Knowledge, information needs and behavior regarding HIV and sexually transmitted infections among migrants from sub-Saharan Africa living in Germany: Results of a participatory health research survey

Background: A total of 3,419 new HIV diagnoses were reported in Germany in 2016, with migrants from sub-Saharan Africa (misSA) accounting for 14.1%. To understand the driving factors behind the epidemiological situation, we conducted a quantitative cross-sectional survey on knowledge, attitudes, behavior, and practices regarding HIV and sexually transmitted infections (STIs) among misSA living in six German cities utilizing participatory health research. Methods: Participants were recruited by peer researchers. Levels of knowledge, information needs, and preferred methods of information dissemination were analyzed to inform future prevention planning. Additionally, we analyzed sexual behavior and other risk factors for contracting HIV and STIs. The results may facilitate the formulation of targeted prevention messages in the future. Results: We included 2,432 participants in the analysis. General knowledge about HIV was adequate, as 86.9% were aware of the presented information. Statements about HIV co-infections were prior knowledge for 53.4% of the participants and about German HIV policies and HIV testing for 54.7%. Knowledge about other STIs differed, ranging from 69.6% who have ever heard of gonorrhea to 23.8% who have ever heard of genital warts. Groups with particular knowledge gaps were i) younger misSA, ii) recent migrants, iii) misSA without regular access to the German health care system, iv) misSA of lower socioeconomic status, and v) misSA with Muslim religious affiliation. The majority of participants reported information needs (72.8%), and 71.3% wanted to obtain this information from health professionals. Male misSA were more likely to report five or more sexual partners compared to females. Less than half of participants reported always using condoms with non-steady sexual partners (46.8%). Reasons for not using condoms differed between males and females. A considerable proportion of females (16.3%) and males (6.8%) experienced sexualized violence. More than one fourth of women (26.9%) were affected by female genital mutilation/cutting. Discussion: Future prevention planning should focus on sub-groups with particular knowledge gaps, recognizing their preferred methods of information dissemination. Prevention messages for male misSA should focus on their own risk perception and for female misSA on empowerment, e.g. to negotiate condom use.Peer Reviewe

Impact of HIV knowledge and stigma on the uptake of HIV testing – Results from a community-based participatory research survey among migrants from sub-Saharan Africa in Germany

Background: In 2015, 3,674 new HIV diagnoses were notified in Germany; 16% of those newly diagnosed cases originated from sub-Saharan Africa (sSA). One quarter of the newly diagnosed cases among migrants from sSA (MisSA) are notified as having acquired the HIV infection in Germany. In order to reach MisSA with HIV testing opportunities, we aimed to identify which determinants influence the uptake of HIV testing among MisSA in Germany. Methods: To identify those determinants, we conducted a quantitative cross-sectional survey among MisSA in Germany. The survey was designed in a participatory process that included MisSA and other stakeholders in HIV-prevention. Peer researchers recruited participants to complete standardized questionnaires on HIV knowledge and testing. We conducted multivariable analyses (MVA) to identify determinants associated with ever having attended voluntary HIV testing; and another MVA to identify determinant associated with having had the last voluntary HIV test in Germany. Results: Peer researchers recruited 2,782 participants eligible for inclusion in the MVA. Of these participants, 59.9% (1,667/2,782) previously had an HIV test. For each general statement about HIV that participants knew prior to participation in the study, the odds of having been tested increased by 19% (OR 1.19; 95%-CI: 1.11–1.27). Participants reporting that HIV is a topic that is discussed in their community had 92% higher odds of having been tested for HIV (OR 1.92; 95%-CI: 1.60–2.31). Migrants living in Germany for less than a year had the lowest odds of having had their last HIV test in Germany (OR 0.17; 95%-CI: 0.11–0.27). Additionally, MisSA 18 to 25 years (OR 0.55; 95%-CI: 0.42–0.73) and participants with varied sexual partners and inconsistent condom use (OR 0.75; 95%-CI: 0.44–0.97) had significantly lower odds of having had their last HIV test in Germany. Discussion: Through participatory research, we were able to show that knowledge about HIV and discussing HIV in communities increased the odds of having attended HIV testing among MisSA. However, recent migrants and young sexually active people are among the least reached by testing offers in Germany. Community-based interventions may present opportunities to reach such migrants and improve knowledge and increase discussion about HIV

From peer to peer: Reaching migrants from sub-Saharan Africa with research on sexual health utilizing community-based participatory health research

Migrants from sub-Saharan Africa (misSA) in Germany are disproportionally affected by HIV. To develop targeted interventions, it is necessary to collect data on knowledge, attitudes, behaviour and practices (KABP) regarding HIV and sexual health. However, misSA are difficult to reach and to sample: a) it is unknown how many people with an African migration background are living in Germany, and b) HIV and sexual health topics are highly stigmatized in these communities. We utilized a community-based participatory health research approach to develop a study protocol and conducted a KABP survey on HIV and sexual health among misSA in six German cities between 2015 and 2016. A convenience sample of 2,879 participants was recruited by 99 trained peer researchers through outreach in their local communities. Due to steering of recruitment, the study population reflected the official registered misSA population well and was diverse in terms of sociodemographic characteristics. Peer researchers mainly recruited participants that were similar to themselves with regard to gender, age and regions of origin. Male and younger peer researchers more often recruited participants from vulnerable sub-groups like migrants with a probably undocumented legal status who could not have been reached by probability sampling based on population registers.Peer Reviewe

Reasons for not having undertaken an HIV test among the participants of the MisSA study in Germany 2014–2016 (n = 1,054, multiple answers possible).

<p>Reasons for not having undertaken an HIV test among the participants of the MisSA study in Germany 2014–2016 (n = 1,054, multiple answers possible).</p

Univariable and multivariable analysis for the association between having had the last HIV test in Germany and sociodemographic factors, HIV knowledge, stigma and risk factors among participants of the MisSA study in Germany 2014–2016 (excluding testing without consent for visa, asylum and work purposes) (n = 2,782).

<p>Univariable and multivariable analysis for the association between having had the last HIV test in Germany and sociodemographic factors, HIV knowledge, stigma and risk factors among participants of the MisSA study in Germany 2014–2016 (excluding testing without consent for visa, asylum and work purposes) (n = 2,782).</p

Univariable and multivariable analysis for the association between uptake of HIV testing (ever having undertaken an HIV test) and sociodemographic factors, HIV knowledge, stigma and risk factors among participants of the MisSA study in Germany 2014–2016 (excluding testing without consent for visa, asylum and work purposes) (n = 2,782).

<p>Univariable and multivariable analysis for the association between uptake of HIV testing (ever having undertaken an HIV test) and sociodemographic factors, HIV knowledge, stigma and risk factors among participants of the MisSA study in Germany 2014–2016 (excluding testing without consent for visa, asylum and work purposes) (n = 2,782).</p

Characteristics of male and female participants of the MisSA study in Germany 2014–2016 (n = 2,913) and differences between male and female participants (chi-squared test).

<p>Characteristics of male and female participants of the MisSA study in Germany 2014–2016 (n = 2,913) and differences between male and female participants (chi-squared test).</p