Sexual Health Help-Seeking Behavior among Migrants from Sub-Saharan Africa and South East Asia living in High Income Countries: A Systematic Review

Abstract

The number of migrants has increased globally. This phenomenon has contributed to increasing health problems amongst migrants in high-income countries, including vulnerability for HIV acquisition and other sexual health issues. Adaptation processes in destination countries can present difficulties for migrants to seek help from and gain access to health services. This study examined migrants’ from sub-Saharan Africa (SSA) and South East Asia (SEA) sexual health help-seeking behavior in high-income countries with universal health coverage. The systematic review followed PRISMA guidelines and was registered with PROSPERO. Several databases were searched from 2000 to 2017. Of 2824 studies, 15 met the inclusion criteria. These consisted of 12 qualitative and three quantitative studies conducted in Australia, Spain, the United Kingdom, Belgium, Scotland, Ireland, and Sweden. Migrants experienced a range of difficulties accessing health services, specifically those related to sexual health, in high-income countries. Few studies described sources of sexual health help-seeking or facilitators to help-seeking. Barriers to access were numerous, including: stigma, direct and indirect costs, difficulty navigating health systems in destination countries and lack of cultural competency within health services. More culturally secure health services, increased health service literacy and policy support to mitigate costs, will improve health service access for migrants from SSA and SEA. Addressing the structural drivers for stigma and discrimination remains an ongoing and critical challenge.

The role of mobility in sexual risk behaviour and HIV acquisition among sub-Saharan African migrants residing in two European cities

“…Epidemiological evidence shows that HIV risk for women is often associated with regular relationships, since interpersonal dynamics in long term relationships may act as a barrier to adopting protective behaviours [51]. Alongside, migration-related stressors including adaptation processes in host countries have been viewed as increasing migrants' vulnerability for sexual health-related problems, such as HIV and other STI [52]. By having condomless sex in both their host country and their homeland, migrants may be at risk of cross-border transmission of HIV and other STI as documented elsewhere [53].…”

Why I Can’t, Won’t or Don’t Test for HIV: Insights from Australian Migrants Born in Sub-Saharan Africa, Southeast Asia and Northeast Asia

“…Previous work has identified the role of community and religious leaders in addressing HIV stigma and increasing uptake of HIV testing [23,71], and peer workers in facilitating access to services [72]. To date, there is little published research on interventions to increase HIV testing among migrants in high-income countries [13,60], and further research is needed to identify what works with different groups in various settings. Interventions should target risks for migrants associated with frequent travel back to countries of birth, promote safe sexual behaviour whilst travelling, and encourage testing on return [26,64].…”

“…The reasons for late diagnosis of HIV among SSA and SEA migrants living in high-income countries (HIC), such as Australia, are broadly understood. Our previous research indicated that population mobility (movement between countries) can be a risk factor for HIV, as risk behavior of the individual may change in the destination country [8,9,10,11,12,13]. Mobility may also increase vulnerability to HIV acquisition, as an individual’s access to health services and social support changes [8].…”

“…A systematic review of barriers and facilitators to HIV testing among migrants in HIC also found low knowledge of HIV, poor patient-provider relationships, and concerns of confidentiality acted as barriers to testing [25]. There has been little research addressing Australian migrants’ perspectives on the barriers and facilitators to accessing HIV-related health services in Australia [13].…”

Distance as Explanatory Factor for Sexual Health Centre Utilisation in an Infrastructure-Rich Urban Area in the Netherlands: A Population-Based Multilevel Study

“…Previous research showed that more distant healthcare facilities may actually be preferred for stigmatized health conditions (24,25). It is known that migrants perceive more shame and stigma related to STIs (5,26). Also, perceived issues with con dentiality and privacy at the GP may play a role in choosing anonymous STI testing at the SHC (4,27).…”