[Observing migration and deficiencies in health care - STD center at the Cologne Municipal Health Department]

Abstract

Background: In spite of the compulsory health insurance in Germany, many people only have limited access to medical services. This has serious consequences, especially in the field of sexual health. The affected people are not only undocumented migrants, but also many people from the new European Union countries who are temporarily living in Germany. Many of these people, especially in larger cities, frequent STD counselling centers.

Method: Since 2002, in addition to basic socio-demographic data, other anonymous data have been recorded for all consultations in the STD offices of the Cologne Health Department. These data include the patients' country of origin, rea-son for consultation, whether the patients are medically insured, as well as the medical services provided and the diagnoses. The data is evaluated with the help of EpiInfo.

Results: During the study period, between 608 and 883 people visited the STD Counselling Centre per year. During this period, 4 235 people received in total medical help. The proportion of patients with a migration history rose from 65% in 2002 to 83% in 2010. The proportion of patients without health insurance rose from 45% (2002) to 67% (2010).About half of the counselled migrants were, at least for a short time, involved in professional sexwork. The number of counselled patients from the sub-Saharan region decreased from 123 (2002) to 72 (2010). The number of patients from Central Europe increased from 112 to 364 in this period.Migrants were over-represented in the group of patients who were diagnosed with gonorrhea and trichomoniasis, as well as among women with a conspicuous cytological swab. Chlamydia infections were, in contrast, more frequent among German clients.Gender, sexual orientation, age and the proportion of people involved in sexwork are, however, more important predictive factors than having an immigration status.

Conclusion: The client spectrum has changed considerably during the study period.These changes are related to economic and political developments, as well as to the consequences of immigration laws. For the majority of patients with a migration history, the STD centre is the primary means of access to medical care in Germany. The rapid change in the client spectrum, the patients' limited access to information and to medical care and the resulting changes in epidemiology represent a major challenge for the public health services.