Author: aj s

AIDS: June 19, 2015 – Volume 29 – Issue 10 – p 1239-1246 doi: 10.1097/QAD.0000000000000724

Authors: John Pachankis, Mark Hatzenbuehler, Ford Hickson, Rigmor C. Berg, Peter Weatherburn, Ulrich Marcus, Axel J. Schmidt

Abstract

Objective: Substantial country-level variation exists in prejudiced attitudes towards male homosexuality and in the extent to which countries promote the unequal treatment of MSM through discriminatory laws. The impact and underlying mechanisms of country-level stigma on odds of diagnosed HIV, sexual opportunities, and experience of HIV-prevention services, needs and behaviours have rarely been examined, however.

Design: Data come from the European MSM Internet Survey (EMIS), which was administered between June and August 2010 across 38 European countries (N = 174 209).

Methods: Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes held by the citizens of each country. We also assessed concealment, HIV status, number of past 12-month male sex partners, and eight HIV-preventive services, knowledge, and behavioural outcomes.

Results: MSM living in countries with higher levels of stigma had reduced odds of diagnosed HIV and fewer partners but higher odds of sexual risk behaviour, unmet prevention needs, not using testing services, and not discussing their sexuality in testing services. Sexual orientation concealment mediated associations between country-level stigma and these outcomes.

Conclusion: Country-level stigma may have historically limited HIV transmission opportunities among MSM, but by restricting MSM’s public visibility, it also reduces MSM’s ability to access HIV-preventive services, knowledge and precautionary behaviours. These findings suggest that MSM in European countries with high levels of stigma are vulnerable to HIV infection. Although they have less opportunity to identify and contact other MSM, this might change with emerging technologies.

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International Journal of Sexual Health, 27:3, 286-302, DOI: 10.1080/19317611.2014.982263

Authors: Rigmor C. Berg, Axel J. Schmidt, Peter Weatherburn, The EMIS Network

ABSTRACT

Objectives: Transactional sex (TS) is generally defined as the trading of sex for material goods. Cast within the broader context of prostitution laws, we examined variations in the sociodemographic profile of men who have sex with men engaging in TS by payment direction (buying/selling). Methods: The data were collected as part of the 38-country European Men who have sex with men Internet Survey project, conducted in 2010. Results: About 12% of respondents reported engaging in TS in the past year. TS was associated with laws, age, education, employment, and residence. Conclusions: The striking sociodemographic differences in TS by payment direction suggest a power differential and a leading role of socioeconomic factors in TS.

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Journal of Gay & Lesbian Mental Health, 19:3, 285-302, DOI: 10.1080/19359705.2015.1024375

Authors: Rigmor C. Berg, Peter Weatherburn, Michael W. Ross, Axel J. Schmidt, The EMIS Network

Abstract

The objective of this article is to examine internalized homonegativity (IH) in relation to aspects of well-being and several measures of clinical importance among men-who-have-sex-with-men (MSM) in 38 countries. The data were collected as part of the EMIS project. The multivariable regression analysis identified independent associations with IH for nongay identity, younger age, being closeted, limited gay social affiliation, and sexual unhappiness. IH was also positively associated with loneliness, inability to decline unwanted sex, and being less knowledgeable about HIV and HIV testing. These results provide evidence that homonegative internalization merits consideration as a predisposing factor in several aspects of ill health. There are also several clinical implications of this project, including: (1) Treatment of lesbian, gay, and bisexual (LGB) persons should address gay self-acceptance, as internalized homonegativity seems to be a predisposing factor in several aspects of ill health among this population, and (2) therapy that is used to help LGB persons accept and integrate a gay or lesbian identity seems particularly important for younger, nongay identified persons.

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PLoS ONE 10(3): e0121047. https://doi.org/10.1371/journal.pone.0121047

Authors: Ulrich Marcus, Ford Hickson, Peter Weatherburn, Martina Furegato, Michele Breveglieri, Rigmor C Berg, Axel J. Schmidt

Abstract

Background: The preventive effects of antiretroviral treatment (ART) on onward transmission of HIV are a major reason for broadening eligibility for ART. In the WHO European Region, surveillance reveals substantial differences in access to ART across regions and sub-populations. We analysed self-reported data on ART and reasons for not taking ART from EMIS, a large Pan-European Internet survey among men-who-have-sex-with-men (MSM).

Methods: Respondents from 38 European countries reported their last HIV test result and, if diagnosed with HIV, their treatment status, and reasons for not taking or having stopped ART from a 7 item multiple choice list and/ or answered an open-ended question to give other reasons. Responses were classified as fear of consequences, perceived lack of need, and ART inaccessibility based on factor analysis. Associations between not taking ART because of fear of consequences, and demographic, behavioural and contextual indicators were identified in a multivariable regression model.

Results: 13,353 (7.7%) of 174,209 respondents had been diagnosed with HIV. Among them 3,391 (25.4%) had never received ART, and 278 (2.1%) had stopped taking ART. Perceived lack of need was by far the most common reason for not taking or stopping ART (mentioned by 3259 (88.8%) respondents), followed by fear of consequences (428 (11.7%)), and ART inaccessibility (86 (2.3%)). For all reasons, an East-West gradient could be seen, with larger proportions of men living in Central and Eastern Europe reporting reasons other than medical advice for not taking ART. A minority of men were reluctant to start ART independent of medical advice and this was associated with experiences of discrimination in health care systems.

Conclusions: ART is widely available for MSM diagnosed with HIV across Europe. Not being on treatment is predominantly due to treatment not being recommended by their physician and/or not perceived to be needed by the respondent.

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https://doi.org/10.1016/j.eimc.2014.07.012

Authors: Percy Fernández-Dávila, Cinta Folcha, Laia Ferrera, Raúl Sorianog, Mercedes Diezd, Jordi Casabona

Abstract

Objectives: To compare sexual practices and risk behaviours between MSM who were first diagnosed with hepatitis C (HCV) in the previous 12 months and those who were never diagnosed; and, to identify factors associated with a diagnosis of HCV.

Methods: The European-MSM-Internet-Survey (EMIS) was implemented for 3 months during 2010, mainly on websites for MSM. Data on socio-demographic characteristics, sexual behaviour, drug use, STI history, and other sexual health variables were collected. The Chi-square test and logistic regression analysis were used to analyse the data.

Results: Data from 13,111 respondents were analysed. The proportion of MSM who had ever been diagnosed with HCV infection was 1.9% (n = 250), and of those currently infected with the virus was 0.6% (n = 78). The percentage of those first diagnosed in the last 12 months was 0.4% (n = 46), of whom 70% were HIV-negative and 22% had HIV coinfection. Having a first diagnosis of HCV in the last 12 months was more common among HIV-positive than among HIV-negative MSM (0.9% vs 0.4%) and among MSM born abroad than among Spanish-born (0.7% vs 0.3%). MSM diagnosed with HCV in the last 12 months were more likely to have had: more than 10 sexual partners, sex abroad, receptive anal intercourse, insertive/receptive fisting, and unprotected anal intercourse with non-steady partners of unknown or discordant HIV-status. Likewise, they reported more frequent visits to sex-focused venues, higher drug use, as well as a higher proportion of STI diagnosis. In the multivariate model, visiting a public sex-focused venue, practicing receptive fisting, using erection enhancing medication and having a diagnosis of syphilis were independently associated with a first diagnosis of HCV in the last 12 months.

Conclusions: HCV infection does not seem to be restricted to HIV-infected MSM. Certain sexual behaviour (fisting, visiting sex-focused venues), drug use, and ulcerative STI seem to be associated with a diagnosis of HCV.

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Health & Sexuality, 16:9, 1113-1127, DOI:10.1080/13691058.2014.932923

Todd Sekuler, Michael Bochow, Ursula von Rüden, Jürgen Töppich

Abstract

To assess the situation of bisexually active men in the German HIV epidemic, data from a 2010 internet survey about sexual health among men who have sex with men were used to assess HIV testing rates, condom use and risk contact among the following groups of respondents: bisexually active single men, bisexually active men with a regular female partner, bisexually active men with a regular male partner and exclusively homosexually active men. Of the 54,387 respondents from Germany, 12% reported having sex contacts with both men and women in the previous year. Descriptive statistics were used to explore the sample’s socio-demographic characteristics and to identify relevant inter-group differences in sexual attraction, identity, awareness among contacts of attraction to men, number of sex partners, history of anal intercourse, recruitment of partners online, history of HIV testing and drug use. Multivariable regression analyses were used to assess potential associations between these variables and risk contacts, defined as having reported unprotected anal intercourse with male partners of unknown or discordant serostatus in the previous year. Bisexually active groups reported relatively few risk contacts, strengthening the argument that there is little support for the existence of a substantial ‘bisexual bridge’ in Germany.

A fin de evaluar la situación de hombres bisexualmente activos con respecto a la epidemia del VIH/sida en Alemania, se utilizaron los datos de una encuesta por Internet llevada a cabo en 2010 sobre la salud sexual de hombres que tienen relaciones homosexuales con el objetivo de analizar las tasas de la prueba de detección del virus del sida, el uso de preservativos y el contacto de riesgo entre los siguientes grupos de participantes: hombres solteros bisexualmente activos, hombres bisexualmente activos que tienen una pareja femenina regular, hombres bisexualmente activos que tienen una pareja masculina regular y hombres con actividad exclusivamente homosexual. De los 54.387 entrevistados en Alemania, 12% informaron haber tenido contactos sexuales tanto con hombres como con mujeres el año anterior. Mediante estadísticas descriptivas, se analizaron las características sociodemográficas de la muestra y se identificaron las diferencias relevantes entre los grupos en cuanto a la atracción sexual, la identidad, la conciencia de la atracción hacia los hombres entre los contactos, el número de parejas sexuales, antecedentes de relaciones anales, captación de parejas por Internet, antecedentes de la prueba del sida y el consumo de drogas. Se usaron análisis de regresión multivariables para evaluar las posibles asociaciones entre estas variables y los contactos de riesgo, definidos como haber informado de relaciones anales sin protección con parejas masculinas con condición serológica desconocida o discordante el año anterior. Los grupos bisexualmente activos informaron de relativamente pocos contactos de riesgo, lo que refuerza el argumento de que existe poca evidencia para la existencia de un importante “puente bisexual” en Alemania.

Les résultats d’une enquête en ligne (2010) sur la santé sexuelle des hommes qui ont des rapports avec des hommes ont été utilisés pour évaluer la situation des hommes bisexuels sexuellement actifs dans le contexte de l’épidémie de VIH/sida en Allemagne. Cette étude s’est plus précisément intéressée aux taux de recours au dépistage du VIH, d’usage du préservatif et de contacts à risque parmi les groupes suivants: a) hommes bisexuels sexuellement actifs et vivant seuls b) hommes bisexuels sexuellement actifs et ayant une partenaire régulière c) hommes bisexuels sexuellement actifs et ayant un partenaire régulier d) hommes sexuellement actifs, exclusivement homosexuels. 12 % des 54,387 répondants à l’enquête ont déclaré avoir eu des contacts sexuels à risque aussi bien avec des hommes qu’avec des femmes dans l’année précédente. La statistique descriptive a été utilisée pour explorer les caractéristiques sociodémographiques de l’échantillon et identifier les différences pertinentes entre les groupes pour les questions d’attirance sexuelle, d’identité, de sensibilité parmi les répondants (lors des contacts) à leur attirance pour les hommes, de nombre de partenaires sexuels, d’histoire de rapports sexuels anaux, de rencontres de partenaires en ligne, d’histoire de dépistage du VIH et d’usage de drogues. Les analyses par régression multivariée ont été employées pour évaluer les associations potentielles entre ces variables et les « contacts à risque » (c’est‐à‐dire « avoir eu des rapports anaux non protégés avec des partenaires masculins de statut sérologique vis‐à‐vis du VIH inconnu ou différent dans l’année précédente »). Dans les groupes d’hommes bisexuels sexuellement actifs, les déclarations de contacts à risque sont relativement peu nombreuses – ce qui vient étayer l’argument selon lequel une « bisexualité‐passerelle pour le VIH » conséquente en Allemagne n’a pas de réel fondements.

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