Category: EMIS 2017

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EMIS 2017 International reports 2017

LAMIS: Community Reports Latin America

In February 2022, Right PLUS published four infographics as Community Reports in Spanish: about knowledge of and access to ART; about migration to love more openly as a gay or bisexual or trans person, anxiety and depression; on substance use; and on HIV, STS, and hepatitis B & C .

In April 2020, the Brazilian NGO Associação Brasileira de Lésbicas, Gays, Bissexuais, Travestis, Transexuais e Intersexos (ABGLT), published a comparable Community Report for Brazil, based on data from the Latin American Internet Survey (LAMIS), with support from Maria Amelia de Sousa Mascena Veras (Faculdade de Ciências Médicas da Santa Casa de São Paulo) and Sigma Research. 

Community Report (Brasil)

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EMIS 2017 Journal Articles 2017

Factors associated with low levels of HIV testing among young men who have sex with men (MSM) participating in EMIS-2017 in Spain

Sex Transm Infect 2022; 98(7):518-524. doi: 10.1136/sextrans-2021-055193.

Authors: Nuria Gallego, Asuncion Diaz, Cinta Folch, Sebastian Meyer, Maria Vazquez, Jordi Casabona, Victoria Hernando 

Abstract

Purpose: The European Men who have sex with men Internet Survey looked over the characteristics and needs of men who have sex with men (MSM) across Europe. Our objective was to estimate the prevalence of HIV testing and its associated factors among MSM younger than 25 years old participating in the EMIS-2017 in Spain.

Methods: Multivariable regression model was used to compare those who had been tested for HIV within the last 12 months and those that had not.

Results: Of 2313 participants, 1070 (46.3%) had been tested for HIV in the past 12 months. Increased age (age 19-21 years, aOR=3.38 (95% CI 2.57 to 4.44); age 22-24 years, aOR=5.26 (4.06 to 6.92) compared with age 16-18 years); being migrant (Latin America: aOR=1.34 (0.98 to 1.84); Europe, North America and Mediterranean countries (aOR=1.56 (0.98 to 2.51) compared with those from Spain); living more openly with one’s sexuality (out to some people (aOR=1.53 (1.19 to 1.96)); out to all or almost all people (aOR=2.24 (1.75 to 2.87) compared with those out to none or a few people); having had one condomless steady partners in the las year ((aOR=1.59 (1.26 to 2.02)); having had condomless non-steady partners in the last year (one: aOR=1.76 (1.35 to 2.29)); two or more partners: aOR=2.37 (1.84 to 3.04)); and having practised sex work in the past year (aOR=1.52 (1.07 to 2.13)) were associated with increased odds of HIV testing. Living in a smaller city was associated with less likelihood of HIV testing (<1 00 000 inhabitants: aOR=0.51 (95% CI 0.41 to 0.64); 100 000-500 000: aOR=0.68 (95% CI 0.54 to 0.86) compared with more than 500 000).

Conclusion: Young MSM showed low HIV testing rate. Future programming specifically targeting this population, especially those middle adolescents, living in a medium-small city and having less ‘outness’, can help increase HIV testing and prevent access barriers.

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EMIS 2017 Journal Articles 2017

Predictors of knowledge of and access to biomedical prevention among MSM and transgender men in Latin America: Results from the Latin American internet survey.

HIV Medicine; 23(7):764–773. doi: 10.1111/hiv.13238

Authors: Avelino-Silva, V. I., Vasconcelos, R., Cerqueira, N. B., Marcus, U., Schmidt, A. J., & Veras, M. A.

Abstract

Introduction

HIV is still a central public health issue in Latin America, disproportionally affecting key populations. Knowledge and access to biomedical prevention strategies, including treatment as prevention (TASP) or undetectable = untransmissible (U=U), pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP), are the first steps to increasing uptake. We used data from the Latin American MSM Internet Survey (LAMIS) to describe knowledge and access to biomedical HIV prevention strategies among gay, bisexual, transgender and other men who have sex with men (MSM) living in 18 Latin American countries.

Methods

We compared LAMIS data across countries and according to age categories using frequencies and percentages. We also used multivariable models to explore whether age, gender identity, sexual identity, steady partnership, HIV status and education were independently associated with outcomes.

Results

In all, 55 924 participants were included. Most were cisgender (99%) and identified as gay/homosexual (77%) or bisexual (17%). Schooling levels were very high, with 89% reporting highest attained education as tertiary level, university or post-graduation. In total, 16% had been previously diagnosed with HIV; of those, rates of undetectable viral load varied from 60% in Venezuela to 83% in Brazil. Overall, 54%, 54% and 52% of participants already knew about PEP, PrEP and U=U, respectively. Participants from Brazil and those aged between 26 and 55 years, living with diagnosed HIV and having a gay/homosexual identity had greater levels of awareness about biomedical prevention strategies.

Conclusions

Our study highlights gaps in HIV prevention campaigns directed to MSM in Latin America resulting in low uptake of biomedical prevention methods.

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EMIS 2017 Journal Articles 2017

Influence of Internalised Homonegativity on sexual risk behaviour of men who have sex with men in Spain

Sexuality & Culture, published online first 27 November 2021 (doi: 10.1007/s12119-021-09925-7).

Authors: İbrahim Sönmez, Cinta Folch, Nicolas Lorente, Rigmor C. Berg, Natalie Thurlby & Axel J. Schmidt

Abstract

In a sample of men who have sex with men (MSM) (N = 3436) in Spain who bear intrinsic HIV risk, we investigated how internalised homonegativity (IH) is associated with the number of non-steady male partners with condomless intercourse (as a proxy of sexual risk behaviour). Using structural equation modelling (SEM), we examined the relationship between IH and sexual risk behaviour, and mediating effects of HIV/PrEP knowledge and substance use during sex on this relationship. We found no direct association between IH and sexual risk behaviour, nor did IH influence substance use during sex. In line with our hypothesis, association between IH and sexual risk behaviour was significant when mediated by HIV/PrEP knowledge. We found that as IH increased, sexual risk behaviour decreased, because higher IH was associated with lower HIV/PrEP knowledge while higher HIV/PrEP knowledge was associated with increased non-condom use with non-steady partners. Substance use during sex was significantly associated with sexual risk behaviour. Our results emphasize the continuing importance of prevention strategies focused on behavioural changes and community level interventions, especially targeting substance use.

© 2021 Springer Nature Switzerland AG

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EMIS 2017 Journal Articles 2017

Awareness of, willingness to take PrEP and its actual use among Belgian MSM at high risk of HIV infection: secondary analysis of the Belgian European MSM internet survey

AIDS and Behavior, published online first 24 November 2021 (doi: 10.1007/s10461-021-03526-z).

Authors: Veerle Buffel, Thijs Reyniers, Caroline Masquillier, Estrelle Thunissen, Christiana Nöstlinger, Marie Laga, Edwin Wouters, Wim Vanden Berghe, Jessika Deblonde, Bea Vuylsteke

Abstract

We examined PrEP awareness, willingness to take it and early PrEP use among men who have sex with men (MSM) at increased risk of HIV acquisition in Belgium. This analysis of the Belgian EMIS online data of 2017–2018 adopts a cascade approach, with the following steps quantified as conditional probabilities: being eligible for, aware of, willing to take PrEP, and PrEP use. One out of three MSM was eligible to use PrEP according to the operationalized Belgian reimbursement criteria. PrEP awareness was lower among socioeconomically vulnerable MSM, MSM living outside large cities, MSM who were less open about their sexuality and those who did not identify as gay or homosexual. A lack of PrEP knowledge, a higher self-efficacy regarding safe sex, having a steady partner and reporting more symptoms of depression were related to unwillingness to use PrEP. Among those willing to take PrEP, less than one third were actually using PrEP. Not using PrEP was associated with living in small cities and experiencing financial problems.

Keywords: Awareness of and willingness to use PrEP; Cascade approach; Eligibility criteria; Men who have sex with men (MSM); Pre-exposure prophylaxis (PrEP) use.

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EMIS 2017 Journal Articles 2017

Acceptability of pre-exposure prophylaxis for HIV prevention among gay men and other men who have sex with men: Analysis of LAMIS 2018-Chile

Revista Chilena De Infectologia: Organo Oficial De La Sociedad Chilena De Infectologia, 38(5), 655-666. https://doi.org/10.4067/s0716-10182021000500655

Authors: Adrian P, C., & Stuardo Á, V.

Abstract

Background:

Chile is facing a re-emergence of the HIV epidemic, concentrated among men who have sex with men (MSM). Pre-exposure prophylaxis (PrEP) is a biomedical intervention that effectively prevents HIV transmission among MSM.

Aim:

The study was designed to estimate acceptability of PrEP and identify factors associated with PrEP-related attitudes and behaviors among MSM using LAMIS 2018 – Chile study data.

Methods:

Data were taken from the LAMIS 2018 – Chile study, a cross-sectional study of gay, bisexual, transgender, and other MSM. Our subsample included 3976 participants with self-reported HIV-negative or unknown status who responded to sociodemographic questions and items related to PrEP. Bivariate analysis and multivariate logistic regression analysis were performed to identify factors associated with acceptability of PrEP.

Results and Discussion:

A total of 55.7% of the sample reported high PrEP acceptability. Logistic regression indicated that engaging in sex without a condom (ORa = 1.67, IC 95% 1.42-1.97) and having previously used PrEP (ORa = 1.99, IC 95% 1.41-1.62) were associated with high acceptability to use PrEP, while having a stable partner was associated with low acceptability. The estimate of PrEP acceptability was relatively high among participants. However, interventions to increase awareness and promote demand for PrEP may be beneficial. Furthermore, this study demonstrates the need for non-governmental organizations to participate in such strategies and for measures that address regionally-relevant emerging phenomena.

Keywords: pre-exposure prophylaxis (PrEP); HIV prevention; men who have sex with men (MSM)

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EMIS 2017 Journal Articles 2017

Changes in the prevalence of self-reported sexually transmitted bacterial infections from 2010 and 2017 in two large European samples of men having sex with men – is it time to re-evaluate STI-screening as a control strategy?

PLoS ONE, 2021; 16(3): e0248582 (doi: 10.1371/journal.pone.0248582).

Authors: Ulrich Marcus, Massimo Mirandola, Susanne B Schink, Lorenzo Gios, Axel J Schmidt

Abstract

Background/Objectives: Many European countries reported increased numbers of syphilis, gonorrhoea and chlamydia diagnoses among men who have sex with men (MSM) in recent years. Behaviour changes and increased testing are thought to drive these increases.

Methods: In 2010 and 2017, two large online surveys for MSM in Europe (EMIS-2010, EMIS-2017) collected self-reported data on STI diagnoses in the previous 12 months, diagnostic procedures, STI symptoms when testing, number of sexual partners, and sexual behaviours such as condom use during the last intercourse with a non-steady partner in 46 European countries. Multivariate regression models were used to analyse factors associated with diagnoses of syphilis, gonorrhoea/chlamydia, and respective diagnoses classified as symptomatic and asymptomatic. If applicable, they included country-level screening rates.

Results: Questions on STI diagnoses and sexual behaviours were answered by 156,018 (2010) and 125,837 (2017) participants. Between 2010 and 2017, overall diagnoses with gonorrhoea/chlamydia and syphilis increased by 76% and 83% across countries. Increases were more pronounced for asymptomatic compared to symptomatic infections. The proportion of respondents screened and the frequency of screening grew considerably. Condomless anal intercourse with the last non-steady partner rose by 62%; self-reported partner numbers grew. Increased syphilis diagnoses were largely explained by behavioural changes (including more frequent screening). Gonorrhoea/chlamydia increases were mainly explained by more screening and a change in testing performance. A country variable representing the proportion of men screened for asymptomatic infection was positively associated with reporting symptomatic gonorrhoea/chlamydia, but not syphilis.

Discussion/Conclusion: The positive association of country-level screening rates with the proportion of symptomatic infections with gonorrhoea/chlamydia may indicate a paradoxical effect of screening on incidence of symptomatic infections. Treatment of asymptomatic men might render them more susceptible to new infections, while spontaneous clearance may result in reduced susceptibility. Before expanding screening programmes, evidence of the effects of screening and treatment is warranted.

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EMIS 2017 Journal Articles 2017

Chemsex and diagnoses of syphilis, gonorrhoea and chlamydia among men who have sex with men in the UK: a multivariable prediction model using causal inference methodology

Sexually Transmitted Infections, 2021; 97:282-289. (doi: 10.1136/sextrans-2020-054629).

Authors: Louis MacGregor, Manik Kohli, Katharine J Looker, Ford Hickson, Peter Weatherburn, Axel J Schmidt, Katy M Turner

Abstract

Introduction: In the last decade diagnoses of most STIs have risen among men who have sex with men (MSM). Although a significant proportion of this is likely due to increased STI screening, understanding the role of behavioural drivers remains critical. We measure the associations between stimulant use to enhance and prolong sexual experiences (chemsex) and bacterial STI diagnoses in UK MSM, individually considering HIV-diagnosed MSM, pre-exposure prophylaxis (PrEP) users and other MSM.

Methods: We used the UK 2017-2018 European MSM Internet Survey data (n=9375). We constructed causal inference models using multivariable logistic regression, calculating adjusted OR (aOR) and 95% CI of the associations between participation in recent (≤12 months) exclusively dyadic or multipartner chemsex versus no chemsex and recent self-reported diagnoses of syphilis, gonorrhoea and chlamydia.

Results: Among MSM with an HIV diagnosis, 25% of users indicated recent multipartner chemsex, vs 28% of PrEP users and 5% of other MSM. Adjusting for age, ethnicity, UK birth, cis-trans status, sexual identity, education, settlement size and relationship status, participation in recent multipartner chemsex versus no chemsex was associated with greater odds of recent syphilis, gonorrhoea and chlamydia diagnosis. aORs for recent syphilis, gonorrhoea and chlamydia diagnoses were 2.6 (95% CI 1.7 to 4.1), 3.9 (95% CI 2.6 to 5.8) and 2.9 (95% CI 1.9 to 4.3), respectively, in HIV-diagnosed MSM; 1.9 (95% CI 1.1 to 3.3), 2.9 (95% CI 2.0 to 4.2) and 1.9 (95% CI 1.3 to 2.8), respectively, in PrEP users; and 4.0 (95% CI 2.3 to 6.9), 2.7 (95% CI 1.9 to 3.8) and 2.3 (95% CI 1.6 to 3.4), respectively, in other MSM. Conversely, exclusively dyadic chemsex had no significant associations with bacterial STI diagnoses among HIV-diagnosed MSM, only gonorrhoea (aOR 2.4, 95% CI 1.2 to 4.7) among PrEP users and syphilis (aOR 2.8, 95% CI 1.4 to 5.6) among other MSM.

Discussion: Multipartner chemsex may drive the association between chemsex and bacterial STI diagnoses and thus should be the focus of future tailored chemsex interventions. Additionally, PrEP acceptability among MSM and particularly chemsex participants has generated an emergent group suitable for such interventions.

Keywords: Chlamydia trachomatis; gay men; gonorrhoea; sexual behaviour; syphilis.

© Author(s) (or their employer(s)) 2021. No commercial re-use. Published by BMJ.

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EMIS 2017 Journal Articles 2017

An update on the performance of STI services for gay and bisexual men across European cities: results from the 2017 European MSM Internet Survey

Sexually Transmitted Infections, 2021; 97: 201-208 (doi: 10.1136/sextrans-2020-054681).

Authors: Jason Doran, Peter Weatherburn, Ford Hickson, Ulrich Marcus, David Reid, Axel Jeremias Schmidt

Abstract

Objectives: Rectal STIs compromise health and are common in men who have sex with men (MSM). However, the European-MSM-Internet-Survey (EMIS-2010) showed that in 2010, the prevalence of anal swabbing during STI screening by MSM varied widely across 40 European cities. In this paper, we replicate a variety of measures of STI testing performance using 2017-18 data and extending the geographic spread of the analysis.

Methods: Data were analysed from the EMIS-2017, a 33-language online sexual health survey accessible from 18 October 2017 to 31 January 2018. We focus on a subsample of 38 439 respondents living in the same 40 European cities we reported on in 2010. For a broader perspective, we also included an additional 65 cities in the analysis (combined n=56 661). We compared the prevalence of STI screening in MSM and disclosure of same-sex sexual contacts to the healthcare provider. We applied multivariable logistic regression models to compare the odds of MSM receiving each of four diagnostic procedures, including anal swabbing in the previous 12 months, controlling for age, HIV diagnosis, pre-exposure prophylaxis use and number of sexual partners.

Results: In 2017, across 40 European cities, the proportion of respondents screened for STIs ranged from under 19% in Belgrade to over 59% in London. At an individual level, in comparison to London, the adjusted OR (AOR) of having received anal swabbing ranged from 0.03 in Belgrade, Bucharest and Istanbul to 0.80 in Oslo, with little evidence for a difference in Amsterdam and Dublin. Since 2010, most cities in West and South-west Europe have substantially narrowed their performance gap with London, but some in East and South-east Europe have seen the gap increase.

Conclusions: Although comprehensive STI screening in MSM has expanded across many European cities, the low prevalence of anal swabbing indicates that rectal STIs continue to be underdiagnosed, particularly in East/South-east Europe.

A community-friendly summary was written by Roger Pebody and published on 3 Dec 2020 in nam/aidsmap: Rectal STIs are still not being diagnosed in many European cities, due to inadequate screening

Keywords: health services research; homosexuality; policy; screening; sexual health.

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EMIS 2017 Journal Articles 2017

Potential alcohol use disorder among MSM in Ireland – Findings from the European MSM internet survey (EMIS 2017)

Drug and Alcohol Dependence, 2021; 223: 108698 (doi: 10.1016/j.drugalcdep.2021.108698).

Authors: Fionn P. Daly, Kate O’Donnell, Martin P. Davoren, Chris Noone, Peter Weatherburn, Mick Quinlan, Bill Foley, Derval Igoe, Peter M. Barrett

Abstract

Background: Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) disproportionately affects men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this.

Methods: The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD.

Results: In total, 1793 MSM met inclusion criteria. 31 % screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95 %CI 1.01–2.18), native to Ireland (vs. non-native) (aOR 1.49 95 %CI 1.12–1.96), unemployed (vs. employed) (aOR 1.80 95 %CI 1.02–3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95 %CI 1.14–2.63) (other illicit drugs, aOR 2.28 95 %CI 1.67–3.09), reported anxiety/depression (vs. none) (aOR 1.73 95 %CI 1.12–2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95 %CI 1.09–2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95 %CI 0.46−0.93).

Conclusions: The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.

Keywords: Men who have sex with men (MSM); Alcohol use disorder (AUD); Drug use; Depression/Anxiety; Homophobia; HIV / AIDS

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