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EMIS 2017 Journal Articles 2017

Determinants of HIV Testing Among Migrant Men Who Have Sex With Men from Sub‐Saharan Africa and Other Regions Residing in 10 European Countries

AIDS and Behavior 2024; (doi: 10.1007/s10461-023-04239-1)

Authors: Oladipupo Shobowale, Axel J. Schmidt, Paula Meireles, Daniela Rojas Castro, Sandrine Detandt, Sarah E. Stutterheim, Peter Weatherburn, Kai J. Jonas

Abstract

Migrant men who have sex with men (mMSM) from sub-Saharan Africa (SSA) and other regions outside Europe are highly vulnerable to HIV. However, research on the determinants of HIV testing among mMSM from SSA, and how these differ across the categories of mMSM living in Europe, is limited.

Using data from the European MSM Internet Survey (EMIS- 2017), we assessed HIV testing prevalence and recency in mMSM from SSA and other mMSM residing in ten European countries, as well as the determinants of HIV testing across different mMSM categories with logistic regression analyses.

Ever-testing for HIV was slightly higher in mMSM from SSA (83%) compared to other mMSM categories (75–80%), except for mMSM from Latin America and Caribbean region (84%). Overall, 20% of mMSM had never tested. In multivariable analysis, higher age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.01–1.10), higher HIV knowledge (AOR 1.45, 95%-CI 1.11–1.90), and residence in smaller settlements (AOR 0.45, 95%-CI 0.21–0.96) were significantly associated with ever testing for HIV in mMSM from SSA. Comparing mMSM from SSA to mMSM from other regions, we found varying significant similarities (higher age, residence in smaller settlements and HIV knowledge) and differences (lower educational attainment, not identifying as gay, being a student, and limited disclosure of homosexual attraction) in the determinants of ever-testing for HIV.

Community-specific interventions addressing identified sociodemographic and behavioral determinants to increase HIV testing uptake in the different mMSM categories and better data for further research are warranted.

Available online

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EMIS 2017 Journal Articles 2017

Comparison of the burden of self-reported bacterial sexually transmitted infections among men having sex with men across 68 countries on four continents

BMC Public Health 2023; 23:1008 (doi: 10.1186/s12889-023-15946-8)

Authors: Ulrich Marcus, Maria Veras, Jordi Casabona, Carlos F. Caceres, Nathan Lachowsky, Susanne B. Schink, Axel J. Schmidt

Abstract

Background 

Men who have sex with men (MSM) are in general more vulnerable to sexually transmitted infections (STIs) than the heterosexual men population. However, surveillance data on STI diagnoses lack comparability across countries due to differential identification of MSM, diagnostic standards and methods, and screening guidelines for asymptomatic infections.

Methods 

We compared self-reported overall diagnostic rates for syphilis, gonorrhea, and chlamydia infections, and diagnostic rates for infections that were classified to be symptomatic in the previous 12 months from two online surveys. They had a shared methodology, were conducted in 68 countries across four continents between October 2017 and May 2018 and had 202,013 participants.

Results 

Using multivariable multilevel regression analysis, we identified age, settlement size, number of sexual partners, condom use for anal intercourse, testing frequency, sampling rectal mucosa for extragenital testing, HIV diagnosis, and pre-exposure prophylaxis use as individual-level explanatory variables. The national proportions of respondents screened and diagnosed who notified some or all of their sexual partners were used as country-level explanatory variables. Combined, these factors helped to explain differences in self-reported diagnosis rates between countries. The following differences were not explained by the above factors: self-reported syphilis diagnoses were higher in Latin America compared with Europe, Canada, Israel, Lebanon, and the Philippines (aOR 2.30–3.71 for symptomatic syphilis compared to Central-West Europe); self-reported gonorrhea diagnoses were lower in Eastern Europe and in Latin America compared with all other regions (aOR 0.17–0.55 and 0.34–0.62 for symptomatic gonorrhea compared to Central-West Europe); and self-reported chlamydia diagnoses were lower in Central East and Southeast Europe, South and Central America, and the Philippines (aOR 0.25–0.39 for symptomatic chlamydia for Latin American subregions compared to Central West Europe).

Conclusions 

Possible reasons for differences in self-reported STI diagnosis prevalence likely include different background prevalence for syphilis and syndromic management without proper diagnosis, and different diagnostic approaches for gonorrhea and chlamydia.

Available online

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EMIS 2017 Journal Articles 2017

Spatio-temporal changes in pre-exposure prophylaxis uptake among MSM in mainland France between 2016 and 2021: a Bayesian small area approach with MSM population estimation

J. Int. AIDS Soc. 2023, 26:e26089 (doi: 10.1002/jia2.26089)

Authors: Haoyi Wang, Jean-Michel Molina, Rosemary Dray-Spira, Axel J. Schmidt, Ford Hickson, David van de Vijver, Kai J. Jonas

Abstract:

Introduction

In France, oral pre-exposure prophylaxis (PrEP) for HIV prevention has been publicly available since 2016, mainly targeting at men who have sex with men (MSM). Reliable and robust estimations of the actual PrEP uptake among MSM on a localized level can provide additional insights to identify and better reach marginalized MSM within current HIV prevention service provision. This study used national pharmaco-epidemiology surveillance data and regional MSM population estimations to model the spatio-temporal distribution of PrEP uptake among MSM in France 2016–2021 to identify marginalized MSM at risk for HIV and increase their PrEP uptake.


Methods

We first applied Bayesian spatial analyses with survey-surveillance-based HIV incidence data as a spatial proxy to estimate the size of (1) regional HIV-negative MSM populations and (2) MSM who could be eligible for PrEP use according to French PrEP guidelines. We then applied Bayesian spatio-temporal ecological regression modelling to estimate the regional prevalence and relative probability of the overall- and new-PrEP uptake from 2016 to 2021 across France.


Results

HIV-negative and PrEP-eligible MSM populations vary regionally across France. Île-de-France was estimated to have the highest MSM density compared to other French regions. According to the final spatio-temporal model, the relative proba- bility of overall PrEP uptake was heterogeneous across France but remained stable over time. Urban areas have higher-than- average probabilities of PrEP uptake. The prevalence of PrEP use increased steadily (ranging from 8.8% [95% credible interval 8.5%;9.0%] in Nouvelle-Aquitaine to 38.2% [36.5%;39.9%] in Centre-Val-de-Loire in 2021).


Conclusions

Our results show that using Bayesian spatial analysis as a novel methodology to estimate the localized HIV- negative MSM population is feasible and applicable. Spatio-temporal models showed that despite the increasing prevalence of PrEP use in all regions, geographical disparities and inequalities of PrEP uptake continued to exist over time. We identified regions that would benefit from greater tailoring and delivery efforts. Based on our findings, public health policies and HIV prevention strategies could be adjusted to better combat HIV infections and to accelerate ending the HIV epidemic.

Available online

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EMIS 2017 National reports 2017

EMIS-2017 National Reports

Since data collection has closed in February 2018, 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 July 2023, 22 countries have provided at least one national report. Many countries were interrupted in their report writing by the COVID-19 pandemic. We might still receive a report from the Netherlands, Poland, Portugal, and Slovakia. No reports are expected from Bulgaria, Croatia, Finland, Hungary, Lebanon, Lithuania, Latvia, North Macedonia, Romania, Serbia, Slovenia, the Philippines, 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

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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

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

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.

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