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EMIS 2010 Journal Articles 2010

Are men who have sex with men in Europe protected from hepatitis B?

Epidemiology and Infection, 148, E27. doi:10.1017/S0950268820000163

Authors: M. Brandl, A. J. Schmidt, U. Marcus, M. an der Heiden, S. Dudareva

Abstract

Hepatitis B vaccination is recommended for men who have sex with men (MSM) in many countries, but information on vaccine coverage is scarce. We studied hepatitis B vaccination programmes and coverage among MSM in Europe to guide prevention. From a large (N = 174 209) pan-European MSM survey (EMIS-2010), we used data on self-reported hepatitis B vaccination, age, education, settlement size and disclosure of the same-sex sexual orientation (‘outness’). We excluded participants with a history of hepatitis B. In multilevel (participants, countries) logistic regression models, we calculated adjusted odds ratios (aOR) with 95% confidence intervals (95% CI). We analysed data of 163 987 MSM in 38 European countries: 38.3% were ‘out’ to all or almost all, 56.4% reported vaccination against hepatitis B and 65.5% lived in countries with free recommended hepatitis B vaccination for MSM. In the final model the odds for being vaccinated increased with outness (‘out to all or almost all’: aOR 1.76, 95% CI 1.70–1.83 vs. ‘out to no one’) and with living in countries, where hepatitis B vaccination was recommended and free-of-charge for MSM (aOR 2.21, 95% CI 1.47–3.32 vs. ‘no or unclear recommendation’). To increase hepatitis B vaccination coverage among MSM, implementation of MSM-specific recommendations and improvement of the societal climate for MSM is needed.

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EMIS 2017 Journal Articles 2017

Canadian results from the European Men-who-have-sex-with-men Internet survey (EMIS-2017)

Can Commun Dis Rep. 2019 Nov 7;45(11):271-282. doi: 10.14745/ccdr.v45i11a01.

Authors: N Brogan, D M Paquette, N J Lachowsky, M Blais, D J Brennan, T A Hart, B Adam

Abstract

Background: In 2017, the international European Men-who-have-sex-with-men Internet Survey (EMIS-2017) collected data from 50 countries, including Canada for the first time.

Objective: To provide an overview of the Canadian EMIS-2017 data to describe the sexually transmitted and other bloodborne infection (STBBI) related needs of gay, bisexual and other men who have sex with men (gbMSM).

Methods: The EMIS-2017 questionnaire was an updated version of EMIS-2010. It included self-reported sociodemographic data, experience of discrimination, mental health and substance use, knowledge of preexposure prophylaxis (PrEP) for HIV, sexual practices and history of STBBI testing and diagnosis. Analysis was largely descriptive.

Results: Of the 6,059 respondents from Canada, 5,165 participants met the inclusion criteria for this analysis. The majority of participants were born in Canada (79.3%); and over half of the respondents (56.7%) were under the age of 39. In terms of discrimination related to their attraction to other men, participants reported high levels of intimidation (31.9%), verbal abuse (22.1%) and physical violence (1.5%) in the previous year. Regarding mental health, 23.9% had a moderate to severe depression/anxiety score. Almost two-thirds (64.1%) indicated substance use and one-fifth (21.5%) reported chemsex (or the use of stimulant drugs to make sex more intense or last longer). Only 8.4% of participants reported use of PrEP for HIV; however, 51.7% reported being likely to use PrEP if it was available and affordable. Sexual practices, such as condom use, varied by PrEP use with 91.3% of men using PrEP reporting condomless anal intercourse (CAI) compared with 71.5% of men not on PrEP. In terms of STBBI testing, 1.5% reported being diagnosed with hepatitis C and 9.0% reported an HIV diagnosis. Of those with an HIV diagnosis, most were on treatment (99.1%) and had an undetectable viral load (96.7%).

Conclusion: gbMSM in Canada experienced stigma, discrimination and mental health problems; substance use was high as were high-risk sexual practices, such as CAI, among some groups of men. There was a gap between the proportion of men who were interested in PrEP and those who actually used it; and comprehensive STBBI testing was low.These findings can inform public health action and provide a baseline to examine the impact of current and new interventions.

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EMIS 2017 Journal Articles 2017

Cross-sectional analysis of chemsex drug use and gonorrhoea diagnosis among men who have sex with men in the UK

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.

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EMIS 2010 Journal Articles 2010

Links between transactional sex and HIV/STI-risk and substance use among a large sample of European men who have sex with men.

BMC Infectious Diseases, 2019; 19(1):686 (doi: 10.1186/s12879-019-4326-3).

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

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EMIS 2017 Journal Articles 2017

Estimating the ‘PrEP Gap’: how implementation and access to PrEP differ between countries in Europe and Central Asia in 2019

Eurosurveillance, 2019; 24(41) (doi: 10.2807/1560-7917).

Authors: Rosalie Hayes, Axel J. Schmidt, Anastasia Pharris, Yusef Azad, Alison E. Brown, Peter Weatherburn, Ford Hickson, Valerie Delpech, Teymur Noori, the ECDC Dublin Declaration Monitoring Network.

Abstract

In 2019, only 14 European and Central Asian countries provided reimbursed HIV pre-exposure prophylaxis (PrEP). Using EMIS-2017 data, we present the differ-ence between self-reported use and expressed need for PrEP in individual countries and the European Union (EU). We estimate that 500,000 men who have sex with men in the EU cannot access PrEP, although they would be very likely to use it. PrEP’s potential to eliminate HIV is currently unrealised by national healthcare systems.

This article is copyright of the authors or their affiliated institutions, 2019

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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.

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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

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EMIS 2010 Journal Articles 2010

Structural validation and multiple group assessment of the short internalized homonegativity scale in homosexual and bisexual men in 38 European countries: results from the European MSM internet survey

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.

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EMIS 2010 Journal Articles 2010

Illicit drug use among gay and bisexual men in 44 cities: Findings from the European MSM Internet Survey (EMIS)

International Journal of Drug Policy, 2016; 38:4-12 (doi:10.1016/j.drugpo.2016.09.007).

Authors: Axel J. Schmidt, Adam Bourne, Peter Weatherburn, David Reid, Uli Marcus, Ford Hickson & The EMIS Network

Abstract

Background: Anecdotal evidence suggests that men who have sex with men (MSM) are increasingly combining sex and illicit drugs (an activity referred to as ‘chemsex’), in particular GHB/GBL, ketamine, crystal meth, or mephedrone (here called 4-chems). Use of such drugs has been associated with mental health and sexual health harms. We aim to compare patterns of illicit drug use among MSM in 44 European urban centres.

Methods: In 2010, EMIS recruited 174,209 men from 38 countries to an anonymous online questionnaire in 25 languages. As harm reduction services for drugs and sex are organised at a local level, we chose to compare cities rather than countries. We defined 44 cities based on region/postal code and settlement size. For multivariable regression analyses, three comparison groups of MSM not living in these cities were applied: MSM living in Germany, the UK, and elsewhere in Europe.

Results: Data from 55,446 MSM living in 44 urban centres were included. Use of 4-chems (past 4 weeks) was highest in Brighton (16.3%), Manchester (15.5%), London (13.2%), Amsterdam (11.2%), Barcelona (7.9%), Zurich (7.0%) and Berlin (5.3%). It was lowest in Sofia (0.4%). The rank order was largely consistent when controlling for age, HIV diagnosis, and number of sexual partners. City of residence was the strongest demographic predictor of chemsex-drug use.

Conclusion: Use of drugs associated with chemsex among MSM varies substantially across European cities. As city is the strongest predictor of chemsex-drug use, effective harm reduction programmes must include structural as well as individual interventions.

Keywords

Illicit drugs; Chemsex; MSM; Gay men; Homosexuality; Internet Survey; European cities; Substance use

© 2016 Elsevier B.V. All rights reserved.

For a full copy of the paper please email Ford Hickson

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EMIS 2010 Journal Articles 2010

The geography of sexual orientation: structural stigma and sexual attraction, behavior, and identity among men who have sex with men across 38 European countries

Archives of Sexual Behavior, 2017, 46(5), 1491–1502 (doi: 10.1007/s10508-016-0819-y).

Authors: John E. Pachankis, Mark L. Hatzenbuehler, Massimo Mirandola, Peter Weatherburn, Rigmor C. Berg, Ulrich Marcus, Axel J. Schmidt

Abstract

While the prevalence of sexual identities and behaviors of men who have sex with men (MSM) varies across countries, no study has examined country-level structural stigma toward sexual minorities as a correlate of this variation. Drawing on emerging support for the context-dependent nature of MSM’s open sexual self-identification cross-nationally, we examined country-level structural stigma as a key correlate of the geographic variation in MSM’s sexual attraction, behavior, and identity, and concordance across these factors.Data come from the European MSM Internet Survey, a multi-national dataset containing a multi-component assessment of sexual orientation administered across 38 European countries (N=174,209).Country-level stigma was assessed using a combination of national laws and policies affecting sexual minorities and a measure of attitudes toward sexualminorities held by the citizens of each country. Results demonstrate that inmore stigmatizing countries,MSM were significantly more likely to report bisexual/heterosexual attractions, behaviors, and identities, and significantly less likely to report concordance across these factors, than in less stigmatizing countries. Settlement size moderated associations between country-level structural stigma and odds of bisexual/heterosexual attraction and behavior, such that MSM living in sparsely populated locales within high-structural stigma countries were the most likely to report bisexual or heterosexual behaviors and attractions. While previous research has demonstrated associations between structural stigma and adverse physical and mental health outcomes among sexual minorities, this study was the first to show that structural stigma was also a key correlate not only of sexual orientation identification, but also of MSM’s sexual behavior and even attraction. Findings have implications for understanding the ontology of MSM’s sexuality and suggest that a comprehensive picture of MSM’s sexuality will come from attending to the local contexts surrounding this important segment of the global population.

Keywords

Sexual orientation, Stigma, Minority stress, Men who have sex with men, male bisexuality.

For a full copy of the paper please email Peter Weatherburn

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