More people are living with HIV in Bristol than in other parts of the UK. Bristol’s late diagnosis rate is also higher than the national average (58%).
Early diagnosis is life changing. A person living with HIV who starts treatment early can live just as long as someone without HIV. Treatment can also reduce the virus to “undetectable” levels, meaning it cannot be passed on to others.
African and Caribbean communities are disproportionately affected by HIV in Bristol.
People from African and Caribbean heritage communities make up 5.9% of the city’s population. But in 2022 28% of people living with HIV in Bristol were from these communities. The rate of diagnosed HIV per 1,000 residents aged 15–59 was 21.2 for Black Africans, compared to 0.7 for white residents.
Stigma – negative or shameful views – surrounding HIV and sexual health, and past negative experiences of healthcare can prevent people of African and Caribbean heritage accessing HIV and sexual health services.
In 2019 Bristol became a ‘Fast Track City’ aiming to end new HIV infections and HIV stigma by 2030.
Common Ambition Bristol (CAB) is a major co-produced project working to tackle health inequities and reduce HIV transmission in Bristol. This pioneering study involves members of African and Caribbean communities living in Bristol, working in equal partnership with sexual health staff and service providers. Together this group has reviewed, developed, trialled and evaluated interventions to increase HIV testing and reduce HIV stigma.
CAB launched in 2021 and for the first 3 years was funded by the Health Foundation. It is led by Brigstowe, a Bristol-based charity for people living with HIV, in partnership with African Voices Forum, University Hospitals Bristol and Weston NHS Foundation Trust (who host Yuno Sexual Health), Bristol City Council and Fast Track Cities Bristol.
Researchers from ARC West and the NIHR Health Protection Research Unit in Evaluation and Behavioural Science at the University of Bristol work in collaboration with community members to evaluate the project.
Project aims
The project aims to reverse HIV health inequalities experienced by people of African and Caribbean heritage living in Bristol and the surrounding area by:
- Increasing HIV knowledge
- Reducing HIV stigma
- Increasing uptake of wider sexual health services
- Increasing uptake of HIV testing and PrEP (a pill that can stop you getting HIV)
What we hope to achieve
Common Ambition Bristol aims to increase uptake of HIV testing in Bristol’s African and Caribbean communities. It does this by reducing the stigma around HIV and sexual health and improving access to services.
This could reduce both the transmission of HIV and the instances of late HIV diagnosis, improving health outcomes for people who are diagnosed.
What we are doing
CAB interventions
The CAB Project Delivery Group (PDG) is made up of 6 community members working in equal partnership with 4 sexual health staff. Together they have co-produced and delivered the following 4 interventions since 2021:
- Community outreach in black-owned businesses
- Dedicated community sexual health testing clinics
- Targeted health promotion events
- Multimedia resources
Evaluation
We are evaluating the CAB programme in the following 4 ways:
- Evaluating the co-production process: Through yearly interviews with the PDG
- Evaluating the process of implementing the interventions: Through interviews, observations and surveys with members of the public and those delivering the interventions
- Evaluating the outcome and impact: Quantifying the impact of CAB interventions on uptake of HIV testing, PrEP and wider sexual health services and testing in the African and Caribbean heritage community
- Health economics analysis: We are estimating the cost of developing and delivering the CAB programme, to determine whether it is cost-effective and represents good value for money
A team of community researchers have conducted interviews and surveys and helped analyse the data. From our findings we gave feedback to help the PDG to improve the interventions. We are exploring how effective they are.
Sharing our learning
We are sharing our work with a wide range of groups including sexual health professionals, NHS trust board members, medical students, researchers and community members.
What we have achieved so far
- Extra funding: In 2023 CAB interventions received additional local authority funding, while the research team received an NIHR Public Health Research Programme grant to continue evaluation
- Sustainability: In 2025 CAB was commissioned as part of the new sexual health service for Bristol, North Somerset and South Gloucestershire, securing 10 years of funding
- Adding value to the Trust: University Hospitals Bristol and Weston NHS Foundation Trust, which hosts Yuno Sexual Health, have incorporated learning from CAB into their Experience of Care Trust-wide 3-year programme
- Awards: CAB has won a 2024 PENNA award and was highly commended for an HSJ award 2025
- Career development: A CAB community researcher has been awarded an NIHR doctoral fellowship
Resources
- We have produced an interactive PDF toolkit. This shares our learning from the first 3 years of Common Ambition Bristol’s co-production process. It will be of use to teams who want to co-produce service improvement with minoritised communities. Co-production toolkit
- Our first publication has been led by CAB community researcher and NIHR doctoral student Temilola Adeniyi. Barriers and Facilitators to HIV Testing among African and Caribbean Heritage Communities: A Mixed Methods Study.
Collaborators
- Professor Jeremy Horwood, Professor of Social Sciences and Health, University of Bristol
- Professor Frank de Vocht, Applied Data Sciences Team Co-lead, University of Bristol
- Rami Ghali, Chief Executive Officer, Brigstowe
- David Dravie-John, Vice-Chair, African Voices Forum
- Jo Copping, Consultant in Public Health Medicine, Bristol City Council
- Lindsey Harryman, Consultant in Genitourinary Medicine, Yuno Sexual Health, University Hospitals Bristol and Weston NHS Foundation Trust
- Katy Turner, Reader in Infectious Disease Epidemiology, NIHR Health Protection Research Unit (HPRU) in Behavioural Science and Evaluation, University of Bristol