About 45% of these new cases were among migrants from Sub-Saharan Africa, who only account for 0.65 per cent of the Belgian population. These figures don't even reflect the actual extent of the problem: an estimated two- thirds of Sub-Saharan African migrants carry the virus without knowing it.

At the Institute for Tropical Medicine (ITM) in Antwerp, Dr Lazare Manirankunda investigated why so many migrants wouldn't get tested for HIV, although free testing and treatment are available in Flanders. He carried out in-depth discussions with immigrants from a number of countries, including the Democratic Republic of Congo, Ghana and Nigeria, living in Antwerp and Ghent.

"The first barrier is fear," Manirankunda says: fear of dying, fear of being rejected, fear of being deported. Also, African migrants often perceive that their own risk of being infected with HIV is low because they associate HIV with promiscuous sexual behaviours. All in all, HIV and health in general are low on the migrants' list of worries.

"They are here to survive and find a good life," explains Manirankunda. "An HIV diagnosis would mean the end of that goal."

This study was carried out as part of the HIV-SAM project, launched in 1996 at the institute to curb the HIV epidemics among Sub-Saharan African migrants. A team of three specialists works in close contact with African organisations to reach out to the community. They co-organise health promotion activities throughout the year during social and cultural events.

The activities now focus on fighting the stigma by inviting, for instance, people living with HIV and AIDS to share their experiences. Also, HIV-SAM is now reaching out to medical doctors and hosting a seminar for general practitioners on 30 September at the institute.

"Doctors are often worried that pushing migrants to get tested might be considered discriminatory, or even racist," Manirankunda notes. However, studies showed that Sub-Saharan migrants respect their doctor's authority and will often agree to testing if he or she suggests it. The researcher insists: "Doctors have a responsibility."

www.hivsam.be