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EMIS 2017 International reports 2017

EMIS-2017 and LAMIS: UNAIDS

For World AIDS Days 2018–2021 we partnered with UNAIDS to present some key findings from the European and Latin American MSM Internet Surveys on the UNAIDS website for key populations. Findings are shown as interactive maps that include various sexual health indicatiors for gay men, bisexual men and other MSM.

Recruitment and Outness
  • Crude Recruitment Rate: Number of men reached by EMIS-2017/LAMIS, per 10,000 men aged 15–65
  • Not open about sexual orientation (non-outness): “Out” to few or none of friends, family, work (%)
HIV
  • HIV diagnosis: ever diagnosed with HIV (%)
  • Recent HIV diagnosis: HIV diagnosis in the past 12 months (%), excluding men diagnosed with HIV more than 12 months ago
  • HIV testing: Tested for HIV in the last 12 months (%), excluding those diagnosed longer ago
  • Community-based HIV testing: Using community HIV- testing at last HIV test (%, denominator includes untested  men)
Sexually Transmitted Infections: Testing, Diagnosis, and Partner Notifiaction
  • Comprehensive STI screen: HIV test, STI blood test, rectal swab, urethral (trans men if applicable: vaginal) swab or urine in the last 12 months (%), excluding men diagnosed with HIV more than 12 months ago
  • STI testing: any test for a sexually transmitted infection, in the previous 12 months (%)
  • Disclosure in health care: Disclosure of same-sex contacts towards health care provider during STI-testing in the last 12 months (%)
  • Syphilis: diagnosed in the previous 12 months (%)
  • Symptomatic syphilis: in the previous 12 months (%)
  • Gonorrhoea: diagnosed in the previous 12 months (%)
  • Symptomatic gonorrhoea: in the previous 12 months (%)
  • Chlamydia: diagnosed in the previous 12 months (%)
  • Symptomatic chlamydia: in the previous 12 months (%)
  • Partner notification among men with syphilis (%)
  • Partner notification among men with gonorrhoea (%)
Interventions
  • Targeted information:  Saw or heard information about HIV/STIs for MSM, last 12 months (%)
  • Received free condoms: Received free condom from NGOs, clinics, bars, or saunas, last 12 months (%)
Risk and precaution behaviour
  • Condomless anal sex: Condomless anal sex with non-steady male partners of unknown HIV status, last 12 months (%)
  • PrEP use:  Currently taking HIV pre-exposure prophylaxis daily or on demand (%), excluding HIV-diagnosed men
Knowledge
  • Lack of PrEP knowledge: Not knowing that PrEP is a pill taken before as well as after sex to prevent HIV infection (%) 
  • Lack of PEP knowledge: Not knowing that PEP stops HIV infection after exposure (%)
  • Lack of U=U knowledge: Not knowing U=U (that a person with undetectable viral load cannot pass on HIV, %) 
Vaccinations
  • HAV vaccination: history of at least one dose of hepatitis A vaccine (%), exluding those with a history of hepatitis A
  • HBV vaccination: history of at least one dose of hepatitis B vaccine (%), exluding those with a history of hepatitis B

Suggested citation for EMIS/LAMIS indicators on the UNAIDS website for key populations:

UNAIDS Key Population Atlas: EMIS & LAMIS Indicators for men-who-have-sex-with-men. Geneva, 2018–21. Available at: https://kpatlas.unaids.org/dashboard

Disclaimer: Indicators published on the UNAIDS website for key populations based on data collected by the Latin America MSM Internet Survey (LAMIS) are not official/governmental data of the participating countries.

Available in 33 languages, the European MSM Internet Survey (EMIS-2017) recruited 137,358 qualifying participants from 46 countries across Europe and Lebanon, Israel, Canada and the Philippines. The Latin American MSM Internet Survey (LAMIS) recruited 64,655 participants from 18 countries.

EMIS-2017 was undertaken by researchers from Sigma Research at the London School for Hygiene and Tropical Medicine and the Robert Koch Institute. Data was collected between 18 October 2017 and 31 January 2018.

LAMIS, using the same questionnaire and finishing data collection on 12 May 2018, was the first multi-country survey for gay, bisexual, and other men who have sex with men (MSM) in Latin America. It was implemented by researchers from Right PLUS*, a coalition of researchers from Latin America, Portugal, Spain and the Netherlands, with support from the EMIS team.

EMIS and LAMIS required a great deal of international cooperation and relied on the support of national stakeholders to aid local recruitment. Through this cooperation comparable data are now available for the first time for more than 60 countries across 4 continents.

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EMIS 2017 Questionnaires

EMIS-2017 Questionnaires & Variable Manual

The following questionnaires have been used in the projects reported elsewhere on this website. Individuals and organisations are welcome to use individual questions, or whole questionnaires, on the understanding that they credit Sigma Research in any written outputs from the project.

Manual

EMIS-2017 Variable Manual

Questionnaires

EMIS-2017 English language version (PDF of online only questionnaire)

EMIS-2017 Albanian language version (PDF of online only questionnaire)

EMIS-2017 Arabic language version (PDF of online only questionnaire)

EMIS-2017 Bulgarian language version (PDF of online only questionnaire)

EMIS-2017 Croatian / Serbian language version (PDF of online only questionnaire)

EMIS-2017 Czech language version (PDF of online only questionnaire)

EMIS-2017 Danish language version (PDF of online only questionnaire)

EMIS-2017 Dutch language version (PDF of online only questionnaire)

EMIS-2017 Estonian language version (PDF of online only questionnaire)

EMIS-2017 Filipino Cebuano language version (PDF of online only questionnaire)

EMIS-2017 Filipino Tagalog language version (PDF of online only questionnaire)

EMIS-2017 Finnish language version (PDF of online only questionnaire)

EMIS-2017 French language version (PDF of online only questionnaire)

EMIS-2017 German language version (PDF of online only questionnaire)

EMIS-2017 Greek language version (PDF of online only questionnaire)

EMIS-2017 Hebrew language version (PDF of online only questionnaire)

EMIS-2017 Hungarian language version (PDF of online only questionnaire)

EMIS-2017 Italian language version (PDF of online only questionnaire)

EMIS-2017 Latvian language version (PDF of online only questionnaire)

EMIS-2017 Lithuanian language version (PDF of online only questionnaire)

EMIS-2017 Macedonian language version (PDF of online only questionnaire)

EMIS-2017 Maltese language version (PDF of online only questionnaire)

EMIS-2017 Norwegian language version (PDF of online only questionnaire)

EMIS-2017 Polish language version (PDF of online only questionnaire)

EMIS-2017 Portuguese language version (PDF of online only questionnaire)

EMIS-2017 Romanian language version (PDF of online only questionnaire)

EMIS-2017 Russian language version (PDF of online only questionnaire)

EMIS-2017 Slovak language version (PDF of online only questionnaire)

EMIS-2017 Slovenian language version (PDF of online only questionnaire)

EMIS-2017 Spanish language version (PDF of online only questionnaire)

EMIS-2017 Swedish language version (PDF of online only questionnaire)

EMIS-2017 Turkish language version (PDF of online only questionnaire)

EMIS-2017 Ukrainian language version (PDF of online only questionnaire)

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EMIS 2017 Journal Articles 2017

Social and behavioural determinants of syphilis: Modelling based on repeated cross-sectional surveys from 2010 and 2017 among 278,256 men who have sex with men in 31 European countries

Lancet Reg Health Eur. 2022 Aug 9;22:100483. doi: 10.1016/j.lanepe.2022.100483. eCollection 2022 Nov.

Authors: Ana Mendez-Lopez, David Stuckler, Ulrich Marcus, Ford Hickson, Teymur Noori, Robert N Whittaker, Klaus Jansen, Asuncion Diaz, Lukasz Henszel, Annie Velter, Jan C Semenza, Axel J Schmidt

Abstract

Background: Syphilis case notifications among men-who-have-sex-with-men (MSM) have increased markedly over the past two decades in Europe. We tested several potential factors for this resurgence.

Methods: Self-reported data from two cross-sectional waves of the European MSM Internet Survey (EMIS-2010 and EMIS-2017, N = 278,256 participants living in 31 European countries) were used to fit multivariable hierarchical logistic regression models designed to evaluate potential social, behavioural, and interventional determinants of syphilis diagnosis. Additional multivariable hierarchical negative binomial models investigated determinants of the number of non-steady male condomless anal intercourse (CAI) partners. We tested the hypothesis that more CAI and syphilis-screening are associated with syphilis resurgence, both linked to use of pre-exposure prophylaxis (PrEP).

Findings: Between 2010 and 2017, incidence of syphilis diagnosis in the previous 12 months rose from 2.33% (95%CI: 2.26-2.40) of respondents reporting a syphilis diagnosis in 2010 compared with 4.54% (95%CI: 4.42-4.66) in 2017. Major factors contributing to syphilis diagnosis were living with diagnosed HIV (adjusted odds ratio (aOR) 2.67, 95%CI: 2.32-3.07), each additional non-steady male CAI partner (aOR 1.01, 95%CI: 1.01-1.01), recency of STI-screening (previous month vs no screening, aOR 25.76, 95%CI: 18.23-36.41), selling sex (aOR 1.45, 95%CI: 1.27-1.65), and PrEP use (aOR 3.02, 95%CI: 2.30-3.96). Living with diagnosed HIV (adjusted incidence rate ratio (aIRR) 3.91, 95%CI: 3.77-4.05), selling sex (aIRR 4.39, 95%CI: 4.19-4.59), and PrEP use (aIRR 5.82, 95%CI: 5.29-6.41) were associated with a higher number of non-steady male CAI partners. The association between PrEP use and increased chance of syphilis diagnosis was mediated by STI-screening recency and number of non-steady male CAI partners, both substantially higher in 2017 compared to 2010.

Interpretation: Syphilis cases are concentrated in three MSM population groups: HIV-diagnosed, PrEP users, and sex workers. Behavioural and interventional changes, particularly more non-steady male CAI partners and recency of STI-screening, are major contributing factors for increasing syphilis diagnoses among MSM in Europe.

Funding: European Centre for Disease Prevention and Control.

Available online

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EMIS 2017 Journal Articles 2017

Determinants of PrEP Uptake, Intention and Awareness in the Netherlands: A Socio-Spatial Analysis

Int J Environ Res Public Health. 2022 Jul 20;19(14):8829. doi: 10.3390/ijerph19148829.

Authors: Haoyi Wang, Oladipupo Shobowale, Chantal den Daas, Eline Op de Coul, Bouko Bakker, Aryanti Radyowijati, Koenraad Vermey, Arjan van Bijnen, Wim Zuilhof , Kai J Jonas

Abstract

PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called “Randstad”, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0-10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04-4.4). Lower education (aOR = 0.4, 95% CI 0.2-0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7-2.0) and high education. We showed that regional differences-MSM in non-urban regions-and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

Available online

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EMIS 2017 International reports 2017

LAMIS: Latin America Report

Latin American MSM Internet Survey.

[ES] Encuesta latinoamericana por internet en hombres que tienen sexo con hombres.
[PT] Pesquisa da América Latina online em homens que fazem sexo com homens.

Suggested citation:
Reyes-Diaz M, Folch C, Celly A, Stuardo V, Veras V, Schmidt AJ, Cáceres CF, Casabona J. LAMIS-2018: Informe Regional. Right PLUS/Coalition PLUS. 2022.

Download report as PDF

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EMIS 2017 Journal Articles 2017

Chemsex users in Czechia: EMIS survey

Cent Eur J Public Health. 2022 Jun;30(2):86-92. doi: 10.21101/cejph.a6923.

Authors: Xenie Uholyeva, Michal Pitoňák

Abstract

Objectives: Chemsex is a phenomenon highly relevant to public health concerns. Our primary aim is to describe the Czech chemsex scene regarding substances used, sexual behaviour, mental health, sexual life satisfaction, internalization of homonegative attitudes, and prevalent chemsex patterns.

Methods: The data from the European Men Who Have Sex With Men Internet Survey (EMIS) 2017 were used. The mental health of chemsex users was assessed by the Patient Health Questionnaire 4 (PHQ4), internalized homonegativity was measured using the Short Internalized Homonegativity Scale. A sample of 87 men who have sex with men (MSM) chemsex users and a comparison group of 261 MSM were selected from the total sample of 1,688 respondents. Mann-Whitney and χ2 tests were used to compare groups.

Results: Active chemsex users made up 5% of the sample (87 of 1,688), with an average age of 37 years. Chemsex users were more likely to engage in condomless sex with non-steady partners (χ2 = 46.8, p < 0.001), and had dramatically more STIs, such as HIV (χ2 = 52.9, p < 0.001), HCV (χ2 = 25.9, p < 0.001), and syphilis (χ2 = 41.5, p < 0.001). Chemsex users frequently injected drugs (n = 19, 20%). More than half (n = 48; 55%) of chemsex users had sober sex in the last 4 weeks. Chemsex culture was associated with riskier substance use, both in terms of mode and frequency. The mental health of chemsex users in our sample did not differ significantly from the comparison group (χ2 = 0.2, p < 0.7). Chemsex users did not conceal their sexual identity more often than the comparison group, on the contrary, 69% (n = 59) of them were out to most significant others, compared to 53% (n = 134) in the comparison group (χ2 = 8.8, p < 0.05). In addition, we did not find differences in the degree of internalized homonegativity (χ2 = 0.9, p < 0.4). Chemsex users were clearly and significantly more satisfied with their sex life than the comparison group (Mann-Whitney U test, p < 0.001).

Conclusions: In our sample, chemsex use was not associated with a negative impact on health or wellbeing. Our results suggest that chemsex is not a homogeneous phenomenon. Many different patterns and subcultures exist, some of them are riskier, some safer than others.

Available online

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EMIS 2017 Journal Articles 2017

Salud psicosocial de la población de gais, bisexuales y otros hombres que tienen sexo con hombres (HSH) en Colombia.

Revista Colombiana de Psiquiatría, S0034745022000592. https://doi.org/10.1016/j.rcp.2022.04.010

Author: Restrepo Pineda, J. E.

Introduction

Psychosocial health is fundamental to the well-being of the human being. In the case of the gay, bisexual and other men who have sex with men (MSM) population, it is affected by discrimination, homophobia, marginalisation and social exclusion.

Methods

A quantitative investigation was designed, which used a virtual survey. Kruskal Wallis tests were performed for the difference in medians between the internalised Index of Homphobia (IH) and various variables; this same test was used for the comorbidity between anxiety and depression.

Results

A sample of 8,208 individuals was obtained, with ages between 18 and 75 years. Between the IH indices and the educational level variable, statistically significant differences are observed in the medians of the different categories. On the other hand, 8.0% of the population presents with moderate levels of comorbidity between anxiety and depression and 4.0%, a severe level.

Discussion

IH decreases as the subjects prepare academically, while the severity of anxiety and depression is greater in those who report complicated affective relationships. People with a diagnosis of HIV present with a greater severity of depressive symptoms.

Conclusions

IH, depression, and anxiety are linked to intersectional discrimination, leading to greater individual and social vulnerability for people who are gay, people who are bisexual, and other men who have sex with men that directly affects their psychosocial health.

Available online

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EMIS 2017 Journal Articles 2017

Stigmatizing Policies Interact with Mental Health and Sexual Behaviours to Structurally Induce HIV Diagnoses Among European Men Who Have Sex with Men

AIDS Behav 2022; 26(10):3400-3410. doi: 10.1007/s10461-022-03683-9

Authors: Kristefer Stojanovski, Elizabeth J King, K Rivet Amico, Marisa C Eisenberg, Arline T Geronimus, Sladjana Baros, Axel J Schmidt

Abstract

Structural stigma shapes men who have sex with men’s (MSM’s) mental health and sexual behaviours. The aim of this study was to examine how stigmatizing policies interact with downstream anxiety/depression and sexual behaviours to structurally pattern HIV disparities among European MSM. We conducted a secondary data analysis of the European Men-who-have-sex-with-men Internet Survey (EMIS) from 2017. We included a total of 98,600 participants living in 39 European countries. We used the Rainbow Index, a score given to countries based on their sexual and gender minority policies as the predictor of HIV diagnosis. We conducted adjusted random intercept and slope multi-level logistic regressions. In adjusted models, higher Rainbow Index scores was associated with lower predictive probabilities of diagnosed HIV, regardless of the number of condomless intercourse partners. The predictive probability of HIV diagnosis was also lower, regardless of severity of anxiety/depression, where the Rainbow Index score was better. Country-level policies interact with downstream sexual behaviours and anxiety/depression to structurally influence HIV diagnosis among MSM in Europe.

Available online

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EMIS 2017 Journal Articles 2017

What is the empirical basis for converting banded ordinal data on numbers of sex partners among MSM into a continuous scale level variable? A secondary analysis of 13 surveys across 17 countries

BMC Med Res Methodol 22, 59 (2022). https://doi.org/10.1186/s12874-021-01483-8

Authors: Ana Mendez‑Lopez, Ford Hickson, Klaus Jansen, Nathan Lachowsky, Fiona Burns, Cinta Folch, Annie Velter, Peter Weatherburn, Ulrich Marcus , Ursula von Rüden, Massimo Mirandola, Lorenzo Gios, Jamie Frankis, David J. Brennan and Axel J. Schmidt

Abstract

Background: To provide empirically based guidance for substituting partner number categories in large MSM surveys with mean numbers of sexual and condomless anal intercourse (CAI) partners in a secondary analysis of survey data.

Methods: We collated data on numbers of sexual and CAI partners reported in a continuous scale (write-in number) in thirteen MSM surveys on sexual health and behaviour across 17 countries. Pooled descriptive statistics for the number of sexual and CAI partners during the last twelve (N = 55,180) and 6 months (N = 31,759) were calculated for two sets of categories commonly used in reporting numbers of sexual partners in sexual behaviour surveys.

Results: The pooled mean number of partners in the previous 12 months for the total sample was 15.8 partners (SD = 36.6), while the median number of partners was 5 (IQR = 2–15). Means for number of partners in the previous 12 months for the first set of categories were: 16.4 for 11–20 partners (SD = 3.3); 27.8 for 21–30 (SD = 2.8); 38.6 for 31–40 (SD = 2.4); 49.6 for 41–50 (SD = 1.5); and 128.2 for ‘more than 50’ (SD = 98.1). Alternative upper cut-offs: 43.4 for ‘more than 10’ (SD = 57.7); 65.3 for ‘more than 20’ (SD = 70.3). Self-reported partner numbers for both time frames consistently exceeded 200 or 300. While there was substantial variation of overall means across surveys, the means for all chosen categories were very similar. Partner numbers above nine mainly clustered at multiples of tens, regardless of the selected time frame. The overall means for CAI partners were lower than those for sexual partners; however, such difference was completely absent from all categories beyond ten sexual and CAI partners.

Conclusions: Clustering of reported partner numbers confirm common MSM sexual behaviour surveys’ questionnaire piloting feedback indicating that responses to numbers of sexual partners beyond 10 are best guesses rather than precise counts, but large partner numbers above typical upper cut-offs are common.

Available online

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EMIS 2017 Journal Articles 2017

Would eligible gay, bisexual and other men who have sex with men use PrEP? Awareness, knowledge, eligibility and intention to use PrEP among EMIS-2017 participants in Spain

Prev Med 2022; 156:106962. doi: 10.1016/j.ypmed.2022.106962.

Authors: Carlos Iniesta, Cinta Folch, Sebastian Meyer, María Vázquez, Jordi Casabona, Asunción Díaz

Abstract

Pre-exposure prophylaxis (PrEP) is an efficacious strategy for reducing the incidence of HIV infection. It has been available in Spain since 2019. We aim to report on awareness, knowledge of, intention to use, and eligibility for PrEP and related factors among participants in the European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017) in Spain. We used Spanish data from EMIS-2017, a cross-sectional study performed among gay, bisexual, and other men who have sex with mean (GBMSM) from 50 countries. We found that 65.3% of the 10,634 participants were aware of PrEP, some 30.1% of those HIV-negative and ≥ 18 years were eligible and 52.7% of those eligible intended to use it. Regarding knowledge about PrEP, only 15.4% of the participants knew 3 statement with true information about that PrEP meant. Older age, being born in Western Europe (WE) and greater outness were associated with greater awareness. Older age, being born in Latin America or Caribbean or WE, sex work, and living in a large city were associated with greater eligibility. A greater degree of outness was associated with reduced intention to use. Our study point to possible barriers in the implementation of PrEP in Spain and similar countries.

Available online