A scoping review of sexual and reproductive health recommendations in the context of migration to Europe

In recent years, growing instability and conflict around the world have continued to fuel outward migration, including migration to the EU/EEA. Many migrants hail from countries and regions with a higher burden of STIs-including HIV-and are exposed to enhanced risks of sexual and gender-based violence leading to sexual health issues during their journeys. This scoping review aims to identify existing sexual health recommendations for non-European migrants in the EU/EEA and identify gaps in their implementation. Sexual health recommendations formulated in relation to the migrant population in peer- reviewed journals or by expert consensus, between 2010 and 2021, were included. A keyword search was used to retrieve relevant publications on PubMed, ScienceDirect, the Cochrane Library databases, WHO and ECDC websites. The search strategy employed was charted in a dedicated Prisma Chart. Overall, 180 publications were retrieved. Based on the abstract and after eliminating duplicates, 33 publications were included for full-text reading. The references of these publications were screened. In total, 19 publications met the inclusion criteria. Evidence-based sexual health recommendations target only newly arrived migrants and migrant children (at arrival and during stay in the country). Screening practices are mostly informed by the country of origin and related prevalence, which remains a limitation; challenges faced during migration should also be considered. Implementation and compliance with these recommendations remain uncertain, as sexual health is not funded and addressed in a uniform manner across Europe.

Epidemiology and determinants of reemerging bacterial sexually transmitted infections (STIs) and emerging STIs in Europe

In this scoping review, we offer a comprehensive understanding of the current and recent epidemiology, challenges, and emerging issues related to bacterial sexually transmitted infections (STIs) in the WHO European Region. We endeavour in collating data from both EU/EEA and non- EU/EEA countries, thereby giving a complete picture of the region which highlights the higher notification rates in Northern and Western countries than other regions, likely due to differences in testing, access to testing, and surveillance capacity. We provide an up-to-date review on the current knowledge of determinants and persistent inequities in key populations as well as the use of molecular epidemiology for identifying transmission networks in gonorrhoea and syphilis, and detecting chlamydia mutations that evade molecular diagnosis. Finally, we explore the emerging STIs in the region and the evolving transmission routes of food and waterborne diseases into sexual transmission. Our findings call for harmonized STI surveillance systems, proactive strategies, and policies to address social factors, and staying vigilant for emerging STIs.

Gender, migration and violence among third country nationals accessing the sexual health clinic in Malta

BACKGROUND

In 2020 the number of displaced people worldwide reached 41.3 million (IOM, 2020). Among them, are many migrants and refugees at risk of sexual and gender-based violence (SGBV). Healthcare providers have a key role to play in identifying migrant victims/survivors of violence.

OBJECTIVES

This paper seeks to assess STIs prevalence, sexual health and sexual violence among third country nationals (TCNs) attending the GUC in Malta.

METHODS

This is a mixed methods study carried out at the Genitourinary Clinic (GUC), which is the only public sexual health clinic in Malta. Demographic data, sexual history and diagnoses of patients attending the GUC between January 2018 and December 2019 were collected and retrospectively analysed. A SGBV risk assessment was performed through a semi-structured questionnaire.

RESULTS

In the 24-month study period, a total of 12,654 patients accessed the GUC in Malta. Demographic data was collected on age, gender, nationality, marital status, and sexual orientation. 16.4% (n=2,064) of these were extra-European migrants, predominantly male. 80 different nationalities were recorded, with the 5 most common being Nigerian, Filipino, Libyan, Syrian and Brazilian. The average age was 32.6 years. Over 110 sex workers were visited at the GUC in the study period - 20 were foreign, primarily from China. The presence of a "massage parlour owner" during consultation, lack of control over passports and other factors were identified as warning signs of trafficking. 5 cases of sexual violence and forced prostitution involving girls from Sub-Saharan Africa and, in 2 cases, boys recently arrived in Malta by boat, were encountered. 6 African women accessing the service exhibited a type of female genital mutilation (FGM).

CONCLUSIONS

Migration, sexual health and SGBV overlap in important ways. Further research and training in SGBV and migration in the healthcare setting and awareness-raising about existing services among the migrant population are required.

Sexually transmitted infections' epidemiology and knowledge, attitude and practice survey in a set of migrants attending the sexual health clinic in Malta

BACKGROUND

The number of international migrants is estimated at 272 million people worldwide. In Europe, migrants face the disproportionate burden of infectious diseases, including hepatitis B and C, HIV and sexually transmitted infections (STIs). High-risk behaviours, sexual abuse, poor living conditions and barriers to accessing health care may affect migrants' sexual health, leading to infections.

OBJECTIVES

The study evaluates STIs and HIV prevalence and knowledge, attitude and practice (KAP) in non-European migrants attending the sexual health clinic in Malta. It also seeks to explore situations of human trafficking (HT), sex/gender-based violence (S/GBV) and female genital mutilations (FGM).

METHODS

This is a mixed-method study, based on quantitative and qualitative research within a single centre. An anonymous pretested questionnaire was administered to non-European migrants attending the genitourinary clinic (GUC) with the assistance of an ethnocultural agent. Demographics, STI diagnoses and risk behaviours were collected from the GUC database, linked to the questionnaires and analysed.

RESULTS

A total of 143 migrants took part in the study, 73% were young male and 16.7% men who have sex with men (MSM). Forty-one different nationalities were recorded, and the top ones were Nigerian (12%), Filipino (7.4%) and Chinese (5.4%). Concerning risk behaviours, 33.8% of respondents had never used a condom and 76.5% had had sex with multiple partners in the 6 months prior to the study. STI prevalence was 73.1%. Of the patients interviewed, six females were Chinese sex workers employed in massage parlours, potentially trafficked to Malta.

CONCLUSIONS

The study outcomes support the need of improving awareness about STIs/HIV risk and testing. In migrants at particular risk for HIV, combination prevention strategies should include access to pre-exposure prophylaxis and antiretrovirals independently from migrants' legal status. Finally, STIs/HIV prevention in migrants should be linked with interventions tackling HT and other forms of S/GBV.