Migration and Sexual Health Services Use – Results from the German Health and Sexuality Survey (GeSiD)

Introduction Migration background is an important predisposing characteristic of health service use (HSU). In this
cross-sectional survey, we aim to explore the association between migration background and HSU in the context of
sexual health.
Methods In a population-representative sample of 4,955 persons from all German federal states (data collection 2018/2019),
we examined the HSU of first-generation (15.9% of the total sample) and second-generation migrants (9.8%) compared to
non-migrants (74.3%). Outcomes of sexual HSU ranged from primary and secondary prevention measures such as human
papillomaviruses (HPV) vaccination and chlamydia test to HSU due to sexual problems in the relationship, and consultations
on contraceptives, and HIV or other STIs.
Results Generally, first-generation migrants used sexual health services less often than non-migrants. Notably, first-
generation migrant women had lower odds of being vaccinated against HPV (OR = 0.24; 95% CI: 0.14; 0.38), of a
lifetime use of both a chlamydia test in the context of a screening program for young women (OR = 0.21; 95% CI:
0.11; 0.39), and a HSU due to contraceptives (OR = 0.40; 95% CI: 0.28; 0.58). Second-generation migrants resembled
more closely the non-migrants, only showing differences regarding the use of the HPV vaccination (OR = 0.48; 95%
CI: 0.30; 0.76).
Policy Implications First-generation migrants showed remarkable differences in the HSU compared to non-migrants.
Therefore, this group should be targeted with the aim of a more equitable HSU that is mainly based on the needs
for health services and not restricted due to formal or informal barriers. Both migration generations had lower
odds of being vaccinated against HPV indicating the need for a better education regarding the benefits and risks of
vaccinations.
Keywords Health service use · HPV vaccination · Chlamydia test · Contraceptives · Migration · Generational cohorts
approach · Native population