Author: aj s

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EMIS 2024 International reports 2024

Who is the sexiest man on the planet?

At the end of EMIS-2024, we asked one deliberately unserious question: who is the sexiest man on the planet?

Not everyone appreciated it. Some respondents called it a stupid question. Others thanked us for ending a long survey on a lighter note.

Either way, the answers were revealing.

Not celebrities

Across EMIS-2024 overall, the most common answers were not famous people at all.

A large share of responses was non-specific or highly personal (34%), or missing altogether (15%). Among the clear, repeated answers, two stood out:

  • “Myself” (11%)
  • “My partner” (8%)

Both were more common than any individual celebrity. Even the most frequently named public figures — including Henry Cavill, Brad Pitt, Timothée Chalamet, and Chris Hemsworth — remained below 5%.

The strongest signal, then, is not about fame, but about proximity.

This pattern is not new. In EMIS-2010 and EMIS-2017, “myself” and “my partner” were also among the most common answers, with Brad Pitt — rather than Henry Cavill — leading the celebrity rankings. In 2010, the results were even compared to a Eurovision Sexiest Men Contest, reflecting a similarly playful mix of shared references and local variation.

A shared cultural pool

Where celebrities do appear, the pattern looks less like a universal ranking and more like a generational effect within a shared reference set.

A small group of widely recognisable figures recurs across most breakdowns, but without forming a single stable hierarchy. Rather, the results suggest a common cultural pool, shaped by media exposure and cohort.

Notably, in a survey largely of gay and bisexual men and trans people, these recurring names cluster around white male actors who are publicly presented as cisgender and heterosexual and embedded in mainstream film culture.

Countries: similar structure, local flavour

Across countries, the same structure repeats: many responses are non-specific or highly personal, while “myself” and “my partner” appear consistently and celebrities form a secondary layer.

At the same time, there are some memorable variations.

In Belgium, Germany, and Israel, versions of “stupid question” made it into the top eight responses. In the United Kingdom — and also in Moldova — respondents were more likely to meet the question in the spirit of (British) humour, welcoming a slightly irreverent tone.

In some countries, variants of “all men are sexy” appeared among the more frequent answers. In others, respondents named types rather than individuals — for example muscular men or hairy “bears”.

A serious note on a non-serious question

This was not designed as a scientific ranking of attractiveness, but as a playful open-text item at the end of a long survey.

Even so, the pattern is clear: attraction in EMIS-2024 is not only directed towards celebrities. It is also relational, local, and sometimes self-referential.

In EMIS-2024, the sexiest man on the planet was often not a film star. Quite often, he was you — or someone you love.

Among named responses, the rankings are as follows:.

Overall

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Brad Pitt
  5. Timothée Chalamet
  6. Chris Hemsworth
  7. Tom Holland
  8. Ryan Reynolds

Trans community

  1. My partner
  2. Myself
  3. Pedro Pascal
  4. Henry Cavill
  5. Jason Momoa
  6. Mads Mikkelsen
  7. Ryan Reynolds
  8. Keanu Reeves

Ages 16–24

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Tom Holland
  5. Timothée Chalamet
  6. Manu Ríos
  7. Ryan Reynolds
  8. Chris Evans

Ages 25–39

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Timothée Chalamet
  5. Tom Holland
  6. Chris Hemsworth
  7. Chris Evans
  8. Jake Gyllenhaal

Ages 40+

  1. Myself
  2. My partner
  3. Brad Pitt
  4. Henry Cavill
  5. Chris Hemsworth
  6. Timothée Chalamet
  7. George Clooney
  8. Ryan Gosling

Selected countries

Austria

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Ryan Reynolds
  5. Timothée Chalamet
  6. All men are sexy
  7. Brad Pitt

Azerbaijan

  1. Myself
  2. My partner
  3. Zamiq Həsənov
  4. Burak Özçivit
  5. Antonio Banderas
  6. Tarkan
  7. Brad Pitt

Belgium

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Brad Pitt
  5. Timothée Chalamet
  6. Tom Holland
  7. Ryan Reynolds
  8. Stupid question

Bulgaria

  1. Myself
  2. Henry Cavill
  3. My partner
  4. Chris Hemsworth
  5. Matt Bomer
  6. All men are sexy
  7. Brad Pitt
  8. Manu Ríos

Croatia

  1. Henry Cavill
  2. Myself
  3. My partner
  4. Brad Pitt
  5. Ryan Reynolds
  6. Chris Evans
  7. Joško Gvardiol
  8. Ryan Gosling

Cyprus

  1. Myself
  2. Henry Cavill
  3. My partner
  4. Chris Hemsworth
  5. Jason Statham
  6. Ryan Gosling
  7. Timothée Chalamet
  8. Tom Hardy

Czechia

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Brad Pitt
  5. Tom Holland
  6. Timothée Chalamet
  7. All men are sexy
  8. Chris Evans

Denmark

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Ryan Reynolds
  5. Timothée Chalamet
  6. Jonathan Bailey
  7. Brad Pitt
  8. Chris Hemsworth

Estonia

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Tom Holland
  5. Barry Keoghan
  6. Brad Pitt
  7. Jake Gyllenhaal
  8. Jason Momoa

Finland

  1. My partner
  2. Henry Cavill
  3. Myself
  4. Chris Hemsworth
  5. Timothée Chalamet
  6. Pedro Pascal
  7. Ryan Gosling
  8. Ryan Reynolds

France

  1. My partner
  2. Myself
  3. Brad Pitt
  4. Henry Cavill
  5. Timothée Chalamet
  6. Ryan Gosling
  7. Tom Holland
  8. Chris Hemsworth

Germany

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Chris Hemsworth
  5. Tom Holland
  6. Stupid question
  7. Timothée Chalamet
  8. Brad Pitt

Greece

  1. Henry Cavill
  2. Myself
  3. My partner
  4. Brad Pitt
  5. Tom Hardy
  6. Chris Hemsworth
  7. George Clooney
  8. Ryan Gosling

Hungary

  1. My partner
  2. Henry Cavill
  3. Myself
  4. Timothée Chalamet
  5. Tom Holland
  6. Chris Hemsworth
  7. Manu Ríos
  8. Ryan Reynolds

Ireland

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Chris Hemsworth
  5. Timothée Chalamet
  6. Ryan Reynolds
  7. Tom Hardy
  8. Pedro Pascal

Israel

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Brad Pitt
  5. Timothée Chalamet
  6. Tom Holland
  7. Stupid question
  8. Chris Hemsworth

Italy

  1. Myself
  2. Henry Cavill
  3. My partner
  4. Brad Pitt
  5. Chris Evans
  6. Chris Hemsworth
  7. Manu Ríos
  8. Timothée Chalamet

Kazakhstan

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Brad Pitt
  5. Johnny Depp
  6. Jake Gyllenhaal
  7. Tom Cruise

Luxembourg

  1. My partner
  2. Henry Cavill
  3. Myself
  4. Ryan Reynolds
  5. Brad Pitt
  6. Chris Evans
  7. Timothée Chalamet
  8. Tom Holland

Malta

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Timothée Chalamet
  5. Brad Pitt
  6. Chris Evans
  7. Chris Hemsworth
  8. Jake Gyllenhaal

Moldova

  1. Myself
  2. My partner
  3. Brad Pitt
  4. Volodymir Zelenskyi
  5. David Beckham
  6. Nice Question
  7. Chris Evans
  8. Henry Cavill

Netherlands

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Brad Pitt
  5. Timothée Chalamet
  6. Tom Holland
  7. Chris Hemsworth
  8. Ryan Reynolds

Norway

  1. My partner
  2. Henry Cavill
  3. Myself
  4. Tom Holland
  5. Timothée Chalamet
  6. Chris Hemsworth
  7. Brad Pitt
  8. Ryan Reynolds

Poland

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Timothée Chalamet
  5. Brad Pitt
  6. Tom Holland
  7. Ryan Reynolds
  8. All men are sexy

Portugal / Spain

  1. Myself
  2. Henry Cavill
  3. My partner
  4. Brad Pitt
  5. Chris Hemsworth
  6. José Condessa (Portugal) / Miguel Ángel Silvestre (Spain)
  7. Chris Evans
  8. Manu Ríos (Portugal) / Ricky Martin (Spain)

Romania

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Timothée Chalamet
  5. Brad Pitt
  6. Chris Hemsworth
  7. Ryan Reynolds
  8. Jacob Elordi

Slovakia

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Timothée Chalamet
  5. Chris Evans
  6. Chris Hemsworth
  7. Tom Holland
  8. Brad Pitt

Russia

  1. Myself
  2. My partner
  3. Brad Pitt
  4. Tom Holland
  5. Timothée Chalamet
  6. Henry Cavill
  7. All men are sexy
  8. Ryan Gosling

Sweden

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Brad Pitt
  5. Timothée Chalamet
  6. Chris Hemsworth
  7. Ryan Reynolds

Switzerland

  1. My partner
  2. Myself
  3. Henry Cavill
  4. Ryan Reynolds
  5. Chris Hemsworth
  6. Jake Gyllenhaal
  7. Timothée Chalamet

Ukraine

  1. Myself
  2. My partner
  3. Henry Cavill
  4. Brad Pitt
  5. Tom Holland
  6. Ryan Gosling
  7. Timothée Chalamet
  8. All men are sexy

United Kingdom

  1. Myself
  2. Henry Cavill
  3. My partner
  4. Tom Holland
  5. Ryan Reynolds
  6. Tom Daley
  7. Chris Hemsworth
  8. Timothée Chalamet
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EMIS 2024 Journal Articles 2024 Published Articles

European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2024): Design and Methods

Sexuality Research and Social Policy, 2026 (doi:10.1007/s13178-026-01288-8).

Authors: Liana Aphami, Tamás Bereczky, Jules L Casalini, Nikolay Lunchenkov, Ulrich Marcus, Kai J Jonas, Axel J Schmidt.

Abstract

Introduction. Men-who-have-sex-with-men (MSM), as well as transgender and non-binary individuals, continue to face a disproportionate burden of stigma, mental health challenges, HIV, and other sexually transmitted infections. To address their needs, public health planners require reliable and comparable data. Monitoring behaviours in these populations also supports the evaluation of health policies.

Methods. The European-MSM-Internet-Survey (EMIS-2024) builds on our international surveys conducted in 2010 and 2017, expanding its scope to include explicitly transgender women and non-binary people. It provides much-needed data for planning interventions, promoting health, and harmonising behavioural surveillance. A key strength of EMIS-2024 is the use of a shared sampling frame and a core questionnaire across all participating countries. This approach allows meaningful cross-national comparisons, unlike many national surveys with varying methods. The three core consortium partners (Deutsche Aidshilfe, Robert Koch Institute and Maastricht University) led the revision of the EMIS-2017 questionnaire.

Results. Over 60 partners from 40 countries played a key role in the survey’s success, providing high-quality translations in 35 languages and actively promoting the survey. National partners ensured the survey’s visibility, credibility, and relevance once dating app advertisements or invitations appeared. The survey ran online during the first half of 2024. Overall, 165,380 responses were received, of which 50,330 qualified for the analytic sample.

Conclusions and Policy Implications. EMIS-2024 demonstrates that large-scale, multi-country sexual health surveys are feasible with public funding. A harmonised questionnaire, shared sampling strategy, and meaningful community involvement were key to generating robust, comparable data across Europe.

Country groupings used in EMIS-2024. For analytical purposes in the methods paper, countries are grouped as follows. We suggest this structure as a useful framework for international comparative analyses and journal articles:

  • EEA: Countries of the European Economic Area.
  • Non-EEA Advanced Economies: High-income countries outside the EEA within the WHO European Region (including Switzerland, Israel, and the United Kingdom), based on the International Monetary Fund (IMF) classification of advanced economies.1
  • Western Balkans & Türkiye: Non-EEA countries in south-eastern Europe.
  • Eastern Europe and Central Asia (EECA): Non-EEA countries of the former Soviet Union.

This grouping facilitates epidemiological interpretation and comparability of trends across countries with markedly different economic conditions and epidemiological profiles. The grouping also reflects differences in study coordination and funding arrangements across participating countries and regions.

Available online

Suggested citation:

Aphami L, Bereczky T, Casalini JL, Lunchenkov N, Marcus U, Jonas KJ, Schmidt AJ. European Men-Who-Have-Sex-With-Men and Trans People Internet Survey (EMIS-2024): Design and Methods. Sex Res Soc Policy (2026). https://doi.org/10.1007/s13178-026-01288-8

  1. “Advanced economies” follow the International Monetary Fund’s World Economic Outlook country classification (International Monetary Fund, World Economic Outlook Database: Country Composition of WEO Groups). Alternatively, the term “non-EEA high-income countries” may be used to distinguish between EEA and non-EEA high-income countries, based on the World Bank country classification (World Bank. World Bank Country and Lending Groups). ↩︎
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EMIS 2024 International reports 2024

ECDC Report on STIs

Monitoring of the responses to sexually-transmitted infection epidemics in EU/EEA countries, 2024

Report Details:
Stockholm, European Centre for Disease Prevention and Control, 2024 (ISBN 978-92-9498-855-3).

Suggested Citation:

European Centre for Disease Prevention and Control. Monitoring of the responses to sexually transmitted infection epidemics in EU/EEA countries, 2024. Stockholm: ECDC; 2025

Download report as PDF

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EMIS 2017 Journal Articles 2017 Published Articles

Prevalence and associated factors of selling sex among men who have sex with men (MSM) in Latin America: results from the Latin American MSM Internet Survey in 18 countries (LAMIS-2018)

BMJ Global Health, 10:e021058, 2025 (doi:10.1136/bmjgh-2025-021058).

Authors: Mariano Salazar, Nicolas Lorente, Axel J Schmidt, Kai Jonas, Signe Svallfors, Anna Mia Ekström, Torsten Berglund, Carlos F Cáceres, Susanne Strömdahl, Valeria Stuardo, Jordi Casabona

Introduction: Selling sex has been associated with negative social and health outcomes, but most studies have been limited geographically and have not distinguished between selling and buying sex. This study assesses prevalence and factors associated with selling sex in the last 12 months among men who have sex with men (MSM) in 18 Latin American countries.

Methods: Data were collected in 2018 through the Latin American MSM Internet Survey, a cross-­ sectional online survey. Of 64 655 participants, 9585 were excluded due to data inconsistencies on age and partner status, and 1728 due to missing outcome data, yielding an analytic sample of 53 342. Multivariable logistic regression was used for analysis.

Results: Overall, 6.9% (10.3% among MSM aged 18–24) reported selling sex in the previous year. Higher odds of selling sex were associated with younger age, low education, being born abroad, low financial coping, substance use, potential alcohol dependency, early sexual debut with a male partner, low sexual agency and sex with women. High educational level and having a steady male partner were associated with lower odds.

Conclusions: Key factors associated with selling sex among MSM in Latin America include socioeconomic, behavioural and relational variables. Harm reduction and preventive interventions may be particularly needed among younger MSM. Codeveloping these interventions with the MSM community can ensure sustainability, relevance and strengthen providers’ ability to offer individualised, respectful care. Longitudinal and qualitative studies are needed to monitor long-­ term health and tailor interventions to individual needs.

Available online

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EMIS 2017 Journal Articles 2017 Published Articles

Modelling the health and cost implications of expanded access to HIV, HCV and sexually transmitted infection testing in Switzerland

Swiss Medical Weekly, 155(12):4581, 2025 (doi:10.57187/s.4581).

Authors: Harsh Vivek Harkare, Marina Antillón, Axel J. Schmidt, Fabrizio Tediosi

Background: This study was conducted as part of the Swiss National Programme to Stop HIV, Hepatitis B Virus, Hepatitis C Virus and Sexually Transmitted Infections (NAPS), which aims to reduce the spread of sexually transmitted infections in Switzerland. The goal was to identify the most effective and cost-efficient screening strategies to lower the incidence of human immunodeficiency virus (HIV), hepatitis C virus (HCV), syphilis, Neisseria gonorrhoeae and Chlamydia trachomatis by improving access to screening.

Methods: A Markov model was developed to assess the impact of various screening strategies among key populations over two years, including men who have sex with men (MSM), female sex workers (FSW) and people who inject drugs (PWID). The model further stratifies individuals based on partner number (MSM) and injection-equipment sharing (PWID). Comprehensive cost estimates for screening and treatment were derived from insurance data, literature and expert opinions. The effectiveness of screening interventions was evaluated by measuring reductions in disease incidence and cost savings, comparing the costs of screening to those of acute and chronic care for prevented infections.

Results: Increased screening frequency among key populations led to a reduction in incidence for all five infections studied. The largest effect was seen in people who inject drugs who share injecting equipment, where HCV incidence fell by up to 76% with four annual screens. However, only screening for HIV, HCV and syphilis proved to be cost-saving. Screening for Chlamydia trachomatis and Neisseria gonorrhoeae consistently incurred net costs due to the high screening costs and relatively low treatment costs.

Conclusion: Targeted expansion of screening among key populations can reduce the incidence of HIV, HCV and syphilis in Switzerland, with regular screening offering potential cost savings to insurers under specific coverage and treatment scenarios.

Available online

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EMIS 2024 Published Articles

On the regional distribution of chemsex in Germany

Authors: Dirk Sander & Axel J Schmidt.

Suggested citation: Sander D, Schmidt AJ (2025). Zur regionalen Verbreitung von Chemsex in Deutschland (EMIS-2024). Deutsche Aidshilfe, Berlin.

Abstract:

Chemsex—the use of psychoactive stimulant substances to enhance and prolong sexualised social encounters—has become a significant public health issue in recent years. Member organisations of the AIDS service sector have implemented targeted support services and provide education and training for counselling, care, and peer-led self-help.

For the planning and delivery of health interventions, it is essential to understand how many people are affected by health impairments associated with substance use in sexual settings. Such information determines the level and distribution of resources required across prevention, counselling, self-help, and therapeutic services in order to prevent or reduce health-related harms.

Accordingly, this analysis uses data from EMIS-2024, together with population estimates, to describe the prevalence of chemsex-related behaviours in Germany, differentiated by federal states and selected larger cities.

Our calculations indicate that the alignment between existing services and potential needs points to a marked underprovision. Existing services should therefore be expanded and new approaches developed. These approaches must be capable of reducing existing stigma related to (homo)sexuality and substance use, thereby facilitating access to services for those affected.

Available online in German
See also the German-language news segment produced by Hessischer Rundfunk.

Categories
EMIS 2024 National reports 2024

EMIS-2024 National Reports

EMIS-2024: Germany. On the regional distribution of chemsex in Germany

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EMIS 2017 Journal Articles 2017 Published Articles

Levels of Homonegative Abuse Among Men Who Have Sex with Men in Peru and Their Association with STI and/or HIV Testing: An Analysis from the Latin American Men Internet Survey

International Journal of Sexual Health, 2025 (doi: 10.1080/19317611.2025.2573694).

Authors: Joselito Malca-Hernandez, Michael Reyes-Diaz, Axel J Schmidt & Carlos F. Caceres

Abstract

Objectives: To examine the prevalence and geographic distribution of homonegative abuse (HA) among men who have sex with men (MSM) in Peru and its association with HIV/STI testing.

Methods: We analyzed data from 1,934 MSM from Peru who participated in the 2018 Latin American Men Internet Survey (LAMIS). We assessed the prevalence and geographic distribution of HA (intimidation, verbal abuse, and physical violence due to sexual orientation) across four macro-regions: Lima/Callao, Coast, Highlands, and Amazonia. Associations with sociodemographic characteristics and HIV/STI testing behavior were explored through comparative analyses, using prevalence ratios adjusted for key sociodemographic variables.

Results: Approximately 61% of participants reported HA in the previous year. Intimidation (56%) was the most common, followed by verbal abuse (34%) and physical violence (4%).HA was more prevalent in the Coast (67%) and Highlands (66%) than in Lima/Callao (59%). Factors positively associated with recent HA included younger age, financial hardship, lower education, gay identity, and high levels of outness. No significant association was found between HA and HIV/STI testing.

Conclusions: HA is prevalent among Peruvian MSM, especially outside the capital macro-region (Lima/Callao). These findings highlight the need for further research to investigatewhether specific sources of HA may be linked to reduced use of sexual healthcare services among MSM in Peru and support targeted interventions addressing the sociocultural contexts that perpetuate abuse against MSM in Peru.

Available online

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EMIS 2024 International reports 2024

EMIS-2024: Community Reports Europe

We thank our network partners for their translations of the following Community Reports.

The 1st EMIS-2024 Community Report, aimed at EMIS respondents as well as MSM and trans and non-binary people in general, has been published in 33 languages in June/July 2025. We thank our network partners for their contributions and translations, and particularly Dr. Dirk Sander and Dr. Tamás Bereczky of the German NGO Deutsche Aidshilfe (German AIDS Federation) for leading the process.

The first Community Report focusses on mental health and chemsex.

1st EMIS-2024 Community Report

1st EMIS-2024 Community Report Arabic (العربية)

1st EMIS-2024 Community Report Armenian (Հայերեն)

1st EMIS-2024 Community Report Bosnian-Croatian-Serbian-Montenegrin (Srpskohrvatski)

1st EMIS-2024 Community Report Bulgarian (Български)

1st EMIS-2024 Community Report Czech (Čeština)

1st EMIS-2024 Community Report Danish (Dansk)

1st EMIS-2024 Community Report Dutch (Nederlands)

1st EMIS-2024 Community Report English

1st EMIS-2024 Community Report Estonian (Eesti)

1st EMIS-2024 Community Report Finnish (Suomi)

1st EMIS-2024 Community Report French (Français)

1st EMIS-2024 Community Report Georgian (ქართული)

1st EMIS-2024 Community Report German (Deutsch)

1st EMIS-2024 Community Report Greek (Ελληνικά)

1st EMIS-2024 Community Report Hebrew (עברית)

1st EMIS-2024 Community Report Hungarian (Magyar)

1st EMIS-2024 Community Report Italian (Italiano)

1st EMIS-2024 Community Report Kazakh (Қазақ тілі)

1st EMIS-2024 Community Report Latvian (Latviešu)

1st EMIS-2024 Community Report Lithuanian (Lietuvių)

1st EMIS-2024 Community Report Macedonian (македонски)

1st EMIS-2024 Community Report Maltese (Malti)

1st EMIS-2024 Community Report Norwegian (Norsk)

1st EMIS-2024 Community Report Polish (Polski)

1st EMIS-2024 Community Report Portuguese (Português)

1st EMIS-2024 Community Report Romanian (Română)

1st EMIS-2024 Community Report Russian (Русский)

1st EMIS-2024 Community Report Slovak (Slovenčina)

1st EMIS-2024 Community Report Slovenian (Slovenščina)

1st EMIS-2024 Community Report Spanish (Español)

1st EMIS-2024 Community Report Swedish (Svenska)

1st EMIS-2024 Community Report Turkish (Türkçe)

1st EMIS-2024 Community Report Ukrainian (Українська)

Categories
EMIS 2017 Journal Articles 2017 Published Articles

PrEP Coverage in men who have sex with men in Germany across 95 regions

German-Austrian AIDS Conference (DÖAK) 2025. Poster Nr. 194.

Authors: Axel J Schmidt, Daniel Schmidt, Dirk Sander, Silke Klumb.

Abstract

Background. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical intervention for HIV prevention. 
Its adaption among men-who-have-sex-with-men (MSM) is vital for achieving public health goals. 

This study assesses PrEP coverage across 95 postal code areas (PCAs) in Germany, identifying underserved regions and visualising supply-demand gaps using geographic data. 

Methods: We used geo data from the German Ministry of Health (gesund.bund.de) to locate physicians qualified to prescribe PrEP under statutory health insurance (supply). 

MSM populations (excluding HIV-diagnosed men) engaging in anal sex with multiple partners in the same regions (demand) were estimated (EMIS-2017 data). Standardisedsupply-demand ratios (SSDRs) were calculated, ranging from 0 to 1.

Postal code areas for Berlin (10,12,13), Hamburg (20,22), Munich (80,81), and Ruhr (44,45) were merged for the maps.

Findings: By Q3/2024, 455 physicians across Germany were prescribing PrEP. The highest MSM concentrations were in postal code areas 10xxx (Berlin; k=10.7), 20xxx (Hamburg; k=6.8), and 80xxx (Munich; k=4.0). Despite large prescriber numbers in these three cities (N=79, N=31, and N=32), SSDRs were moderate (0.39, 0.50, and 0.47). 

Conversely, the highest SSDRs were observed in areas with lower MSM concentrations, including PCAs 54xxx (Trier), 77xxx (Offenburg), 93xxx (Regensburg), and 39xxx (Magdeburg). Notably, 21 PCAs had no qualified prescribers, and 20 had only one.

Interpretation: PrEP supply is uneven across Germany, with better coverage in some regions with lower MSM concentrations but strong engagement from community organisations, while many major cities remain underserved. 

Addressing these disparities requires targeted efforts to increase the number of PrEP prescribers, particularly in urban hubs with significant MSM populations. Improved planning is crucial to ensure equitable access and reduce HIV transmission nationwide.

Available online