Intersecting Structural Vulnerabilities and Health Risks: A Quantitative Epidemiological Study of HIV and STI Burden Among African Migrant Male Sex Workers in Italy. BSGH 027

African migrant male sex workers (AMMSWs) remain underrepresented in Europe’s HIV and STI prevention research. This sequential mixed-methods study examined the prevalence and determinants of HIV and sexually transmitted infections (STIs) among 150 AMMSWs in Verona and Turin, Italy. Guided by the structural vulnerability framework, quantitative data were collected via a REDCap mobile survey and analyzed using descriptive statistics, chi-square tests, and Firth’s penalized logistic regression to identify structural and behavioral correlates of HIV and STI testing outcomes.Among participants, 46.1% who had ever tested for HIV reported a positive result, and 36.0% tested positive for an STI. Firth regression revealed that self-medication as a primary source of care was significantly associated with higher odds of testing HIV negative (AOR = 3.84, 95% CI: 1.26–13.46, p = 0.017). Greater distance to healthcare facilities (≥ 6 km) predicted lower odds of HIV negativity (AOR = 0.41, p = 0.076). For STI outcomes, identifying as gay (AOR = 2.50, 95% CI: 1.08–5.94, p = 0.033) and awareness of HIV/STI services (AOR = 2.29, p = 0.072) were protective, whereas immigration-related healthcare challenges were linked to increased STI positivity (AOR = 0.48, p = 0.071).These results underscore how intersecting structural and behavioral factors, including geographic inaccessibility, stigma, and migration-related barriers, shape health inequities among AMMSWs. Interventions must expand culturally competent, community-led testing, PrEP access, and legal reforms to address the structural drivers sustaining HIV/STI vulnerability.