title: Determinants of HIV, viral hepatitis and STI prevention needs among African migrants in Germany; a cross-sectional survey on knowledge, attitudes, behaviors and practices.
abstract: BACKGROUND
  Migrants from sub-Saharan Africa (MisSA) are a relevant sub-group for HIV-transmission in Germany. A total of 10-15 % of all newly diagnosed cases are MisSA, and approximately one third acquired HIV in Germany. There is limited information on knowledge, attitudes, behaviors and practices (KABP) regarding sexual health in African communities residing in Germany.
  
  
  METHODS
  From October-December 2013 we conducted a cross-sectional survey on KABP regarding HIV, viral hepatitis (HEP), and sexually transmitted infections (STI) among MisSA in Hamburg as a community-based participatory research project to identify knowledge gaps, sexual risk behavior regarding HIV/HEP/STI, HIV/STI-testing history and attitudes toward people living with HIV (PLWH). Trained peer researchers recruited participants through outreach. Questionnaires in German, English or French were either administered face-to-face or self-completed. Questions on knowledge about HIV/HEP/STI presented true statements; participants were asked if they knew the information before. To detect differences in sub-groups, unadjusted odds ratios (OR) were calculated, and a multivariate analysis for knowledge on HIV/HEP/STI was performed.
  
  
  RESULTS
  The final sample included 569 participants of whom 57 % were men. Most participants originated from Western and Central sub-Saharan Africa. Median time living in Germany was 6 years. Overall, 28 % had a university degree and 54 % reported a good level of German language. Over 80 % knew the risks for HIV transmission. A total of 44 % of respondents wrongly assumed that an HIV-diagnosis might lead to deportation and 64 % were not aware of the free and anonymous local HIV/STI-testing service. The proportion of participants with knowledge of presented facts on HEP varied from 40-58 %. The respective proportion on STI was 28-68 % and better among women compared to men (44 % vs. 54 %; OR = 1.45; 95 % CI 1.22-1.74). Men reported more often casual sex partners than women (43 % vs. 23 %; OR = 2.6; 95 % CI 1.7-4.0), and more frequently a previous STI (58 % vs. 39 %; OR = 2.1; 95 % CI 1.1-4.1). Overall, 16 % of women reported a history of sexual violence. The majority of respondents (75 %) reported that they would treat PLWH like any other person.
  
  
  CONCLUSIONS
  Study participants demonstrated good knowledge on HIV-transmission but knowledge gaps regarding HIV/STI-testing services, HEP and STI. This calls for targeted interventions providing more information about these topics in African communities in Hamburg and possibly also elsewhere.
authors.affiliation: Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. Santos-HoevenerC@rki.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Santos-Hövener
authors.affiliation: Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. MarcusU@rki.de.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Marcus
authors.affiliation: Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. KoschollekC@rki.de.
authors.forename: Carmen
authors.initials: C
authors.lastname: Koschollek
authors.affiliation: AIDS Foundation Hamburg, Lange Reihe 32, 20099, Hamburg, Germany. Hapsatou.Oudini@aidshilfe-hamburg.de.
authors.forename: Hapsatou
authors.initials: H
authors.lastname: Oudini
authors.affiliation: AIDS Foundation Hamburg, Lange Reihe 32, 20099, Hamburg, Germany. Mara.Wiebe@aidshilfe-hamburg.de.
authors.forename: Mara
authors.initials: M
authors.lastname: Wiebe
authors.affiliation: Youth Migration Service Hamburg, AWO Schleswig-Holstein, 20099, Hamburg, Germany. Omer-Idrissa.Ouedraogo@awo-sh.de.
authors.forename: Omer Idrissa
authors.initials: OI
authors.lastname: Ouedraogo
authors.affiliation: Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. ThorlieA@rki.de.
authors.forename: Adama
authors.initials: A
authors.lastname: Thorlie
authors.affiliation: Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. BremerV@rki.de.
authors.forename: Viviane
authors.initials: V
authors.lastname: Bremer
authors.affiliation: Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. HamoudaO@rki.de.
authors.forename: Osamah
authors.initials: O
authors.lastname: Hamouda
authors.affiliation: Institute for Epidemiology, Social Medicine and Health Systems Research, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hanover, Germany. Dierks.Marie-Luise@mh-hannover.de.
authors.forename: Marie-Luise
authors.initials: ML
authors.lastname: Dierks
authors.affiliation: Department for Infectious Disease Epidemiology, Division for HIV/AIDS, STI and Blood-borne Infections, Robert Koch Institute, Seestr. 10, 13353, Berlin, Germany. AnderHeidenM@rki.de.
authors.forename: Matthias
authors.initials: M
authors.lastname: An der Heiden
authors.affiliation: Department of Epidemiology, Helmholtz Centre of Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. Gerard.Krause@helmholtz-hzi.de.|Hannover Medical School, Hannover, Germany. Gerard.Krause@helmholtz-hzi.de.
authors.forename: Gérard
authors.initials: G
authors.lastname: Krause
mesh_terms: D000328:Adult; D017954:Africa South of the Sahara; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000517:prevention & control; D006293:Health Promotion / Q000458:organization & administration*; D006505:Hepatitis / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data; D008875:Middle Aged; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000517:prevention & control*; D014171:Transients and Migrants / Q000706:statistics & numerical data*; D055815:Young Adult