# 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

## TL;DR

This study explores how different work environments affect HIV/STI risk among African male and gender-diverse migrant workers in Northern Italy.

## Contribution

The study introduces a mixed-methods approach using the Theory of Planned Behavior to analyze how client-seeking venues influence sexual health outcomes.

## Key findings

- Referral-based networks were the most common client-seeking strategy, significantly associated with sexual health outcomes.
- Online-based sex work showed the lowest condom use and STI disclosure, while brothel-based work showed higher condom use and STI awareness.
- Peer support and negotiation dynamics varied across venues, shaping HIV/STI risk behaviors.

## Abstract

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.

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).

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.

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.