ArticleResearch square2026
Client-Seeking Environments, Safety Management, and Survival Strategies Among African male and gender-diverse refugee/migrant workers in Northern Italy: A Theory of Planned Behavior Mixed-Methods Study. BSGH026.
Article in Research square, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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7 authors.
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Abstract
Background: African male and gender-diverse refugee/migrant workers in Europe face intersecting structural vulnerabilities that shape HIV/STI risk. Client-seeking environments may influence sexual health behaviors, yet limited evidence examines how venue-based strategies affect condom use, STI disclosure, and risk negotiation. Methods: We conducted a sequential exploratory mixed-methods study among African male and gender-diverse refugee/migrant workers in Northern Italy. Qualitative data from 20 in-depth interviews and 2 focus group discussions informed a structured survey administered to 150 participants. Guided by the Theory of Planned Behavior, we examined associations between client-seeking venues and sexual health outcomes, including condom use, STI disclosure, awareness of clients' STI status, and engagement in unprotected sex under financial pressure. Fisher's Exact Test and two-proportion z-tests were used (p < 0.05). Results: Referral-based networks were the most common client-seeking strategy (62.7%), followed by bars/clubs (14.0%), street-based work (13.3%), online platforms (6.7%), and brothels (3.3%). Client-seeking venue was significantly associated with awareness of clients' STI status (p = 0.003), condom use (p = 0.009), STI disclosure (p = 0.005), and acceptance of unprotected sex (p = 0.011). Online-based sex work was associated with the lowest condom use and STI disclosure, while brothel-based work showed higher reported condom use and STI awareness. Qualitative findings indicated that differences in peer support, negotiation dynamics, and perceived control across venues shaped these outcomes. Conclusions: Client-seeking environments are critical determinants of HIV/STI risk among AMGRM. Venue-specific interventions that strengthen peer networks, improve condom negotiation capacity, and integrate digital health strategies are needed to reduce risk and enhance engagement in HIV prevention and care.
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