Journal Articles 2024

Eurosurveillance, 2026, 31(31):pii=2500913. (doi:10.2807/1560-7917.ES.2026.31.31.2500913).

Authors: Disa Hansson, Anastasia Pharris, Axel Jeremias Schmidt, Kai J Jonas, Ulrich Marcus, Diamantis Plachouras, Liselotte Diaz Högberg, Otilia Mårdh, Jose Canevari

Abstract

Background. Doxycycline post-exposure prophylaxis (doxy-PEP) has been shown to reduce the incidence of chlamydia and syphilis among men who have sex with men (MSM) at high risk of sexually transmitted infections (STIs). However, doxy-PEP adds antibiotic exposure and may select for tetracycline resistance in both target and bystander bacteria, raising concerns about antimicrobial resistance (AMR). Quantifying additional antibiotic consumption from doxy-PEP is important for assessing its potential AMR impact at population level.

Aim. We estimated the potential increase in doxycycline consumption attributable to doxy-PEP among MSM using HIV pre-exposure prophylaxis (PrEP) in the European Union and European Economic Area (EU/EEA) and compared it with overall doxycycline and tetracycline-class consumption.

Methods. We used Monte Carlo simulation to estimate annual doxycycline use from doxy-PEP among MSM using PrEP. We estimated population size from the 2024 European MSM Internet Survey and derived doxy-PEP uptake and prescribing frequency from expert elicitation. Estimated consumption in defined daily doses (DDD) per year was compared with tetracycline-class and doxycycline antibiotic use reported by the European Surveillance of Antimicrobial Consumption Network.

Results. Doxy-PEP among MSM using PrEP in the EU/EEA could result in an estimated 4.4 million DDDs of doxycycline annually (95% credible interval (CrI): 0.5–18.1 million), corresponding to a 1.9% increase (95% CrI: 0.2–7.7) relative to 2023 doxycycline consumption.

Conclusions. The estimated Doxy-PEP use constitutes a non-negligible share of total doxycycline consumption in the EU/EEA. Monitoring doxy-PEP uptake and AMR indicators will be essential as more countries consider integrating this intervention into STI prevention strategies.

Methodological note. Because EMIS-2024 overrepresents sexually active MSM, a bias correction factor was applied when extrapolating estimates to the wider population. The correction factor was derived by comparing self-reported syphilis incidence among MSM in EMIS-2024 with the corresponding reported 2023 syphilis incidence from The European Surveillance System (TESSy), hosted by ECDC. The ratio between the EMIS-2024 and TESSy incidences was assumed to reflect the degree of oversampling of highly sexually active MSM. The estimated number of PrEP users was therefore calculated by dividing the unadjusted EMIS estimate by this bias correction factor (2.32).

Available online

Sexuality Research and Social Policy, 2026 (doi:10.1007/s13178-026-01288-8).

Authors: Liana Aphami, Tamás Bereczky, Jules L Casalini, Nikolay Lunchenkov, Ulrich Marcus, Kai J Jonas, Axel J Schmidt.

Abstract

Introduction. Men-who-have-sex-with-men (MSM), as well as transgender and non-binary individuals, continue to face a disproportionate burden of stigma, mental health challenges, HIV, and other sexually transmitted infections. To address their needs, public health planners require reliable and comparable data. Monitoring behaviours in these populations also supports the evaluation of health policies.

Methods. The European-MSM-Internet-Survey (EMIS-2024) builds on our international surveys conducted in 2010 and 2017, expanding its scope to include explicitly transgender women and non-binary people. It provides much-needed data for planning interventions, promoting health, and harmonising behavioural surveillance. A key strength of EMIS-2024 is the use of a shared sampling frame and a core questionnaire across all participating countries. This approach allows meaningful cross-national comparisons, unlike many national surveys with varying methods. The three core consortium partners (Deutsche Aidshilfe, Robert Koch Institute and Maastricht University) led the revision of the EMIS-2017 questionnaire.

Results. Over 60 partners from 40 countries played a key role in the survey’s success, providing high-quality translations in 35 languages and actively promoting the survey. National partners ensured the survey’s visibility, credibility, and relevance once dating app advertisements or invitations appeared. The survey ran online during the first half of 2024. Overall, 165,380 responses were received, of which 50,330 qualified for the analytic sample.

Conclusions and Policy Implications. EMIS-2024 demonstrates that large-scale, multi-country sexual health surveys are feasible with public funding. A harmonised questionnaire, shared sampling strategy, and meaningful community involvement were key to generating robust, comparable data across Europe.

Country groupings used in EMIS-2024. For analytical purposes in the methods paper, countries are grouped as follows. We suggest this structure as a useful framework for international comparative analyses and journal articles:

EEA: Countries of the European Economic Area.
Non-EEA Advanced Economies: High-income countries outside the EEA within the WHO European Region (including Switzerland, Israel, and the United Kingdom), based on the International Monetary Fund (IMF) classification of advanced economies.¹
Western Balkans & Türkiye: Non-EEA countries in south-eastern Europe.
Eastern Europe and Central Asia (EECA): Non-EEA countries of the former Soviet Union.

This grouping facilitates epidemiological interpretation and comparability of trends across countries with markedly different economic conditions and epidemiological profiles. The grouping also reflects differences in study coordination and funding arrangements across participating countries and regions.

Available online

Suggested citation:

Aphami L, Bereczky T, Casalini JL, Lunchenkov N, Marcus U, Jonas KJ, Schmidt AJ. European Men-Who-Have-Sex-With-Men and Trans People Internet Survey (EMIS-2024): Design and Methods. Sex Res Soc Policy (2026). https://doi.org/10.1007/s13178-026-01288-8

“Advanced economies” follow the International Monetary Fund’s World Economic Outlook country classification (International Monetary Fund. World Economic Outlook Database: Groups and Aggregates, April 2025). Alternatively, the term “non-EEA high-income countries” may be used to distinguish between EEA and non-EEA high-income countries, based on the World Bank country classification (World Bank. World Bank Country and Lending Groups). ↩︎