Investigating pathways for predisposing, enabling and need factors in predicting the use of STI/HIV-testing services among Syrian and Iraqi migrants in Scania, Sweden - a cross-sectional study with directed acyclic graphs for modelling pathways to testing

Pia Svensson; Anette Agardh; Slobodan Zdravkovic; Benedict Oppong Asamoah

doi:10.1186/s12889-022-14615-6

Investigating pathways for predisposing, enabling and need factors in predicting the use of STI/HIV-testing services among Syrian and Iraqi migrants in Scania, Sweden - a cross-sectional study with directed acyclic graphs for modelling pathways to testing

BMC Public Health. 2022 Nov 25;22(1):2177. doi: 10.1186/s12889-022-14615-6.

Authors

Pia Svensson¹, Anette Agardh², Slobodan Zdravkovic³, Benedict Oppong Asamoah²

Affiliations

¹ Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden. pia.svensson@med.lu.se.
² Social Medicine and Global Health, Department of Clinical Sciences, Lund University, Malmö, Sweden.
³ Department of Care Science, Faculty of Health and Society and Malmö Institute for Studies of Migration Diversity and Welfare (MIM), Malmö University, Malmö, Sweden.

Abstract

Background: Some groups of migrants have increased vulnerability to Sexually Transmitted Infections (STI) and Human Immunodeficiency Virus (HIV) transmission partly due to a lower uptake of disease preventive activities targeting the general population in receiving country. Limited access to economic and social resources and poor language skills may exacerbate exposure to sexual risks and utilization of health services.

Aim: To explore general and migrant specific predictors for STI/HIV-testing among Syrian and Iraqi migrants in Sweden and to investigate potential pathways that link predisposing, enabling and need- factors to STI/HIV-testing.

Method: Cross-sectional study design based on a migration specific framework for health care utilization. Directed acyclic graphs (DAGs) were used to model assumptions about factors associated with the uptake of STI/HIV-testing services. Bi-variable and multivariable logistic regression analyses assessed individual predictors while adjusting for covariates. The magnitude of the indirect effect of mediating variables were estimated with bootstrap analyses and a method for decomposing the total effect.

Result: The pathways between younger age, unmarried, and self-identifying as bi- or homosexual and testing were mainly indirect, mediated by experiences of sexual coercion and other risk behaviours. One third of the indirect mediating effect of the pathway between higher education and testing could be attributed to Swedish language skills.

Conclusion: Utilization of STI/HIV-testing services among Syrian and Iraqi migrants seemed to be motivated by sexual risk exposure and risk awareness. Interventions should focus on language-adapted information about available screening services and where to go for advice on sexual wellbeing and sexual rights. Such activities should be implemented within an integration promoting framework, addressing structures that increase STI/HIV risk exposure, specifically targeting vulnerable subgroups of migrants.

Keywords: Directed acyclic graph; Health care utilization; Migrant; Prevention; STI/HIV-testing; Sexual risks.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cross-Sectional Studies
HIV Infections* / diagnosis
HIV Infections* / epidemiology
HIV Infections* / prevention & control
Humans
Iraq
Sexually Transmitted Diseases* / diagnosis
Sexually Transmitted Diseases* / epidemiology
Sexually Transmitted Diseases* / prevention & control
Sweden
Syria
Transients and Migrants*