There is an unavailability of comprehensive information in Western Europe on HIV prevalence among Sub-Saharan African immigrants, especially among male and female sex workers. SSA immigrants, men who have sex with men, people who use drugs, and sex workers experience a disproportionate burden of HIV compared to other persons. Thus mirroring reported burdens among the same populations in SSA. Within immigrant gateway countries such as Italy, SSA refugee male and female sex workers may face intersectional stigma, have low HIV knowledge, and have poor access to HIV testing, prevention, and care services. These groups of individuals face a further challenge of economic and legal vulnerabilities and stigma associated with their characteristics (e.g., poverty, sex work, undocumented status, male-to-male sex, Black race, etc.) Hence, it’s important to understand their stigma, HIV and sexual health risk factors, and ways to create interventions to enhance their sexual health.

The RIfESH: The collaboration titled “Refugee Initiative for Enhancing Sexual Health (RIfESH)” Aims to understand HIV risk behaviors, experiences of intersectional stigma, and place-based factors that impact HIV and sexual health outcomes among refugees, especially those with increased risk behaviors such as male and female sex workers and people who use drugs. RIfESH will also develop interventions to improve sexual health among the mentioned refugees in Italy. The empowerment model: RiFESH is unique as it does not only focus on improving sexual health by connecting refugees to services, but the team also includes refugees who work with operators of CIRCOLO Pink and other investigators to lead a positive change in their lives and their peers. This empowerment module patiently trains refugees, irrespective of their educational background, to leverage their experiences working for the general good of refugees in Italy. They lead the recruitment and data collection and will participate in intervention development and implementation.

RIfESH phase 1: To launch the initiative, the team led by Dr. Gamji Rabiu Abu-Ba’are, an assistant professor of nursing and public health from the University of Rochester, secured a pilot grant from Yale University Center for Interdisciplinary Research on AIDs to assess risk behaviors, stigma, and HIV testing among refugee male sex workers. The study hopes to gather information to inform the development of an intervention to address these risk factors and stigma and to enhance capacity for HIV testing through self-testing, which is the first step to entering the HIV care process. This will ultimately lead to a series of interventions that will address HIV and sexual health outcomes among SSA refugees in Verona and Italy at large.

Study activities: The study activities include four focus group discussions among refugees and health care providers in Turin and Verona, two on each site, interviews among ten refugees and providers, and a survey among 150 refugees. This will focus on the travel experience, life experiences in Italy, and HIV outcomes in Italy. This first stage will specifically focus on understanding ways to improve HIV self-testing, an excellent initiative for a mobile population like refugees. Next steps: We will use the information in Phase 1 to seek grants to implement the HIV self-testing intervention and, subsequently, a status-neutral intervention that will link them to HIV prevention and care services regardless of their HIV status after testing.

By Gyasi Nimako Isaac