Categories
EMIS 2017 International reports 2017

European Report 2017

The EMIS Network. EMIS-2017 – The European Men-Who-Have-Sex-With-Men Internet Survey. Key findings from 50 countries.

Report details:
Stockholm, European Centre for Disease Prevention and Control, 2019 (ISBN 978-92-9498-341-1).

Download report as PDF

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EMIS 2017 International reports 2017

EMIS-2017 Community Reports

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

3rd EMIS-2017 Community Report

3rd EMIS-2017 Community Report (Arabic)

3rd EMIS-2017 Community Report (Czech)

3rd EMIS-2017 Community Report (English)

3rd EMIS-2017 Community Report (French)

3rd EMIS-2017 Community Report (German)

3rd EMIS-2017 Community Report (Italian)

3rd EMIS-2017 Community Report (Portuguese)

3rd EMIS-2017 Community Report (Russian)

3rd EMIS-2017 Community Report (Spanish)

3rd EMIS-2017 Community Report (Turkish)

2nd EMIS-2017 Community Report

2nd EMIS-2017 Community Report (Arabic)

2nd EMIS-2017 Community Report (Czech)

2nd EMIS-2017 Community Report (English)

2nd EMIS-2017 Community Report (French)

2nd EMIS-2017 Community Report (German)

2nd EMIS-2017 Community Report (Italian)

2nd EMIS-2017 Community Report (Polish)

2nd EMIS-2017 Community Report (Portuguese)

2nd EMIS-2017 Community Report (Russian)

2nd EMIS-2017 Community Report (Spanish)

2nd EMIS-2017 Community Report (Turkish)

1st EMIS-2017 Community Report

LAMIS-Brazil Community Report (Portuguese)

1st EMIS-2017 Community Report (Arabic)

1st EMIS-2017 Community Report (Bulgarian)

1st EMIS-2017 Community Report (Croatian)

1st EMIS-2017 Community Report (Czech)

1st EMIS-2017 Community Report (Danish)

1st EMIS-2017 Community Report (Dutch)

1st EMIS-2017 Community Report (English)

1st EMIS-2017 Community Report (Estonian)

1st EMIS-2017 Community Report (Finnish)

1st EMIS-2017 Community Report (French)

1st EMIS-2017 Community Report (Switzerland-French)

1st EMIS-2017 Community Report (German)

1st EMIS-2017 Community Report (Switzerland-German)

1st EMIS-2017 Community Report (Greek)

1st EMIS-2017 Community Report (Hebrew)

1st EMIS-2017 Community Report (Hungarian)

1st EMIS-2017 Community Report (Icelandic)

1st EMIS-2017 Community Report (Italian)

1st EMIS-2017 Community Report (Switzerland-Italian)

1st EMIS-2017 Community Report (Latvian)

1st EMIS-2017 Community Report (Lithuanian)

1st EMIS-2017 Community Report (Macedonian)

1st EMIS-2017 Community Report (Norwegian)

1st EMIS-2017 Community Report (Polish)

1st EMIS-2017 Community Report (Portuguese)

1st EMIS-2017 Community Report (Romanian)

1st EMIS-2017 Community Report (Russian)

1st EMIS-2017 Community Report (Serbian)

1st EMIS-2017 Community Report (Slovak)

1st EMIS-2017 Community Report (Slovenian)

1st EMIS-2017 Community Report (Spanish)

1st EMIS-2017 Community Report (Swedish)

1st EMIS-2017 Community Report (Turkish)

1st EMIS-2017 Community Report (Ukrainian)

Categories
EMIS 2017 National reports 2017

EMIS-2017 National Reports

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.

EMIS-2017: Austria EMIS-2017 National Reports

EMIS-2017: Belarus EMIS-2017 National Reports

EMIS-2017: Belgium (België) EMIS-2017 National Reports

EMIS-2017: Belgium (Belgique) EMIS-2017 National Reports

EMIS-2017: Canada (main report) EMIS-2017 National Reports

EMIS-2017: Canada (Infographic summary) EMIS-2017 National Reports

EMIS-2017: Czechia EMIS-2017 National Reports

EMIS-2017: Cyprus EMIS-2017 National Reports

EMIS-2017: Denmark EMIS-2017 National Reports

EMIS-2017: Estonia EMIS-2017 National Reports

EMIS-2017: France EMIS-2017 National Reports

EMIS-2017: Germany EMIS-2017 National Reports

EMIS-2017: Greece (1) EMIS-2017 National Reports

EMIS-2017: Greece (2) EMIS-2017 National Reports

EMIS-2017: Ireland (Main Report) EMIS-2017 National Reports

EMIS-2017: Ireland (Community Report 1) EMIS-2017 National Reports

EMIS-2017: Ireland (Community Report 2) EMIS-2017 National Reports

EMIS-2017: Ireland (Community Report 3) EMIS-2017 National Reports

EMIS-2017: Ireland (Community Report 4) EMIS-2017 National Reports

EMIS-2017: Ireland (Infographic Demographics) EMIS-2017 National Reports

EMIS-2017: Ireland (Infographic Health) EMIS-2017 National Reports

EMIS-2017: Ireland (Infographic Behaviours) EMIS-2017 National Reports

EMIS-2017: Ireland (Infographic Needs) EMIS-2017 National Reports

EMIS-2017: Ireland (Infographic Interventions) EMIS-2017 National Reports

EMIS-2017: Ireland (Health technology assessment for PrEP) EMIS-2017 National Reports

EMIS-2017: Israel EMIS-2017 National Reports

EMIS-2017: Italy EMIS-2017 National Reports

EMIS-2017: Malta EMIS-2017 National Reports

EMIS-2017: Moldova EMIS-2017 National Reports

EMIS-2017: Norway EMIS-2017 National Reports

EMIS-2017: Russia EMIS-2017 National Reports

EMIS-2017: Spain EMIS-2017 National Reports

EMIS-2017: Sweden EMIS-2017 National Reports

EMIS-2017: Switzerland (Suisse) EMIS-2017 National Reports

EMIS-2017: Switzerland (Schweiz) EMIS-2017 National Reports

EMIS-2017: Ukraine EMIS-2017 National Reports

Categories
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 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.

LAMIS funding: 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).

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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)

Categories
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

Available online

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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.

Available online

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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.

Available FREE online

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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.

Available online

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EMIS 2010 Journal Articles 2010

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.

Available FREE online