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EMIS 2010 Journal Articles 2010

Determinants of never having tested for HIV among MSM in the Netherlands

BMJ Open. 2016, 12;6(1):e009480 (doi: 10.1136/bmjopen-2015-009480).

Authors: den Daas C, Doppen M, Schmidt AJ, Op de Coul E

Abstract

Objectives: Men who have sex with men (MSM) who are unaware of their HIV infection are more likely to infect others, and unable to receive treatment. Therefore, we aimed to identify the proportion and characteristics of Dutch MSM who never tested for HIV.

Methods: In 2010, the European MSM Internet Survey (EMIS) recruited 174,209 men from 38 countries through an anonymous online questionnaire in 25 languages. We analysed data from participants living in the Netherlands (N=3787). The outcome we investigated was having never (lifetime) been tested for HIV.

Results: A total of 770 MSM (20.4%) had never been tested for HIV. In multivariate regression analyses, not being from Amsterdam (adjusted OR, aOR 1.54, CI 1.17 to 2.03), with low education (aOR 1.28, CI 1.04 to 1.57) and low knowledge on HIV-testing (aOR 2.23, CI 1.37 to 3.64) were significantly associated with never having tested. Lower sexual risk (including having fewer sexual partners (aOR 2.19, CI 1.57 to 3.04) and no anal intercourse (aOR 5.99, CI 3.04 to 11.77)), and less social engagement (including being less out (aOR 1.93, CI 1.55 to 2.40)) were also associated with having never been tested. Additionally, 36.1% of MSM who never tested for HIV reported high-risk sexual behaviour that may have put them at HIV risk.

Conclusions: MSM make their own risk assessments that inform their choices about HIV-testing. Nevertheless, MSM who were never tested may have been at risk for HIV, and remain important to target for HIV interventions.

Keywords

Epidemiology, Public Health

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EMIS 2010 Journal Articles 2010

Hidden from health: structural stigma, sexual orientation concealment, and HIV across 38 countries in the European MSM Internet Survey

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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EMIS 2010 Journal Articles 2010

Transactional Sex: Supply and Demand Among European Men Who have Sex with Men (MSM) in the Context of Local Laws

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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EMIS 2010 Journal Articles 2010

The Relationship of Internalized Homonegativity to Sexual Health and Well-Being Among Men in 38 European Countries Who Have Sex With Men

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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EMIS 2010 Journal Articles 2010

Antiretroviral Therapy and Reasons for Not Taking It among Men Having Sex with Men (MSM)—Results from the European MSM Internet Survey (EMIS)

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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EMIS 2010 Journal Articles 2010

Hepatitis C virus infection and its relationship to certain sexual practices in men-who-have-sex-with-men in Spain: Results from the European MSM internet survey (EMIS)

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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EMIS 2010 Journal Articles 2010

Are bisexually active men a ‘bridge’ for HIV transmission to the ‘general population’ in Germany? Data from the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS)

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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EMIS 2010 Journal Articles 2010

Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres [es]

Med Clin (Barc). 2014. http://dx.doi.org/10.1016/j.medcli.2014.04.030

Authors: Cinta Folch, Percy Fernández-Dávila, Laia Ferrera, Raúl Soriano, Mercedes Díez, Jordi Casabona

ABSTRACT

Basis and objective: To describe the pattern of drug use among men who have sex with men (MSM) living in Spain and its association with sexual risk practices.

Material and method: The European MSM Internet Survey was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behavior, and other sexual health variables. The association between unprotected anal intercourse (UAI) with casual partners and drug consumption was evaluated using multivariate logistic regression models.

Results: Among the 13,111 participants, most consumed drugs were cannabis (30.1%), popper (28.4%) and cocaine (18.7%). The risk of UAI with casual partners was 1.5 among those who had used drugs in relation to the other participants. The proportion of MSM who had injected drugs at least once in life was 2.5%, and 1.4% in the last 12 months. The prevalence of UAI with casual partners (53.4%), human immunodeficiency virus (HIV) (23%), hepatitis C (8.2%) and sexually transmitted infections (STI) (15.8%) was higher in MSM injectors related to those who had not used injected drugs (P < .05).

Conclusions: The results of this study confirm a high prevalence of drug use in MSM and their relationship to sexual risk behavior. Although the use of injected drugs in MSM is a minority, this group reported a higher level of sexual risk behaviors, self-reported HIV, hepatitis C and other STI.

Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres

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EMIS 2010 Journal Articles 2010

Psychosocial correlates of HIV testing among men who have sex with men in Italy: a cross-sectional study

International Journal of STD & AIDS. 2014;25(7):496-503. doi:10.1177/0956462413515193

Authors: Gabriele Prati, Michele Breveglieri, Raffaele Lelleri, Martina Furegato, Lorenzo Gios, Luca Pietrantoni

Abstract

The objective of this study was to understand the psychosocial correlates of men having sex with men (MSM) who have never been tested (never testers), MSM who have been tested in the last 12 months (recent testers), and MSM who have been tested before (remote testers). A sample of 14,409 Italian HIV-negative adult MSM was recruited via instant messages to the members of five international commercial websites and through clickable banner advertisements on different websites. The most important correlates of never testers compared to recent testers were younger age, sexual orientation concealment, unawareness of free HIV services, having had a partner of unknown serostatus, and lower levels of HIV testing self-efficacy (i.e. the belief in one’s own ability to get a test for HIV). The most important correlates of remote testers compared to recent testers were older age, homosexual orientation, having had a partner of unknown serostatus, unawareness of free HIV services, and lower level of HIV testing self-efficacy. There are different psychosocial correlates of MSM based on HIV testing history. Based on the findings of this study, prevention efforts should be directed toward increasing awareness about the availability of HIV testing services and HIV testing self-efficacy among MSM.7

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EMIS 2010 Journal Articles 2010

Defizite in den Angeboten zur STI-Diagnostik für Männer mit gleichgeschlechtlichen Sexualkontakten in deutschsprachigen Städten. 

Bundesgesundheitsblatt 56: 1609-1618. DOI 10.1007/s00103-013-1855-6

Authors: Axel J. Schmidt, Ulrich Marcus

ABSTRACT

Background. Sexually transmitted infections (STIs) such as anal/genital warts, syphilis, and genital/rectal gonorrheal/chlamydial infections compromise the health of men who have sex with men (MSM), and increase the per-contact risk of HIV infection. Early detection of asymptomatic STIs requires regular screening including physical examinations and collection of clinical specimens that allow for the detection of infections at sites common to men’s same-sex practices.

Methods. From June to August 2010, the European MSM Internet Survey (EMIS) recruited 174,209 MSM from 38 European countries to an anonymous online questionnaire in 25 languages. As sexual health care for MSM in most countries is organized locally, we chose cities for comparison. Multivariable regression models were used to compare accessibility of services and applied diagnostic procedures across 1 Dutch, 1 Swiss, 1 Austrian, 3 English, and 19 German cities (N=29,962). Results. The proportion of respondents tested for STIs in the last 12 months in the absence of symptoms ranged from 13% in Magdeburg to 48% in Amsterdam. At a city level, low STI screening correlated with inaccessible services (R2 =0.72). At an individual level, anal/penile inspection and anal swabbing was most common in English cities and in Amsterdam. Compared to London, MSM in German-speaking cities had an adjusted odds ratio (AOR) of 0.06–0.20 for anal/penile inspection, and of 0.05–0.17 for anal swabbing (p<0.001).

Conclusions. Anal/genital warts and rectal infections are likely to be profoundly underdiagnosed among MSM in all German-speaking cities. This has implications for the sexual health of MSM, for HIV prevention, and for comparing European surveillance data. There is an urgent need to implement or improve sexual health care tailored to MSM at risk for STIs.

Defizite in den Angeboten zur STI-Diagnostik für Männer mit gleichgeschlechtlichen Sexualkontakten in deutschsprachigen Städten