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Substance Use and HIV Risk Among African Refugee and Migrant Sex Workers in Italy: A Mixed-Methods Study Informed by
Samira Shirzaei Nichols1, Gamji Rabiu Abu-Ba'are2,3, Carolina Rigo4
1Department of Computer Information Systems & Analytics, College of Business, University of Central Arkansas, 201 Donaghey Ave, Conway, AR, 72035, USA. sshirzaei@uca.edu.
AIDS and Behavior
|July 14, 2026
Summary
Substance use increases among African refugee and migrant sex workers in Italy after entering sex work. This impacts HIV testing, healthcare access, and STI diagnoses, highlighting structural barriers.
Area of Science:
- Public Health
- Sociology
- HIV Research
Background:
- Substance use is a known risk factor for HIV vulnerability.
- Limited understanding of substance use patterns and structural exclusion among African male and gender-diverse refugee and migrant sex workers in Italy.
Purpose of the Study:
- To explore the intersection of substance use, structural exclusion, and HIV vulnerability in this population.
- To examine changes in substance use before and after entering sex work and its association with HIV-related outcomes.
Main Methods:
- Sequential mixed-methods study in Northern Italy.
- Qualitative strand: 20 in-depth interviews and 2 focus groups.
- Quantitative strand: Structured survey of 150 participants.
Main Results:
- Participants reported significantly higher substance use after entering sex work.
- Injection substance use linked to lower HIV testing, reduced sex work enjoyment, and lower healthcare engagement.
- Non-injection use associated with greater HIV service awareness and higher disclosure odds.
- Escalating substance use correlated with increased HIV testing, healthcare stigma, immigration barriers, and reduced voluntary healthcare access.
Conclusions:
- Structural discrimination and immigration barriers significantly shape substance use and HIV risk for refugee sex workers.
- Interventions must address both structural factors and behavioral HIV prevention strategies.
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