Tag: STIs other than HIV

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EMIS 2010 Journal Articles 2010

What’s on the rise in Sexually Transmitted Infections?

Lancet Reg Health Eur. 2023. (doi: 10.1016/j.lanepe.2023.100742)

Authors: Axel Jeremias Schmidt, Ulrich Marcus

Invited Commentary.

Several factors related to Sexually Transmitted Infections (STIs) transmission and detection are on the rise. For example, there is increasing evidence that e.g., anal intercourse combined with drug use is becoming common among young heterosexuals, and the diversity of heterosexual practices has been on the rise for many years. Data from the European MSM Internet Survey (2010) illustrate how sexual repertoire diversity impacts STIs in MSM, independent of partner numbers (Fig. 1). Unfortunately, much research neglects these specific factors and persists in employing ambiguous terms like “high-risk behaviour” or “risk compensation”, which are poorly defined and often stigmatizing.

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 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 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 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

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EMIS 2017 International reports 2017

EMIS-2017: European Report

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).

Suggested citation:
The EMIS Network. EMIS-2017 – The European Men-Who-Have-Sex-With-Men Internet Survey. Key findings from 50 countries. Stockholm: European Centre for Disease Prevention and Control; 2019.

Download report as PDF

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EMIS 2017 International reports 2017

Maps for “Dublin Declaration Monitoring” 2017

The EMIS Network. EMIS-2017 – The European Men-Who-Have-Sex-With-Men Internet Survey. Maps from the EMIS-2017 Report.

Authors: Peter Weatherburn, Ford Hickson, David S. Reid, Susanne B. Schink, Ulrich Marcus, Axel J. Schmidt

Download maps as PDF

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EMIS 2017 Journal Articles 2017

From HIV-testing to Gay Health Centres: A Mapping of European “Checkpoints”

HIV and Viral Hepatitis (Conference), Malta 2017 – PS2/04; (doi: 10.13140/RG.2.2.26988.77441)

Authors: Axel J. Schmidt, Dirk Sander, Teymur Noori

Abstract

Background

In Europe, HIV/STIs are concentrated in certain vulnerable groups, above all, men who have sex with men (MSM). For this reason, targeted HIV testing interventions are paramount. In 2002, a community-based HIV testing service using rapid HIV-tests was established in Amsterdam and given the name “Checkpoint”. Since then, the concept of community-based centres (CBCs) for HIV-testing and other sexual health services has spread throughout Europe, and many such centres have been established using the name “Checkpoint” (CP). Over the years, many centres have offered more comprehensive services regarding gay health, including testing for other sexually transmitted infections (STIs), counselling on drugs use, vaccination, and even provision of HIV treatment. The aim of this study to map community-based (and other) sexual health centres targeting gay and other MSM in Europe.

Methods

In preparation of the second round of the European MSM Internet Survey (EMIS-2017), the EMIS-Network, consisting of more than 80 academic, governmental, and non-governmental organisations, was contacted by e-mail (08/2015) to identify “Checkpoints” and other sexual health centres for gay men throughout Europe. 56 centres were identified and 54 responded. Representatives for the centres were asked for the exact address of the centre, the year it opened (as an HIV-testing / gay health centre) and the current opening hours per week.

Results

Community-based centres (CBCs, N=44) were distinguished from traditional clinics/private practices (“clinics”, N=10), although such binary classification is not always clear-cut. The label “community-based”, in this context, involves ownership and/or decision power by a collective of gay men. The proportion of gay men among employees was 67% in CBCs and 41% in clinics. CP Riga and Odense had no gay men employed, while CP Amsterdam, Aarhus, Bern, Copenhagen reported less than 50%. The majority of CBCs (68%) and clinics (80%) had gay physicians employed or closely attached.

Recommendations

The list is still incomplete, especially NHS services (UK) and clinics offering gay-friendly HIV-testing are missing. However we believe we covered all comprehensive sexual health services for MSM in Europe that fall into the upper right quadrant of Figure 2. The added value of maintaining up-to-date listing of CBCs is their use in online mapping services and integration in geolocation-based dating-apps targeting MSM. Experience with the European HIV-Testing-Week has shown that reaching out to MSM through push notifications with a spectrum of HIV services and opening times of Checkpoints is both cost-effective and accepted by the community.

Poster available online