Search strategy

We systematically searched the following eight scientific databases: PubMed, Scopus, Web of Science, Embase, ProQuest (Health and Medical Sciences and Public Health Collections), Emcare, PsycINFO, CINHAL and grey literature (relevant and peer-reviewed reports from organisational websites including the World Health Organisation (WHO), Refugees and Migrants, Amnesty International, The United Nation Refugee Agency, International Organization for Migration, Settlement Services International, Red Cross, Medecins Sans Frontières, Armed Conflict Location and Event Data Project, The Uppsala Conflict Data Program). In addition to these databases, the reference lists of all the articles included in this review were screened to identify further potential articles.

The search strategy (S1 Appendix) was based on four major search topics: Individuals from culturally and linguistically diverse backgrounds (CALD)/migrants (as defined in the Australian context [31]), men, gender and sexual and reproductive health. We included peer-reviewed articles published between 2000–2023, due to the availability of official migration trend data, that adhered to the inclusion criteria detailed in Table 1.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Table 1. Inclusion and exclusion criteria of studies included in the scoping review.

https://doi.org/10.1371/journal.pone.0322312.t001

Data extraction and synthesis

All papers identified from the systematic search were downloaded and saved into an Endnote library. They were then transferred to Covidence software for title and abstract screening using the inclusion and exclusion criteria as stated in Table 1.

Five authors independently conducted title/abstract screening and full-text review of the articles (on Covidence), and each study was then independently assessed by two authors; results were cross-checked, and differences were discussed and resolved. The PRISMA flowchart (Fig 1) shows the reasons for article exclusion. Basic data was initially extracted from each paper using an Excel spreadsheet developed by the first author, including information on publication year, study design, country of origin and migration and the SRH themes discussed, such as contraception, marriage etc.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Fig 1. PRISMA flow diagram.

https://doi.org/10.1371/journal.pone.0322312.g001

Due to the high level of qualitative papers included in the review (86.11%), thematic analysis was the most appropriate analysis technique [33]. Frequencies, patterns and relationships found in the quantitative data were transformed into descriptive statistics when thematically analysing the papers. NVIVO software (2023/version 14) was used to analyse and generate initial codes for all included articles, as described in Fig 2. Themes broadly described patterns in the data relevant to the research question.

Download:

• PPT
  PowerPoint slide
• PNG
  larger image
• TIFF
  original image

Fig 2. Timeline of thematic coding events.

https://doi.org/10.1371/journal.pone.0322312.g002

A theoretical framework developed by Evans et al. in 2011 [34] that explores the influence of masculinity throughout the life course was used to further analyse and interpret the results of this review. The Health, Illness, Men and Masculinities (HIMM) framework was adapted to create a deeper understanding of how masculinity intersects with other social determinants of health, including ethnicity, education and community, to influence health outcomes [34]. The framework acknowledges that social, political and historical contexts, as well as life events, influence a man’s views of masculinity, sexuality and health. The analysis for this review was informed by the HIMM framework of the ways that masculinity intersects with migration and cultural beliefs to impact SRH health-seeking behaviours.

I. Depleted masculinity

This theme discusses the ways in which the differences in cultural beliefs and practices impact refugee and migrant men’s views of gender and how these changes result in feelings of depleted masculinity.

1. (i). Changes to traditional roles: “lack of domestic authority”

Many studies in this review found that refugee and migrant men struggled to understand and accept the “threatening” [58] change in “gender and power dynamics” [58] after migration [38,42,43,47,49,52,58,61,65,67], with many Asian and black men living in families where the household is the mothers domain and everything outside of the household is the fathers [58]. However, as many host countries do not follow these traditional gender roles, some men, from a wide range of cultural backgrounds, perceived changes in their gendered responsibilities as “going against religion and tradition” [38] and believed their wives were “too confrontational” [49] and “outspoken” [68] in their new country. However, some men from Asian, black and Hispanic backgrounds, believed “there’s no specific difference in what a man or a woman can do” [67] and felt the change to be “empowering” [58]. This sense of depleted masculinity mainly stemmed from men from global backgrounds no longer being the “head of the house” [47] and losing their “breadwinner status domestically” [43]. This forced men to learn new domestic skills, previously attributed to being “woman’s duties” [57,58,65,68], which caused many to feel “powerless and frustrated” [65]. Two studies involving men from Hispanic and Mexican backgrounds in this review similarly reported that men participated in these domestic duties in their new country but stopped in front of their community, feeling shame with their perceived decreased domestic status [57,68]. In contrast, others from Pakistan found “alternative but valued forms of masculine identity… far removed from the oppressive patriarchal figures”, mainly in “being responsible and caring husbands” [42]. One study involving Mexican men in the United States of America reported that, whilst the “conservative nature of their expectations around gender roles”, including helping with the house work, was maintained after migration, many men did begin to participate in duties they deemed to be “the work of women” [57]. Thus, many found these migratory changes in cultural norms to be a protective factor, with men developing “increased respect of their wives as equal partners” [58].

Moreover, refugee and migrant men across studies strongly believed that women were “more suited for taking care of children” [49,52,67], a belief that was not influenced by the duration of settlement in one study [52] but was deeply ingrained in their cultural beliefs and norms. This “lack of domestic authority” [42], often combined with unemployment and loneliness, resulted in poor mental health among many husbands from diverse cultural backgrounds, contributing to negative experiences in their new country [42,43,47].

1. (ii). Failure to meet expectations: “inadequacy, helplessness and failure”

Eight studies in this review found that feelings of cultural “inadequacy, helplessness and failure” [36] was a source of depleted masculinity for refugee and migrant men [36,40,41,46,52,58,65,69]. Many cultural beliefs showed men, particularly those from Mexican and African backgrounds, as the “provider, protector and guardian” of the family, which “implied the powerful status of men” [52] and displayed their “predatory sexuality” [46]. Thus, refugee and migrant men who failed to build this traditional family (a wife and multiple children), were unable to prove their “legitimate heteronormative sexuality” [46] for both their families in their home country and others in their new country [40,41,46,58,61].

In contrast, some studies involving men from Mexican and Afghanistan, found that “sexual banter and conversations” [52] were a greater source of masculine validity within their new culture [52,65]. Thus, some were able to maintain their masculine status through engagement in these conversations, regardless of relationship status or sexual activity. Further, many men from diverse cultural backgrounds felt increased pressures to build a family after migration, some reporting comments of “you’re worthless, you’re useless” from family members when struggling to meet family and cultural expectations of a “big family” [44,57]. Studies further reported that men from Hispanic and Mexican origins maintained ideas of “machoism”, “infidelity” [58,69], non-use of contraception [58], and “always want[ing] to initiative sex” after migration as ways to “prove their masculinity” through sexuality [69].

Additionally, the unemployment that many refugee and migrant men faced often resulted in them feeling they had lost their “credibility” as a man and a provider [36,43,44,46,47,63,65,67,70]. This resulted in some men, particularly from Afghanistan and Hispanic backgrounds, seeking “unstable sexual partnerships” to gain “housing and support” and a way to compensate for the masculinity they felt they had lost [65,68]. However, unemployment also led to feelings of shame and emasculation for many men due to their inability to support themselves and their families. This depleted some Hispanic men’s “sex drives, motivation, activeness and involvement with their duties” [68], common effects of depression.

The analysis also identified that some men’s feelings of cultural and masculine “failure and inadequacy” were exacerbated by “negative comments from their wives”, “shaming” and criticizing their “lack of economic opportunity” [36]. Some men, from a range of cultural backgrounds including Moroccan and Asian, reported “devising strategies” to reclaim “their power” [61] and “leadership” [49] over their household, turning to anger and violence towards their wives. In contrast, a mixed-methods study found that men who migrated from Africa after their wives struggled with their in-laws’ ability to “exploit their position of power” and force them into domestic chores as ways to undermine them [43]. This resulted in “tension with their own gendered aspirations for life post-migration”, exacerbating feelings of depleted masculinity [43]. Further, some men reported that their wives contributed to these feelings of “emasculation” by supervising their domestic duties, an already threatening chore for many of these men, further resulting in resentment toward their wives and their life in their new country [43].

1. (iii). Marriage, migration and divorce: “against our traditions and customs”

Six studies included in this review involved married and/or divorced migrant men with conflicting views on marriage and divorce [36,38,42,47,61,67]. For some migrant men from a number of cultural backgrounds, including Asian and Middle-Eastern, divorce was seen as going “against our traditions and customs” [36,38], many blaming migration and the changes in gender norms for the deterioration of their marriage. Further, some men claimed divorce after migration was an “exploitation of the situation” by their wives, whose migration was funded by their husbands and who could file for a divorce immediately after migrating [38]. Studies showed that many refugee and migrant men from Middle-Eastern, Hispanic and Mexican backgrounds believed the legal and social systems in their new country were “inclined towards women” [67], believing that negative representations of themselves by their ex-wives would be “easily accepted by institutions of state” [42]. Thus, many questioned if laws around divorce and conflict were “rational” [38,47,61,67], causing feelings of inferiority and depleted masculinity. One study reported migrant men from Pakistan being treated as if they “are zero” and “an America’s movie villain” [42]. Moreover, after migration, many Asian men felt that the unfamiliar “formal systemic response” of officials was “affecting our relationship and our family”, by always looking “at the side of the woman” in situations of marital conflict [47]. As most men were used to conflict being resolved in private settings where they had superiority, this was seen as “symbolising men’s disadvantaged position”, which contributed to feelings of depleted masculinity and anger of migrating [47].

II. Sex and sexuality

This theme explores the ways in which views and understanding of sex and sexuality change after migration, the experiences refugee and migrant men have and how they navigate these changes.

1. (i). Greater freedom: “experience their masculinity through an active sexuality”

Greater sexual freedom often came with migration, with men’s new countries seen as more “permissive” societies [61], having “more liberal attitudes” [48] towards SRH [45,48,50,52,55,59–62,64,66,68,70]. Many appreciated the country’s sexual freedom, wanting to “move away from the cultural silencing of sexuality” [45,66], enabling them to explore greater sexual opportunities and learn more about SRH. However, some Middle-Eastern men also felt that Western countries “view migrant ideas of SRH as out-dated”, arguing that their views are not as “traditional” and “taboo” as many believe [45]. An included quantitative study found that both American’s and Asian migrants held similar views regarding sexual initiative, wife choosing and sexual freedom, even reporting less conservative judgements of female sexual behaviours than white Americans, thus supporting the idea of “out-dated” migrant ideas [48]. The stigma and racial discrimination perpetuated towards them within these beliefs decreased their confidence and comfort in their new home [45].

Many included studies commented on migrant men’s post-migration opportunities to have “casual or compensated sexual relationships” [61], including sex with multiple sexual partners and sex workers. Most men saw this as a “positive or neutral” change, enjoying their new sexual freedom [48,50,53,58,60,61,66,68,70]. Thirteen studies correlated this freedom to men living away from their families as this “reduced the likelihood of sexual activities being discovered” [61] by disapproving family members and cultures [45,48,50,52,55,59,60,62,64,66,68,70]. However, this was controversial for some men in seven studies who mentioned that they felt “morally bound” [45] and “limited” [39] by their cultural beliefs and family. Thus, many sought to avoid community “disapproval” by limiting their exploration of sex and sexuality [39,45,46,62,66,70]. Further, promiscuous sexual experiences came with religious guilt for some migrant men, from South Asian backgrounds, who lost connection to their religion after new sexual experiences; “I don’t feel like a Muslim now” [62]. Some men, from multiple cultural backgrounds including Asia and the Middle-East, also viewed this greater freedom as a new societal pressure, causing them to “doubt one’s own masculinity and heterosexuality” [46] if they “reject the advances of young women” [46,50,52,54,66]. Thus, many conformed to these norms even if they did not want to for fear of losing their masculinity and wishing to fit in with their new country. This finding was aligned with data from a mixed-method study that showed almost 15% of Arabic-speaking migrant men feeling dissatisfaction with their sexual life [39]. Further, one study found that migrant men from African backgrounds wanted to “experience their masculinity through an active sexuality that does not wait for marriage”, seeing migration as an opportunity to defy cultural obligations of abstinence [46]. Seven studies further commented on the sexual activities of men separated from their parents after migration, claiming it to be “a necessity” [70] and something they would happily do, and would need to do, after migration, even if infidelity was against their cultural beliefs [40,48,53,60,66,70]. Some refugee and migrant men from diverse cultural backgrounds “simultaneously saw infidelity as both wrong and normal” [70], alluding that, whilst it goes against their culture and beliefs, it is something they engaged with after migration. This was supported by one of the included quantitative studies, involving men from a range of cultural backgrounds including South America and Africa, that saw positive relationships between migration induced family separation and increased extramarital sexual partners [53].

Holding a woman’s virginity in high regard was still common amongst many migrant men, with some wanting to marry a woman with no previous sexual partners [48,61]. This caused many, particularly those from the Middle-East and Africa, to seek “a marriage partner overseas” (commonly in their home country) as they are “less promiscuous” than the women in their new country [61]. Some men from East Asian backgrounds also negatively commented on migrant women’s abilities to have multiple sexual partners, claiming the “culture is very bad for men, but it is good for women because here, women are gaining control” [66]. Many men from a range of Middle-Eastern and African backgrounds saw woman’s sexual freedom as a threat to their masculine dominance, whilst simultaneously enjoying the freedom for themselves [61]. Conversely, some men’s acculturation experience resulted in an increased “recognition of women as equal and valued partners within sexual encounters” [66] and did not feel their masculinity was jeopardised by women’s abilities to have liberal sexual experiences [48,66].

Ten studies included in this review found that migrant men were able to “talk about sex freely” [40] in their host country [37,40,45,50,54–56,60,62,66]. Many men from Middle-Eastern backgrounds found that “discussion of sexual health issues was “more acceptable” than in their home countries and were “appreciative of the exceptional knowledge levels” that doctors and educators had of SRH issues [37]. Many migrant men were raised in Middle-Eastern and Mexican communities where sexual health problems were viewed as “a threat to masculinity”, thus conversations of SRH were “accompanied with shyness, shame, and taboo” [40], with some fearing “being ostracized” if they mentioned sex in their home country [56]. Thus, the “lingering effects of the traditional system” continued to impact some men’s abilities to speak “openly about sexuality” [60] even after migration [40,50,54,56,62].

1. (ii). Safe sex practices: “struggled to adapt [to] unfamiliar sexual norms”

Many refugee and migrant men “struggled to adapt [to] unfamiliar sexual norms” [64], including the use of contraception and initiation of intercourse [39,51,54,57,58,68]. Men commonly held negative associations with condoms; largely attributed to traditional and cultural beliefs and low SRH literacy. Some South Asian men’s religious beliefs “oppose birth control” and were thus never educated on its use and importance and were thus never educated on its use and importance [51]. Others from Middle-Eastern and Latin American backgrounds believed condoms “interfere with men’s virility and sexual performance” [57,58], and are “not associated with pure love” [68]. Further, some mentioned that “condom-less sex” was “far more normative” in their host country as compared to their home, leading them “to practice the same as others do” [64]. Many from African backgrounds understood that “using contraception in general” ensured “good sexual health” [50,55] and had practiced safe sex in both their home and host countries. Additionally, one study involving migrant men from Mexico mentioned that after migration, men felt they were “more responsible” to use contraception, thus increasing their use of condoms [57].

III. Accessing SRH care in a new country

This theme presents a summary of the barriers and facilitators refugee and migrant men experience in accessing SRH countries in their new countries of resettlement.

1. (i). Financial constraints: “more willing to use such facilities if such services were reasonably priced”

Studies included in this review identified that worldwide, refugee and migrant men faced “financial challenges” [35] when seeking support from SRH care services [35,39,43,44,54,63,64,67], prohibiting them from accessing SRH care, and negatively impacting their health outcomes after migration. Although some studies including men from a range of cultural backgrounds, including Afghanistan and Latin America, reported that refugee and migrant men were satisfied with their new employment opportunities and financial status [58,65], others identified men as having “low-paying jobs” [35], often “below their original qualifications’‘ [44], and were thus “unwilling” to pay for health services “because of other commitments” [35,43,67]. Men agreed that they would be “more willing to use such facilities if they were reasonably priced” [35,54].

Further, many studies identified financial barriers to gaining medical insurance cover [35,37,68], accessing transportation to attend appointments and continuing with care advice, including paying for medications, contraception [54,63] and medical tests [54,63]. The low financial security of many refugee and migrant men from Middle Eastern backgrounds had further implications on their ability to “do anything else”, including attending English language lessons, and learning new skills for employment opportunities [41], negatively influencing their abilities to receive and understand health care advice given.

1. (ii). Language barriers: “trapped by their poor English proficiency”

Low English language proficiency was a barrier to accessing SRH care and education for many refugee and migrant men [35,37,39–41,43,54,63,65,68], some reporting feeling “trapped by their poor English proficiency” [41]. However, studies involving men from multiple backgrounds, including Asia, the Middle-East and South America, further commented on the use of translators during SRH consultations, to which more men agreed did not “guarantee effective communication” [63]. Some men were “uncertain about the reliability of interpreting” [40] and had concerns about the confidentiality of their information with a translator [40,63]. Thus, translators did not always serve as an effective incentive for refugee and migrant men to seek SRH care.

Whilst some studies reported men were able to speak with new health providers without feeling “shy” [40], many men lacked the ability to understand the information presented to them in consults and/or promotional material [37,39,40,50,51,54,56,60,63–65,68]. Their “limited confidence to engage in conversation” [43] with English speakers limited them from attending appointments with English-speaking staff. This struggle was further exacerbated by men’s inability to “decode public transport information” to attend appointments and navigate English phone/online booking systems [43], therefore, were unable to make and attend an appointment regardless of their health symptoms.

1. (iii). Low SRH literacy: “no words in their mother tongue for SRH”

Low SRH literacy and understanding of available services emerged as an important barriers in men from refugee and migrant backgrounds’ confidence to seek SRH care [37,40,50,51,54,56,60,63,64,68]. The cultural “negative connotations” [37] surrounding sexual health [37,56,64] and the limited SRH education received in their home countries, which included countries in the Middle East and Latin America, by both institutions and families [40,56], resulted in many refugee and migrant men having their first “exposure to these topics” [37] after migration.

Men’s knowledge of key SRH topics, including contraception, STIs and safe sex, differed greatly depending on their country of origin, education levels and community, as explained by the HIMM framework [34]. Some studies found sound knowledge of AIDS and HIV among migrant men [50,65], whilst others found men to have limited or incorrect beliefs about their SRH illnesses [60,63,68]. Knowledge of contraception [50,54,56] and safe sex [60] was also reportedly low, with religious beliefs and cultural laws playing a large role in their prior education of sexual practices. One study, focusing on men from the Middle East and Pakistan, also reported that, as the men had not received SRH education in their home countries, but migrated at an older age, they were responsible for “studying these things alone” [40], which was done by many using the Internet as an information source [40,54,56]. Whilst this would have been acceptable for some, others may not have internet access and may not have the language and/or computer literacy skills to retrieve and understand information. For example, one study showed that migrant men from Middle Eastern countries considered sexual health to relate only to infertility and reflected on their home countries belief that “sexual satisfaction and pleasure were not considered as important as building a family” [40]. These men would, thus not know what further SRH information is needed to expand their SRH vocabulary and may have difficulties understanding and relating to SRH topics. Furthermore, some migrant men, mainly from North Africa and the Middle East, found they had “no words in their mother tongue for SRH” [45] terms, making it difficult to interpret their meaning even with a basic understanding of the English language, thus disincentivising them from educating themselves and seeking SRH care [37,45,54].

Many studies reported men had a “lack of awareness” of service centres [37,39,57,65], including testing for HIV and STIs [35,64,65] and family planning [57]. Interestingly, a mixed-methods study found that almost 40% of studied men from a range of Middle-Eastern backgrounds, including Syria and Iran, didn’t know where to gain SRH knowledge after migration, whilst only 30% of females didn’t know where to get SRH information [39]. Some Middle Eastern men attributed this lack of knowledge to the “low frequency of messaging” [37] in their host country regarding available services. Many finding it “harder” to receive information on SRH, including “information about AIDS and condoms”, and care services after migration compared to in their home country [65]. This resulted in both low knowledge of where to seek help and insufficient reinforcement that these care services are necessary and available. This could be further exacerbated by the low SRH literacy and English language proficiency of many men from refugee and migrant backgrounds. Included studies further found that migrant men from North and Central American backgrounds considered SRH services to be “women’s services” [57] as they were “not very seen” in their home country, leaving them unaware of their availability and importance [64]. Most of these studies reported that migrant men highly appreciated the “availability of sex education in [migrant countries] schools” and that the open communication of their host country “increased their awareness of the treatments that are available to achieve this [optimal sexual health and performance]” [37,40,62,66].

Knowledge of contraception [54] and safe sex [60] was also reportedly low, with religious beliefs and cultural laws playing a large role in their prior education of sexual practices. Many men, mainly from the Middle East and Latin America, associated condoms with pregnancy only, disregarding infection, or not perceiving “risk [of STI] from girlfriends, with no acknowledgement that they could be infecting their female partners” [39,68]. Further, others from South Asian backgrounds held the stereotypical belief that they were “out of the environment” of HIV [51] after migration, thus feeling they did not need to protect themselves from it as it was not apparent in their new country. However, some refugee and migrant men believed they were at higher risk of HIV in their new country due to “greater ethnic diversity and increased sexual activity” [54,60,68]. One study focusing on African men mentioned that refugee and migrant men used condoms when engaging in “casual relationships and in contact with a prostitute” seeing these activities as a higher risk of infection [50].

1. (iv). Service and system distrust: “You are better off doing something on your own”

Many included studies indicated that distrust in the host country’s health services and health system were barriers to accessing SRH care [35,37,39,40,54,63,64,68]. Men from refugee and migrant backgrounds commonly found that SRH care in their new country was “different” to that of their origin country [45,54], with contrasting critiques of the systems. A major concern was the “tedious” [37] long wait times to see a doctor [35,39,40,63]. As a result, many did not have the time or patience to visit a health professional for SRH issues, particularly those who viewed SRH as a low priority compared to other challenges, including employment. Some men believed they were “better off doing something on your own” as they didn’t have time to wait for a “consultant or specialist” [35]. Further, some men, from a range of backgrounds including South Asia, East Asi and South America, did not understand the concept of patient “waiting lists” for procedures such as elective surgery and often interpreted this as “a doctor’s incompetence”, as this is not something they would experience in their home country [63]. However, others reported positive service experiences, trusting the care they were receiving was satisfactory and confidential and feeling “respected, listened to and cared for in SRH services” [40,45]. Greater “openness” and “trust” in the services came with longer settlement times in one study that focused on men from the Middle-East in Sweden [40].

A major concern for others was in the confidentiality of their information with doctors [35,37,39,54]. Young men from Middle-Eastern backgrounds, in particular, stated they were “not allowed to talk about that [sex]”, and feared their community would find out about their sexual activity if they consulted a doctor [54]. Further, some North African men felt SRH care workers were “minimally equipped to deal” with their unique needs [45] and were thus sceptical to seek consults and trust the advice given. In contrast, others acknowledged that it would be “hard” for healthcare workers “to keep up” [45] with the varying SRH messages and needs of migrant populations. Many of these navigation difficulties seemed to stem from Middle-Eastern men’s visa and residency status [37,42], some fearing “visa-refusal” if they were sexually ill [37]. Many did not trust the health care services and the confidentiality of their consults [35,37,39,54], these visa fears further prohibited them from discussing their SRH with others and seeking any professional care.

Studies in this review also indicated that the “discrimination” [37] and “underestimation” [40] perpetrated toward migrant men by health care services stopped them from trusting in medical advice, deterring them from attending consultations [35,37,39–41,45,54]. This enhanced many men’s desires to seek SRH care from a provider from the same race/religion as themselves, believing their health advice is “less likely to be biased since we are from the same continent” [41,63,64]. Alongside the ability to converse in their language, men from a range of backgrounds including South and East Asia, South America and Russia believed health professionals from similar backgrounds were able to “understand [them] as a person as well as a patient” [63] providing no racial bias. However, many found it difficult to identify these professionals in their local area, deterring them from accessing any SRH services [63].

Strengths and limitation

This review has some strengths and limitations that should be acknowledged. To the best of our understanding, this is the first global scoping review to synthesise the available evidence on the impact that culturally developed views of gender and gender roles have on men’s experience of SRH in the context of migration to a high-income country. Further, our global review included refugee and migrant men from over 25 countries, providing an excellent understanding of the diverse beliefs and SRH practices of men from a wide range of backgrounds. Similarly, as discussed above with the HIMM framework, it is important to note that ‘migrant’ and ‘refugee’ men are not necessarily similar in their migration journeys and background, thus resulting in different views of masculinity and SRH. Despite this, studies included in this review did not disaggregate results by refugee status, thus making it difficult for our review to aggregate based on different migrant groups. Furthermore, the vast majority of included studies were qualitative in nature, thus urging for future research to include more quantitative and mixed-methods approaches. Whilst this study focused only on those migrating to high-income countries, limiting the reach of more global studies, only three geographic regions were recognised in the included studies (North America, Europe and Australasia). Future research should include a broader range of migration context to deepen our understanding of how diverse cultural backgrounds shape migration experiences and sexual health across different host countries.