Category: EMIS 2017

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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.

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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.

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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.

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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.

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EMIS 2017 Journal Articles 2017 Published Articles

Self-reported hepatitis A and B vaccination coverage among men who have sex with men (MSM), associated factors and vaccination recommendations in 43 countries of the WHO European Region: results from the European MSM Internet Survey, EMIS-2017

EuroSurveillance, 2024; 29(45):pii=2400100 (doi: 10.2807/1560- 7917.ES.2024.29.45.2400100).

Authors: Michael Brandl, Axel J Schmidt, Ulrich Marcus, Erika Duffell, Ettore Severi, Antons Mozalevskis, Anda Kivite-Urtane, Matthias an der Heiden, Sandra Dudareva.

Abstract

Background. Hepatitis A and B vaccinations are recommended for men who have sex with men (MSM), given their increased risk of infection. However, data on vaccination programmes are scarce.

Aim. To use information on vaccination recommendations and vaccine uptake among MSM in the WHO European Region to guide prevention.

Methods. From a large pan-European MSM Internet Survey (EMIS-2017), we analysed data on self-reported hepatitis A and B vaccination status by age, education, financial coping, settlement size, outness (disclosure of sexual behaviour), migration history and diagnosis with hepatitis C or HIV, using multivariable logistic regression. Additionally, we collected information on national hepatitis A and B vaccination recommendations.

Results. We present data of 113,884 MSM, median age 36 years (IQR: 27–47). Vaccination for hepatitis A and B was recommended and free for MSM in 7 and 18 of 43 countries, respectively. Of all respondents, 48% (n = 50,966) reported ever being vaccinated against hepatitis A, and 53% (n = 56,889) against hepatitis B. Odds for being vaccinated against hepatitis A increased with outness (‘out to (almost) all’ aOR: 1.78, 95% CI: 1.72–1.85 vs ‘out to none’) and were higher in countries where vaccination was recommended and free for MSM (aOR:2.22, 95% CI: 1.29–3.82 vs ‘no recommendation’). Results for hepatitis B were similar (outness: aOR:1.81, 95%CI:1.75–1.88 and MSM-specific vaccination recommendation: aOR: 2.44, 95% CI: 1.54–3.85).

Conclusion. Large proportions of MSM in Europe remain vulnerable to hepatitis A and B, despite available vaccination. Implementation of MSM-specific vaccination recommendations and greater efforts to improve the societal climate for MSM are needed to address gaps in vaccine coverage.

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EMIS 2017 Journal Articles 2017 Published Articles

Viral hepatitis knowledge and vaccination awareness among men who have sex with men (MSM) in 43 countries of the WHO European Region: results from the European MSM Internet Survey, EMIS-2017

EuroSurveillance, 2024; 29(45):pii=2400099 (doi: 10.2807/1560-7917.ES.2024.29.45.2400099).

Authors: Sofia Burdi, Michael Brandl, Ulrich Marcus, Erika Duffell, Ettore Severi, Antons Mozalevskis, Kristi Rüütel, Achim Dörre, Axel J Schmidt*, Sandra Dudareva*.

Abstract

Background. Recent hepatitis A virus outbreaks in Europe affecting men who have sex with men (MSM) and ongoing hepatitis B virus transmission among MSM underscore the ongoing need for viral hepatitis prevention in this population.

Aim. To describe viral hepatitis knowledge and associated factors among MSM in the WHO European Region to inform targeted prevention.

Methods. In the European MSM Internet Survey (EMIS-2017), basic knowledge was defined as correctly identifying at least 4 of 5 statements about viral hepatitis and vaccination. We described basic knowledge by country. In a multilevel logistic regression model, we estimated adjusted odds ratios (aOR) with 95% confidence intervals (CI) for having basic knowledge and explanatory variables: sociodemographic characteristics, history of hepatitis C and/or HIV diagnosis, sexual orientation disclosure at last sexually transmitted infections (STI) test and outness..

Results. Of 113,884 participants across 43 WHO European Region countries, 68% demonstrated basic knowledge, ranging from 50% in Israel to 80% in the Netherlands. Basic knowledge was significantly associated with older age (≥ 40 years vs < 25 years, aOR: 2.9, 95% CI: 2.7–3.0), a history of hepatitis C and/or HIV diagnosis (aOR:1.8, 95% CI: 1.7–1.9) and sexual orientation disclosure at last STI test (aOR: 1.3, 95% CI: 1.2– 1.3), among other factors.

Conclusion. We found a knowledge disparity regard- ing viral hepatitis and hepatitis vaccination aware- ness among MSM across Europe, highlighting a need to address these gaps. A non-judgemental, accept- ing climate that allows individuals attending medical services to safely disclose their sexual orientation is fundamental to enable healthcare professionals to target information and preventative measures more effectively.

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EMIS 2017 Journal Articles 2017 Published Articles

Sex work, syndemic conditions and condomless anal intercourse among MSM who engage in sex work in Latin America

Sexual Health, 2024; 21, SH23112 (doi: 10.1071/SH23112).

Authors: Ibrahim Sönmez, Nicolas Lorente, Jocelyn Mesías-Gazmuri, Axel J. Schmidt, Kai J. Jonas, Valeria Stuardo Avila, Ulrich Marcus, Maria Amelia Veras, Jordi Casabona Barbarà, Cinta Folch.

Abstract

Background. In Latin American countries and Suriname, sexual transmission is one of the most common modes of HIV transmission, and men who have sex with men (MSM) who engage in sex work constitute a key population.

Methods. In a sample of MSM (N = 53,166) from the Latin American Internet Survey (2018) across 18 countries, we examined how sex work engagement is associated with syndemic conditions (multidrug use, homophobic abuse, depression/anxiety, alcohol dependency (CAGE alcohol questionnaire) and internalised homonegativity) and condomless anal intercourse with non-steady male partners using separate logistic regressions. We then used a structural equation model to determine if and how syndemic conditions mediate the relationship between sex work engagement and non-steady male partners.

Results. We found that getting paid for sex was associated with less condom use for anal intercourse with non-steady male partners and particular syndemic conditions, such as multidrug use, homophobic abuse and alcohol dependency. In our structural equation model, the results showed that the direct relationship between sex work engagement and non-steady male partners was positive and significant, and syndemic conditions partially mediated this relationship.

Conclusion. Our results highlight the continuing need for including MSM who engage in sex work and those who experience syndemic conditions in the prevention strategies targeted to MSM in Latin America and Suriname, to prevent the transmission of HIV.

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EMIS 2017 Journal Articles 2010 Journal Articles 2017 Published Articles

HIV Testing and Treatment among HIV-Positive Men who have Sex with Men (MSM) Living in Russia: Data from Two Waves of the European MSM Internet Survey

AIDS and Behavior, 2024; 28:4040–4045 (doi: 10.1007/s10461-024-04476-y).

Authors: Rigmor C. Berg, Vegard Skogen, Axel J. Schmidt, Roman Nesterov & Andrey Beloglazov.

Abstract

We examined changes in HIV testing and medical care among men who have sex with men (MSM) in Russia. Data come from the 2010 and 2017 waves of the European MSM Internet Survey. From 2010 to 2017 there was an increase in the proportion who had ever received an HIV test (+ 11.2%), had tested for HIV in the last year (+ 2.1%), had ever taken antiretroviral therapy (ART) (+ 31.9), were currently taking ART (+ 31.5%), and had an undetectable viral load (+ 19.4%). These results are encouraging, yet they also reveal that substantial proportions of MSM experience considerable unmet prevention and treatment needs.

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EMIS 2017 Journal Articles 2017 Published Articles

Still trouble with bleeding: Risk factors for HCV transmission in men who have sex with men and behavioural trajectories from 2019 to 2021

HIV Medicine, 2024; 25(8). (doi: 10.1111/hiv.13657).

Authors: Axel Jeremias Schmidt, Peter Weatherburn, Haoyi Wang, Thomas Lutz, Knud Schewe, Stefan Mauss, Ivanka Krznaric, Axel Baumgarten, Christoph Boesecke, Jürgen K. Rockstroh, Stefan Christensen, Patrick Ingiliz.

Abstract

Objectives

To identify sexual/sex-associated risk factors for hepatitis C transmission among men who have sex with men (MSM) and visualise behavioural trajectories from 2019 to 2021.

Methods

We linked a behavioural survey to a hepatitis C cohort study (NoCo), established in 2019 across six German HIV/hepatitis C virus (HCV) treatment centres, and performed a case–control analysis. Cases were MSM with recent HCV infection, and controls were matched for HIV status (model 1) or proportions of sexual partners with HIV (model 2). We conducted conditional univariable and multivariable regression analyses.

Results

In all, 197 cases and 314 controls completed the baseline questionnaire and could be matched with clinical data. For regression models, we restricted cases to those with HCV diagnosed since 2018 (N = 100). Factors independently associated with case status included sex-associated rectal bleeding, shared fisting lubricant, anal douching, chemsex, intravenous and intracavernosal injections, with population-attributable fractions of 88% (model 1) and 85% (model 2). These factors remained stable over time among cases, while sexual partner numbers and group sex decreased during COVID-19 measures.

Conclusions

Sexual/sex-associated practices leading to blood exposure are key factors in HCV transmission in MSM. Public health interventions should emphasize the importance of blood safety in sexual encounters. Micro-elimination efforts were temporarily aided by reduced opportunities for sexual encounters during the COVID-19 pandemic.

Note: The questionnaire underlying this case-control study based many questions on EMIS-2010 and EMIS-2017.

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EMIS 2017 Journal Articles 2017

Determinants of HIV Testing Among Migrant Men Who Have Sex With Men from Sub‐Saharan Africa and Other Regions Residing in 10 European Countries

AIDS and Behavior, 2024; 28:488–506 (doi: 10.1007/s10461-023-04239-1).

Authors: Oladipupo Shobowale, Axel J. Schmidt, Paula Meireles, Daniela Rojas Castro, Sandrine Detandt, Sarah E. Stutterheim, Peter Weatherburn, Kai J. Jonas.

Abstract

Migrant men who have sex with men (mMSM) from sub-Saharan Africa (SSA) and other regions outside Europe are highly vulnerable to HIV. However, research on the determinants of HIV testing among mMSM from SSA, and how these differ across the categories of mMSM living in Europe, is limited.

Using data from the European MSM Internet Survey (EMIS- 2017), we assessed HIV testing prevalence and recency in mMSM from SSA and other mMSM residing in ten European countries, as well as the determinants of HIV testing across different mMSM categories with logistic regression analyses.

Ever-testing for HIV was slightly higher in mMSM from SSA (83%) compared to other mMSM categories (75–80%), except for mMSM from Latin America and Caribbean region (84%). Overall, 20% of mMSM had never tested. In multivariable analysis, higher age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.01–1.10), higher HIV knowledge (AOR 1.45, 95%-CI 1.11–1.90), and residence in smaller settlements (AOR 0.45, 95%-CI 0.21–0.96) were significantly associated with ever testing for HIV in mMSM from SSA. Comparing mMSM from SSA to mMSM from other regions, we found varying significant similarities (higher age, residence in smaller settlements and HIV knowledge) and differences (lower educational attainment, not identifying as gay, being a student, and limited disclosure of homosexual attraction) in the determinants of ever-testing for HIV.

Community-specific interventions addressing identified sociodemographic and behavioral determinants to increase HIV testing uptake in the different mMSM categories and better data for further research are warranted.

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