In England's West Midlands, HIV prevention is being hampered by language and cultural barriers and lack of targeted outreach efforts to overcome them. Between 1995 and 2006 in the West Midlands, new HIV diagnoses among black Africans rose 100-fold. In the same time-frame, new diagnoses rose six-fold among other mixed ethnic groups; three-fold among black Caribbeans; and two-fold among whites, according to regional health officials.

Demographics may play a role. For example, members of the local Ethiopian and Eritrean communities tend to be younger, single, living alone, and sexually active. Discussing sexual issues is taboo, making external information sources more critical. However, very few culturally sensitive sexual health promotion programs target immigrants from high-prevalence countries.

In interviews, many black Africans said HIV was really more of a problem back home than in the United Kingdom, which was seen as "civilized." Some said they thought all migrants were screened for HIV before being allowed entry, and that the antiretrovirals available in the country "cured" AIDS. Culturally, condoms are seen as implying promiscuity or a lack of trust and are thus unacceptable to many.

Immigration status is also a barrier for HIV prevention and care. Last year, the UK court of appeals ruled that rejected asylum-seekers and other "not ordinary UK residents" are not entitled to free care from the National Health Service. However, many among these groups are the very people most at risk of HIV infection. Political leaders may be reluctant to address these issues due to sensitivities around immigration and race.