Archives of Sexual Behavior. 2022. (doi: 10.1007/s10508-022-02468-4)
Authors: Axel J. Schmidt, Michael W. Ross, Rigmor C. Berg, Peyman Altan
Abstract:
To examine the impact of migration and acculturation of Turkish men who have sex with men (MSM) to Germany, using data from the European MSM Internet Survey (EMIS-2010), on measures of acculturation including circumcision status, internalized homonegativity (IH), HIV/STI knowledge, sexual orientation, outness, HIV-testing, and sexual behaviors.
We compared four groups of MSM: MSM born and residing in Germany who had completed the questionnaire in German (n = 38,915), MSM born and residing in Germany, with a father or mother born in Turkey (n = 97), MSM residing in Germany who were born in Turkey or whose parents were born in Turkey (n = 262), and MSM who were born and residing in Turkey and who completed the questionnaire in Turkish (n = 1,717).
Data showed that there were significant dose–response curves between level of migration and several outcome variables. As exposure to Germany increased, MSM had lower IH, higher HIV/STI knowledge, increased outness, and were less likely to be circumcised. There were similar significant findings with regard to sexual HIV risk behavior (condomless anal intercourse with partners of unknown (or sero-discordant) HIV status).
Data were consistent with acculturation over generations in immigrant groups in MSM migrating from Turkey to Germany. Integration includes both cultural aspects (circumcision) and integration into a more homopositive gay environment (IH, outness, increased HIV/STI knowledge), and sexual HIV risk behavior. Migration and associated acculturation may constitute a risk change for HIV/STI and mental health issues associated with IH and outness.
We thank our network partners for their translations of the following Community Reports.
The 3rd EMIS-2017 Community Report, published 14 August 2021, covers the stress factors affecting mental and sexual health and well-being and was coordinated by Mick Quinlan (Gay Health Network, Dublin, Ireland). It has been translated into the seven most commonly spoken languages in Europe: German, Russian, French, Turkish, Italian, Polish, and Spanish, as well as into Arabic, Czech, and Portuguese. The 3rd community report was funded by Ireland’s Health Services (HSE).
The 2nd EMIS-2017 Community Report, published 27 November 2020, focuses on gay men living with HIV in Europe and was coordinated by Mick Quinlan (Gay Health Network, Dublin, Ireland). It has been translated into the seven most commonly spoken languages in Europe: German, Russian, French, Turkish, Italian, Polish, and Spanish, as well as into Arabic, Czech, and Portuguese. The 2nd community report was funded by Ireland’s Health Services (HSE).
The 1st EMIS-2017 Community Report targeted at EMIS respondents and MSM in general was published in 31 languages by the end of 2018. We thank our network partners for their contributions and translations, and particularly the German NGO Deutsche AIDS-Hilfe for leading the process, and the Swiss AIDS Federation for financial support.
The first Community Report describes safer sex knowledge (including knowledge on Pre-Exposure Prophylaxis (PrEP) and Undetectable=Untransmittable (U=U). The English version was first presented at AIDS2018 in Amsterdam. The Philippines opted out from the 1st Community Report, so it covers 49, not 50, countries.
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.
Since data collection has closed, we have distributed 39 country of residence datasets to our EMIS-2017 partners who are working on a wide range of national reports, in a variety of formats. As these reports are published they will be added here. No datasets were requested from Luxemburg, Bosnia iH, Iceland, or Turkey. As of June 2021, 20 countries have provided at least one national report. Many countries were interrupted in their report writing by the COVID-19 pandemic. We still expect a report from the Netherlands, Poland, Portugal, and Slovakia. No feedback has been received from BG, HR, LV/LT, SI, PH, RS. No reports are expected from Finland, Hungary, Lebanon, North Macedonia, Romania, or the United Kingdom.
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 UNAIDSwebsite 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 the 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.
LAMIS contributions: CEEISCAT, Spain (Jordi Casabona Barbara, Percy Fernández Dávila): LAMIS network and local recruitment coordination, economic and legal aspects of hosting the database. CIISSS, Peru (Carlos F. Cáceres, E. Michael Reyes): LAMIS Report for Latin America. NUDHES, Brazil (Maria Amelia de Sousa Mascena Veras, Daniel Barros): study website and its graphic design. LSHTM, United Kingdom (Sigma Research: Axel J. Schmidt, Ford Hickson, David Reid, Peter Weatherburn): questionnaire design, support with survey software and monitoring of recruitment, graphic arts of banners for promotion, data cleaning and labelling, error handling, variable manual, templates for national and community reports, collaboration with UNAIDS. Robert Koch Institute, Germany (Ulrich Marcus): negotiations with web pages/apps for free promotion of LAMIS and coordination of central recruitment.
LAMIS acknowledgements: We thank all men who took part in LAMIS, as well as our app partners Grindr and PlanetRomeo who helped to recruit participants through free-of-charge instant messages, and our local partners who recruited participants via Facebook and other social media, and placed promotional banners on their websites. Thank you for being part of something huge!
The following list acknowledges all LAMIS partners by country.
AR: Federación Argentina de Lesbianas, Gays, Bisexuales y Trans (FALGBT). BO: Fundación Diversencia; MANODIVERSA. BR: Núcleo de Pesquisa em Direitos Humanos e Saúde LGBT+ (NUDHES) da Faculdade de Ciências Médicas da Santa Casa de São Paulo; ABGLT. CL: Escuela de Salud Pública – Universidad de Chile; Fundación Savia; APROFA. CO: Asociación Ágora; UNIMINUTO Seccional Bello. CR: Centro de Investigación y Promoción para América Central de Derechos Humanos (CIPAC). EC: Fundación Ecuatoriana Equidad. GT: Fundación Sida y Sociedad; Centro de Investigaciones de las Ciencias de la Salud, Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala. HN: Asociación Kukulcan. MX: Red GayLatino. NI: Centro para la Educación y Prevención del SIDA (CEPRESI). PA: Grupo Génesis Panamá+. PY: SOMOSGAY. PE: Center for Research on Sexuality, AIDS and Society at Universidad Peruana Cayetano Heredia. SR: Parea Surinam. SV: Asociación Entre Amigos. UY: Colectivo Ovejas Negras; +VIHdas. VE: Venezuela Igualitaria.
LAMISfunding: Questionnaire design, core survey execution and variable manual were provided by EMIS-2017 (funded by the EU Health Programme 2014–2020 for Europe), and adapted for LAMIS use. Additional financial support was provided by CEEISCAT, CIISSS, Instituto de Saúde Pública da Universidade do Porto, Maastricht University, NUDHES, and Robert Koch Institute.
*The Red Iberoamericana de Estudios en Hombres Gay, otros Hombres que tienen Sexo con Hombres y Personas Trans is composed of the following institutions: Núcleo de Pesquisa em Direitos Humanos e Saúde LGBT+ (NUDHES) da Faculdade de Ciências Médicas da Santa Casa de São Paulo (Brazil); Escuela de Salud Pública, Universidad de Chile (Chile); CIISSS at Universidad Peruana Cayetano Heredia (Peru); CICS – Facultad de Ciencias Médicas, Universidad de San Carlos de Guatemala (Guatemala); Instituto de Saúde Pública da Universidade do Porto (Portugal); the Centre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i VIH/Sida de Catalunya (CEEISCAT, Spain).
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.
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.
Sexual Health, 2019, 16, 464–472 (doi:10.1071/SH18159).
Authors: Manik Kohli, Ford Hickson, Caroline Free, David Reid, Peter Weatherburn
Abstract
Background: Illicit drug use among men who have sex with men (MSM) has been associated with sexual risk and HIV. Less is documented about associations with other sexually transmissible infections (STIs). The aim of the present study was to determine whether the use of drugs commonly associated with chemsex is associated with increased risk of gonorrhoea among MSM.
Methods: Using data from 16 065 UK-based respondents to the European MSM Internet Survey (2010), we examined associations between a recent diagnosis of gonorrhoea and three chemsex drugs (crystal methamphetamine, γ-hydroxybutyric acid (GHB)/γ-butyrolactone (GBL) and mephedrone). Univariate logistic regression identified determinants of gonorrhoea diagnosis and multivariate logistic regression models calculated adjusted odds ratios (aORs) for independent associations between chemsex drugs and gonorrhoea.
Results: MSM who reported using crystal methamphetamine and GHB/GBL in the previous year had 1.92- and 2.23-fold higher odds of gonorrhoea respectively over the same period (P = 0.0001 and P < 0.0001; n = 15 137) after adjusting for age, recruitment website, HIV status, residence and use of other chemsex drugs. MSM reporting the use of all three chemsex drugs had the highest increased odds (aOR 3.58; P < 0.0001; n = 15 174). Mephedrone alone was not associated with gonorrhoea in multivariate models.
Conclusions: Use of chemsex drugs is associated with a higher risk of gonorrhoea. The results of this study complement existing research about crystal methamphetamine and indicate a role for GHB/GBL in adverse sexual health outcomes. The use of mephedrone alongside other chemsex drugs may account for its lack of association with gonorrhoea in multivariate models. Future research should use encounter-level data, examine other STIs and attribute pathways through which chemsex leads to infection.
Authors: Rigmor C. Berg, Peter Weatherburn, Ulrich Marcus, Axel J. Schmidt
Abstract
Background: In Europe, the highest proportion of HIV diagnoses are in gay men and other men who have sex with men (MSM). Globally, HIV prevalence is particularly high among males who report selling sex, but rates among men who buy sex from other men are less clear. This study analyzed the association of transactional sex (TS) and HIV diagnosis, sexually transmitted infection (STI) diagnoses, and various drug use; and examined the variations in TS by payment direction.
Methods: We conducted a cross-sectional, non-randomized, observational study. This European MSM Internet Survey recruited MSM from 38 European countries. For descriptive purposes we stratified according to TS behavior (frequently selling sex, frequently buying sex, neither frequently selling nor buying sex in the previous 12 months), and we constructed separate multivariable logistic regression models to investigate whether engaging in TS accounted for some of the HIV- and STI diagnoses and drug use in this population.
Results: Of almost 161,000 sexually active MSM, 12.2% engaged in TS. The multivariable logistic regression results showed that relative to not frequently engaging in TS, frequently selling sex was independently associated with a higher odds of reporting diagnosed HIV (ever, adjusted odds ratio [aOR] 1.60, confidence interval [CI] 95% 1.39 to 1.85), bacterial STIs (past 12 months, aOR 1.75 CI 95% 1.54 to 2.00), using heroin or crack cocaine or injecting drugs (aOR 3.17, CI 95% 2.70 to 3.73), and using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41). Compared to men not engaging in frequent TS, frequently buying sex was associated with a higher odds of using benzodiazepines (aOR 2.13, CI 95% 1.88 to 2.41).
Conclusions: MSM who frequently sell sex suffer greater sexual- and substance use risks than other MSM, but both men who frequently sell and those who buy sex are more likely to use benzodiazepines. MSM who sell sex to other men constitute an important at-risk population who must be offered targeted health services.
Keywords: drug use; Europe; HIV; men who have sex with men; sexually transmitted infections; transactional sex
Journal of Sex Research, 2018; 55(4-5):617-629 (doi:10.1080/00224499.2017.1380158).
Authors: Ha Tran, Michael W. Ross, Pamela M. Diamond, Rigmor C. Berg, Peter Weatherburn & Axel J. Schmidt
Abstract
Internalized homonegativity (IH) is the internalization of negative attitudes and assumptions about homosexual people by homosexual people themselves. To measure IH, Smolenski, Diamond, Ross, and Rosser (2010) and Ross, Rosser, and Smolenski (2010) revised the Reactions to Homosexuality Scale (RHS) to develop the Short Internalized Homonegativity Scale (SIHS) with eight items. Using the European Men Who Have Sex With Men Internet Survey (EMIS) data, with an analytic sample of 130,718 gay and bisexual men in 38 European countries, we confirmed the validity of the SIHS scale in both training and validation data, in strata of Ross, Berg, et al.’s (2013) three “homosexual discrimination” country clusters, of age, and of education level. However, the performance was less adequate in comparison of gay versus bisexually identified individuals. The latent SIHS structure contains only minor variations across these three strata. The seven-item scale performed as well as the eight-item scale. The SIHS is a promising candidate for standard IH measures, which is invariant across cultural, age, and educational strata.
