one of the organisers, followed by a phone call and an exchange of emails, it was confirmed that I’d create a presentation and deliver a talk titled “Things to consider when engaging Black and minoritised communities in sexual and reproductive health in the UK”.
As an SRH professional with ten years of experience working in the field, I wanted to be sure that I was sharing content that I felt was relevant to the SRH community, but also provided some insight into the roots of inequality within the sector experienced by Black and minoritised communities – which aren’t often discussed. I gave myself just over two weeks to plan and organise my thoughts, and in this time, I decided to arrange my presentation into three sections. The first section focused on the historical legacies of racism and colonisation, the second section provided some suggestions of how to better work with Black and minoritised communities and finally, the last section of the presentation shone a light on examples of best practices from Black and minoritised communities’ groups and organisations working in the sector here in the UK.
I recorded my presentation in just under 15 minutes and submitted it for review; within a few days, it was given the green light by the organising committee and scheduled to launch on the digital platform, which was set to be attended by roughly 500 SRH professionals, all of whom were attending to deliver and engage in talks, participate in Q and A discussions and network with peers. Within minutes of my talk going live on the platform, I received a barrage of messages, tweets and emails from friends and colleagues across the country commending me on the presentation. I’m thankful that it was received so well, and I’m grateful to have been invited to other organisations and spaces to deliver similar talks and presentations. Still, the truth is that talking about racism, and the impacts of inequality within SRH, is emotionally tiring and doesn’t always have to be led by Black or minoritised people.
In the wake of the Black Lives Matter (BLM) resurgence after the brutal murder of George Floyd in America, as well as the glaring spotlight on health inequality nationally and globally during the coronavirus (COVID-19) pandemic (particularly where Black and minoritised communities in the UK have been disproportionately impacted by the virus (ICNARC, 2020)), many people have begun to wake up to the realities of injustice and many have been moving towards creating change. For some groups and organisations, these acts have been performative. For others, I can only hope that it is a conscious step in the right direction towards addressing an unequal society and actively tackling health inequalities long-term.
Part of being anti-racist is about challenging all actions and ideas of prejudice, discrimination and bias, concerning all groups. This effectively means that you don’t have to be on the receiving end of injustice to fight against it, stand up to it or lead a movement to combat it. Certainly, my lived experience as a working-class black woman from inner-city London makes me an expert in my lived experience of prejudice, but those who have witnessed me being discriminated against and said and done nothing in the process are also a big part of the problem.
In the last six months, my good friend and colleague Uzochi Nwaosu, a sexual health advisor and trainee health psychologist, has been co-leading the creation of a special interest group (SIG) at the British Association of Sexual Health and HIV (BASHH) focused on Black and minoritised populations. The SIG will bring together passionate clinicians, academics and community organisations to ensure the sexual health needs of racially minoritised populations are promoted within BASHH and at a wider strategic and policy level.
For far too long, the sexual health needs of racially minoritised people in the UK have been neglected by the sector, including those who commission sexual health services and those who guide sexual health practice. For example, several Public Health England publications (Ratna et al., 2021) identify Black ethnic groups as a sub-group with greater sexual health needs, alongside to young people and men who have sex with men (MSM). However, whilst, and quite rightly, initiatives such as the National Chlamydia Screening Programme and the C-Card condom distribution schemes aim to improve outcomes among young people, and a number of services have been tailored to meet the needs of MSM, the same level of investment in funding and efforts to improve outcomes cannot be identified in services tailored to the needs of Black ethnic groups.
Whilst a SIG in BASHH will help to keep the sexual health needs of racially minoritised populations firmly on the agenda in BASHH, this does not go far enough. Public health authorities, sexual health services and professionals need to stop hiding behind blanket labels such as “hard to reach” or “difficult to engage” and seek to repair the historical mistrust in medical and public health bodies, – underpinned by factors including experiences of systemic racism and discrimination, previous unethical healthcare research in Black populations and negative experiences within culturally insensitive health services (Razai et al., 2021). They must collaborate with community organisations to design and conduct relevant research to better understand needs, and develop appropriate and tailored services to meet these needs.
When thinking about the needs of Black and minoritised communities in SRH, we need our allies in this space to use their positionality to do more. But to do more, this requires compulsory education that highlights inequality, raises awareness of the struggles communities face daily, as well as acceptance that in order to achieve the highest level of clinical excellence and patient safety, eliminating systemic inequalities is everyone’s business.
If we can improve our practice for the most vulnerable patients, we can create a better health system that benefits everyone.
Intensive Care National Audit & Research Centre (ICNARC). ICNARC report on COVID-19 in critical care. ICNARC, 2020.
Ratna N, Sonubi T, Glancy M, Sun S, Harb A, Checchi M, Milbourn H, Dunn J, Sinka K, Folkard K, Mohammed H and contributors. Sexually transmitted infections and screening for chlamydia in England, 2020. September 2021, Public Health England, London. https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1015176/STI_NCSP_report_2020.pdf
Razai M S, Osama T, McKechnie D G J, MajeedA. Covid-19 vaccine hesitancy among ethnic minority groups BMJ 2021; 372 :n513 doi:10.1136/bmj.n513
Rianna Raymond-Williams FRSA FRSPH currently works as Portfolio Manager for Impact on Urban Health (IoUH) which is a part of Guy’s & St Thomas’ Foundation, a charitable foundation. Here, she co-leads work on trust in health systems and the role trust plays in creating health equity. Prior to joining IoUH, Rianna worked as a Sexual Health Advisor for the NHS in East London. She is currently in the first year of her PhD studies at Glasgow Caledonian University in London where she intends to explore how Black women in the UK make sense of their sexual identity.
Uzochi Nwaosu is a Trainee Health Psychologist at UWE Bristol and a Sexual Health Adviser in a GUM/HIV service. He has a particular interest in the sexual health of marginalised groups, including young people and Black ethnic groups, and is passionate about addressing the sexual health inequalities observed among these groups. Uzochi is also in the final year of his professional doctorate at UWE Bristol, where he is currently exploring the sexual health experiences and motivators of Black men in London.