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

PLoS One. 2018 Apr 11;13(4):e0194244. doi: 10.1371/journal.pone.0194244. eCollection 2018.

Abstract

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.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Africa South of the Sahara / ethnology
  • Aged
  • Attitude to Health
  • Community-Based Participatory Research*
  • Cross-Sectional Studies
  • Emigrants and Immigrants
  • Female
  • Germany / epidemiology
  • HIV Infections / diagnosis*
  • HIV Infections / ethnology*
  • HIV Infections / psychology*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Male
  • Middle Aged
  • Patient Education as Topic
  • Risk-Taking
  • Sample Size
  • Sexual Behavior
  • Social Stigma*
  • Surveys and Questionnaires
  • Transients and Migrants
  • Young Adult

Grants and funding

The study was funded by the German Federal Ministry of Health. The funding was granted to the Robert Koch Institute, Berlin, dated August 13, 2014 for the study "KABP (knowledge, attitudes, behaviour and practices)-study with optional HIV/STI-testing among migrants from sub-Saharan Africa living in Germany (MisSA-study)". The funds are budgeted in the federal budget 2014, chapter 1502, title 68618 - Research and projects for identification and elimination of AIDS and other sexual transmitted infections. Project lead: Claudia Santos-Hövener, Grant number: ZMVI5-2514-AUK-001 The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.