Author: aj s

AIDS and Behavior, 2021; 25:3638–3650 (doi: 10.1007/s10461-021-03336-3).

Authors: Sean Colyer, Nathan J Lachowsky, Axel J Schmidt, Barry D Adam, Dana Paquette, Trevor A Hart, David J Brennan, Martin Blais, Abigail E Kroch

Abstract

HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30–49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.

Keywords: MSM; pre-exposure prophylaxis (PrEP); PrEP eligibility; PrEP access; PrEP delivery

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Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz (doi: 10.1007/s00103-021-03429-3)

Authors: Ulrich Marcus & Susanne B. Schink

Abstract

Background: Sexual minorities are highly vulnerable to sexually transmitted infections (STIs), mental health problems such as depression and suicidality, and substance use- associated health and social problems. 

Research question: We describe selected findings from the European MSM Internet Survey (EMIS) 2017, one of the largest online surveys of men who have sex with men, and discuss their implications for prevention in MSM in Germany.

Materials and methods: The overall aim of EMIS-2017 was to collect data for planning HIV and STI prevention and treatment programs. The target population were men living in Europe who have sex with men and/or are attracted to men. The questionnaire contained questions on demography, morbidities, beha- viour, needs and interventions. Participants were recruited mainly via two popular online dating platforms from 10/2017 to 01/2018.

Results and discussion: EMIS-2017 shows that MSM are severely affected by psychological stress and STIs. In terms of psychological stress, younger MSM suffer in particular from depressive disorders and suicidality, while the use of alcohol and other psychoactive substances is of concern among older MSM. MSM are more often affected by STIs than the heterosexual majority population. Many STIs are a- or pauci-symptomatic; thus, screening based on risk-assessment is favoured to detect infections. However, for the time being, for some STIs there is no medical and/or public health evidence to support treatment of asymptomatic infections. EMIS-2017 identified needs by subgroups as far as knowledge gaps on PEP (HIV post-exposure prophylaxis) and PrEP (HIV pre-exposure prophylaxis), being reached by information and prevention offers as well as insufficient uptake of such offers.

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ECDC Technical Report, 2020 (doi: 10.2900/492423).

Authors: Rosalie Hayes, Yusef Azad, Cheryl Gowar, Alison Brown & Valerie Delpech, in collaboration with Axel J. Schmidt and Ulrich Marcus This report is part of the 2018 progress reports monitoring the implementation of the Dublin Declaration. It presents the situation among men who have sex with men (MSM), a key group affected by HIV in the WHO European Region, and outlines priorities for action. In addition, case studies provided by health authorities highlight developments in public health policy and programme implementation, specific to MSM.

Executive Summary

Men who have sex with men have been disproportionately affected by the HIV epidemic since its start in Europe in the 1980s. The burden of HIV on this group has been exacerbated by homophobia and HIV stigmatisation, which hampered the public health response and the availability and accessibility of prevention tools. Today, sex between men remains the main mode of transmission of HIV in Western Europe.

While some countries report a recent decline in HIV incidence among MSM as a result of successful combination prevention efforts, diagnoses have continued to rise in the majority of countries in Europe and Central Asia. In particular, there has been an eight-fold increase (710%) in diagnoses in the East sub-region since 2008.

In the 2018 reporting year, the ECDC survey was used to collect data to monitor implementation of the 2004 Dublin Declaration from the national health authorities in the Region. The survey contained specific questions in relation to the HIV epidemic among men who have sex with men, in addition to questions relating to current national prevention interventions, policies and barriers to the public health response to the epidemic.

Forty-six of the 52 reporting countries prioritise MSM as a key population in their HIV response, with 31 countries selecting MSM as their top priority (17 West; 13 Centre; 1 East). Findings are compared against the global 90-90-90 targets. The report also includes key findings from the European Men who have sex with Men Internet Survey 2017 (EMIS-2017).

The report presents the continuum of HIV care across the region and classifies results according to countries that provided data on: (a) all four stages, (b) no  stages, and (c) at least two consecutive stages of the continuum of care nationally as well as disaggregated data, where available, for MSM. Only 19 countries, i.e. less than half of reporting countries, were able to submit two consecutive stages of data for the HIV continuum for MSM. It is hence difficult to gauge what is the real situation for this key population is across Europe and Central Asia.

Based on the findings, priorities for action to address the HIV epidemic among men who have sex with men are outlined in the report.

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AIDS Care 2020; 32(2):47-56 (doi: 10.1080/09540121.2020.1739219).

Authors: Margot Annequin, Virginie Villes, Rosemary M. Delabre, Tristan Alain, Stéphane Morel, David Michels, Axel Jeremias Schmidt, Annie Velter & Daniela Rojas Castro

Abstract

Pre-exposure prophylaxis (PrEP) is fully reimbursed by the French health insurance system since 2016. However, uptake of PrEP is slower than expected and little is known about men who have sex with men (MSM) who are eligible for PrEP according to French guidelines, but not using it. This study aims to (1) assess and describe MSM that are eligible to PrEP but not using it, and (2) identify potential individual and structural barriers of PrEP uptake among eligible MSM who are aware and intend to take PrEP. Data from EMIS-2017, a cross-sectional internet survey among gay, bisexual, and other MSM, were used. Among 7965 respondents without diagnosed HIV, 9.2% were PrEP users. Among 7231 non-PrEP users, 35.2% were eligible to PrEP and 15.2% were eligible, aware and intended to take PrEP. Eligible MSM who are not using PrEP are mostly younger, students, less “out”, living in small cities, using condoms more frequently but still with low self-efficacy regarding safe sex and more distant from preventive health care and information than PrEP users. Despite free PrEP availability in France, results suggest that PrEP is not fully accessible and that there is a need to increase PrEP demand and decentralize PrEP delivery.

Keywords: MSM; pre-exposure prophylaxis (PrEP); PrEP eligibility; PrEP access; PrEP delivery

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Sexuality Research and Social Policy, 2020; 17:543–557 (doi: 10.1007/s13178-019-00413-0).

Authors: Peter Weatherburn, Ford Hickson, David S. Reid, Ulrich Marcus & Axel J. Schmidt

Abstract

Men-who-have-sex-with-men (MSM) carry a disproportionate burden of sexually transmitted infections across Europe. Health planners require sexual health needs assessment data to respond appropriately. In addition, surveillance of risk and precaution behaviours in this population enables evaluative judgements of policy responses. The European MSM Internet Survey (EMIS-2017) aimed to repeat the pan-European online survey on male homosexual behaviour conducted in 2010, both to update information required to plan and monitor health promotion interventions and consolidate harmonisation of existing behavioural surveillance approaches. Our study team collaborated with more than 200 partners from academia, public health and civil society across 50 countries. Starting from our previous EMIS-2010 questionnaire, partners engaged in three rounds of iterative survey development and piloting until the final content was agreed. Transfer to an online survey application was followed by further pretesting before translation into 32 additional languages, final testing and sign-off. The survey was available to complete online in 33 languages simultaneously from 18 October 2017 to 31 January 2018. Ten international MSMdating mobile apps were paid to send short promotional messages, and national partners promoted the survey via at least another 272 websites and social media accounts. Real-time monitoring of responses facilitated targeted advertising by country and recruitment source. Ultimately 144,305 cases were submitted of which 137,358 (95.2%) were eligible for inclusion. EMIS-2017 demonstrated the feasibility of multi-country online MSM surveying with public funding. Meaningful involvement of a large number of collaborators in the survey design and its execution ensured successful recruitment. Careful design, piloting and presentation ensured the survey was acceptable and had authority and perceived community benefit. Partners in 38 countries have already been supplied with a national database of 100 or more respondents for national analysis, while the study team has focussed on international comparisons among 137,358 respondents in 50 countries.

Keywords: Male homosexuality, Online survey, Behavioural surveillance, Prevention, Internet, HIV, Sexually transmitted infections

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ECDC Technical Report, 2020 (doi: 10.2900/034039).

Authors: Erika Duffell and Teymur Noori

This report provides the first collation of data relating to the monitoring of the progress towards the elimination of hepatitis B and C for EEA countries and the UK. Data were collated from a range of existing sources pertaining to epidemiological context, prevention and control, and impact. Data were also collected directly from all Member States on testing and treatment indicators for the continuum of care in relation to hepatitis B and C. Despite the limitations of existing data sources and inherent difficulties arising from the diversity of data and gaps in completeness, this collated information represents an important step towards understanding the priority areas for action and gaps in the national responses to the hepatitis B and C epidemics. The data also provide an important baseline to help map progress towards the WHO elimination targets and ultimately achieve the 2030 sustainable development goals.  

Executive Summary

Based on estimates of prevalence in the general population, there are an estimated total of 4.7 million chronic hepatitis B virus (HBV) cases and 3.9 million chronic hepatitis C virus (HCV) cases in the European Union/European Economic Area (EU/EEA). Although the region is a low prevalence region for both infections, there is wide variation among countries with estimates of hepatitis B surface antigen (HBsAg) prevalence in the general population up to 4.4% and anti-HCV prevalence to 5.9%. Estimates of HBsAg among key risk groups show similar variation with very high prevalence of HBsAg reported among prisoners (25.2% in Bulgaria) and injecting drug users (5.6% in Cyprus), highlighting gaps in vaccination programmes. There is greater variation in the range prevalence of anti-HCV among key risk groups with extremely high levels of infection (>50%) reported among injecting drug users in most countries with available data and among prisoners (45.8% in Finland).

Estimates of the size of key populations affected by hepatitis are important but are lacking in most countries. Estimates of the prevalence of injecting drug use are available from the European Monitoring Centre for Drugs and Drug Addiction (EMCDDA) and these show variation between countries. Data from three countries indicate that nearly a half of those injecting report having shared needles/syringes in the last four weeks.

Vaccination is a major component of any hepatitis B prevention strategy and data indicate that although four countries lack a national policy for universal vaccination of children, 83% of EU/EEA countries that implement childhood vaccination have achieved 90% coverage with three doses of HBV vaccine. Robust data on coverage among key populations such as prisoners and people who inject drugs (PWID) are lacking and available information suggests gaps in local policies targeting these groups.

Perinatal transmission of HBV is not commonly reported in EU/EEA countries. Countries implement different strategies to prevent mother-to-child transmission but data are lacking on these programmes. Available data from the five countries that implement universal new-born vaccination indicate that four of these countries (80%) report 85% coverage with a timely HBV birth dose1 and all the countries that implement antenatal screening and have available data report 85% coverage of screening in pregnant women and 90% coverage with post-exposure prophylaxis.

In terms of blood safety, the prevalence of HBV and HCV infections among first time blood donors is low and the number of transfusion associated HBV and HCV infections reported by EU/EEA countries is low. All EU/EEA countries screen blood donations using quality assured methods in accordance with to EU standards and have haemovigilance systems in place.

Transmission of infection among men who have sex with men (MSM) was reported to account for around one in seven acute HBV and HCV infections in 2017. Evidence from EMIS-2017 indicates gaps in service provision in relation to HBV vaccination targeting MSM.

PWID are disproportionally affected by HBV and HCV infections due to the sharing of injecting equipment and epidemiological evidence indicates a high prevalence of both infections, especially HCV, and ongoing transmission. Countries have implemented prevention programmes targeting PWID but data on the coverage are lacking from half the countries. The available data indicate that only a small proportion of countries have achieved the 2020 target for coverage of needle and syringe programmes (NSP) but the majority of countries with data have reached the 40% coverage target for opioid substitution therapy (OST).

Around a third of all EU/EEA countries reported no action plan or strategy for hepatitis prevention and control and, of those with a plan/strategy, nearly half reported there was no funding for implementation. However, it should be noted that the existence of an action plan or strategy does not always correlate with progress made at the local level towards elimination.

Overall, 23 countries provided data for at least one of the four key stages of the continuum of hepatitis B care and 27 countries provided data for hepatitis C care. Two countries were able to provide data along the continuum for hepatitis B and 11 countries provided data for hepatitis C. There were significant gaps in the completeness of data and the robustness of the data is suboptimal in many areas. Increasing the availability and robustness of data is important, as it enables countries to assess with confidence the effectiveness of their hepatitis B and C response; monitor progress towards the Sustainable Development Goals (SDGs) and European Action Plan targets and identify areas that require greater attention, particularly the significant health inequalities faced by certain key population groups.

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International Journal of Environmental Research & Public Health, 2020; 17(20): 7379 (doi: 10.3390/ijerph17207379).

Authors: Ford Hickson, Max Appenroth, Uwe Koppe, Axel J. Schmidt, David Reid and Peter Weatherburn

Abstract

Some men who have sex with men (MSM) were assigned female at birth (AFB) and/or identify as trans men. Little is known about how these men differ from other MSM. We compared sexual and mental health indicators from the European MSM Internet Survey (EMIS-2017), comparing men AFB and/or currently identifying as trans men with those assigned male at birth (AMB) who identified as men. EMIS-2017 was an opportunistic 33-language online sexual health survey for MSM recruiting throughout Europe. We used regression models adjusting for age, country of residence and employment status to examine differences across groups. An analytic sample of 125,720 men living in 45 countries was used, of which 674 (0.5%) were AFB and 871 (0.7%) identified as trans men. The two sub-groups were not coterminous, forming three minority groups: AFB men, AFB trans men and AMB trans men. Minority groups were younger and more likely unemployed. Anxiety, depression, alcohol dependence and sexual unhappiness were more prevalent in sex/gender minority men. Conversely HIV and STI diagnoses were less common. AMB trans men were most likely to have sexual risk behavior with steady partners and to have unmet health promotion needs, and were least likely to be reached by interventions. Sex assigned at birth and trans identification were associated with different sexual and mental health needs. To facilitate service planning and to foster inclusion, sex-assigned-at-birth and current gender identity should be routinely collected in health surveys.

Keywords: trans men; homosexuality; transgender; LGBT; anxiety; depression; STIs; HIV; community survey

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