The prevalence of HIV/STD among African migrants in China remains uncertain. In this study, we established a hospital-based surveillance site and reported the HIV/STD prevalence among African migrants in China based on laboratory test results. We found that the utilization of HIV/STD testing services among African migrants in China is inadequate. Additionally, we identified associations between their HIV/STD testing behaviors and factors such as living place in Guangzhou, medical insurance, and health service utilization in China.
Our study revealed a higher prevalence of HIV (1.0%), syphilis (2.5%), and HBV (5.5%) among African migrants compared to all foreigners arriving in Guangzhou (0.02% for HIV, 0.6% for syphilis, and 2.3% for HBV, respectively) [14]. This difference may be attributed to the demographic characteristics of the participants in our study. Specifically, a higher proportion of participants in our study fell within the younger age range (18–49 years: 90.0% vs. approximately 72.3%) and had lower levels of education (high school and below: 58.5% vs. 26.9%). These factors may contribute to a higher proportion of high-risk sexual behaviors [8]. However, when comparing the prevalence of HIV/STD among African migrants with other high-risk groups such as men who have sex with men (HIV: 5.7%, syphilis: 5.8%) and attendees of STD clinics (NG: 11.95%, CT: 12.02%) in China, the prevalence among African migrants still remains relatively low [15–17]. Among the tested HIV/STDs in our research, the prevalence of HBV (5.5%) among African migrants was found to be the highest. However, it was lower than the prevalence in the general Chinese population (6.89%) and the general population of African countries (18.9% in Somalia, 7.8% in Kenya, 8.1% in South Africa, and 8.5% in Uganda) [18–22]. Due to the limited data available in our study, we lack sufficient information to analyze the reasons for the difference in HBV prevalence between African migrants and the general Chinese and African populations. Further research is needed to determine the contributing factors.
Although the HIV/STD prevalence among African migrants in this research was not significantly higher compared to other high-risk groups, it still requires further attention due to the potential risk of HIV/STD infection. The majority of African migrants in this study were young adults, which is consistent with findings from previous studies [23] and indicates a sexually active population. Approximately half of the participants reported engaging in sexual behaviors in Guangzhou, and among them, 31.0% and 27.5% reported never using condoms with regular partners or temporary partners, respectively, highlighting the risk of HIV/STD infection. However, only 23.0% of participants had ever received an HIV test in China, which is considerably lower than the testing rates among African migrants in the United Kingdom (51.8%) and Canada (64.0%) [24, 25], as well as the testing rates reported among individuals aged 15 years and older in South Africa (73.8%-76.7%) [26].
The low HIV/STD test rate can be attributed to several factors. Firstly, there was a policy change in China in 2010 that eliminated the requirement for foreigners to provide negative HIV test results as a visa requirement upon entry. Consequently, there are currently no mandatory HIV testing requirements during their stay in China [27]. Additionally, the low medical insurance coverage, which was only 19.5% in this research, is associated with a lower uptake of HIV/STD testing among African migrants. Furthermore, language barriers have been identified as critical factors affecting the HIV/STD testing behavior of African migrants [8], limiting their access to routine medical services and free HIV/STD testing services in China, such as the HIV voluntary counseling and testing program (VCT) [28, 29].
The low HIV/STD test rate, coupled with limited health service utilization (only about half of the participants received healthcare utilization in the past year in China), hinders the local disease control center (CDC) from obtaining a comprehensive understanding of the HIV/STD prevalence among African migrants. Consequently, effective intervention measures are not readily available. Therefore, it is crucial for the government to actively improve and formulate medical security policies as a priority. Additionally, the following monitoring measures are recommended: 1) Enhance awareness of HIV/STD testing by providing health education in the mother language of African migrants, which should include HIV/STD preventive knowledge and information about nearby health institutions. 2) Increase healthcare utilization rates by improving healthcare availability, including the provision of targeted medical services at African migrant residences and enhancing the language proficiency of healthcare providers. 3) Establish a persistent and active HIV/STD surveillance network among international migrants in China to gather health information that is currently unavailable through the passive surveillance system.
Limitations
Several limitations of this study should be acknowledged. Firstly, although the study site covered the three major African migrant settlements, namely Sanyuanli, Xiaobei, and Taojin, the limited sample size may introduce sampling bias, making it challenging to accurately reflect the level of HIV/STD infection in this population. Secondly, the factors associated with HIV/STD testing among African migrants are numerous and complex, potentially extending beyond the scope of this investigation. Therefore, further research is needed to collect more comprehensive information and provide a deeper understanding of the topic. Lastly, as with any questionnaire survey, recall bias may have existed for some participants, which is inevitable.