Author: aj s

Health & Sexuality, 16:9, 1113-1127, DOI:10.1080/13691058.2014.932923

Todd Sekuler, Michael Bochow, Ursula von Rüden, Jürgen Töppich

Abstract

To assess the situation of bisexually active men in the German HIV epidemic, data from a 2010 internet survey about sexual health among men who have sex with men were used to assess HIV testing rates, condom use and risk contact among the following groups of respondents: bisexually active single men, bisexually active men with a regular female partner, bisexually active men with a regular male partner and exclusively homosexually active men. Of the 54,387 respondents from Germany, 12% reported having sex contacts with both men and women in the previous year. Descriptive statistics were used to explore the sample’s socio-demographic characteristics and to identify relevant inter-group differences in sexual attraction, identity, awareness among contacts of attraction to men, number of sex partners, history of anal intercourse, recruitment of partners online, history of HIV testing and drug use. Multivariable regression analyses were used to assess potential associations between these variables and risk contacts, defined as having reported unprotected anal intercourse with male partners of unknown or discordant serostatus in the previous year. Bisexually active groups reported relatively few risk contacts, strengthening the argument that there is little support for the existence of a substantial ‘bisexual bridge’ in Germany.

A fin de evaluar la situación de hombres bisexualmente activos con respecto a la epidemia del VIH/sida en Alemania, se utilizaron los datos de una encuesta por Internet llevada a cabo en 2010 sobre la salud sexual de hombres que tienen relaciones homosexuales con el objetivo de analizar las tasas de la prueba de detección del virus del sida, el uso de preservativos y el contacto de riesgo entre los siguientes grupos de participantes: hombres solteros bisexualmente activos, hombres bisexualmente activos que tienen una pareja femenina regular, hombres bisexualmente activos que tienen una pareja masculina regular y hombres con actividad exclusivamente homosexual. De los 54.387 entrevistados en Alemania, 12% informaron haber tenido contactos sexuales tanto con hombres como con mujeres el año anterior. Mediante estadísticas descriptivas, se analizaron las características sociodemográficas de la muestra y se identificaron las diferencias relevantes entre los grupos en cuanto a la atracción sexual, la identidad, la conciencia de la atracción hacia los hombres entre los contactos, el número de parejas sexuales, antecedentes de relaciones anales, captación de parejas por Internet, antecedentes de la prueba del sida y el consumo de drogas. Se usaron análisis de regresión multivariables para evaluar las posibles asociaciones entre estas variables y los contactos de riesgo, definidos como haber informado de relaciones anales sin protección con parejas masculinas con condición serológica desconocida o discordante el año anterior. Los grupos bisexualmente activos informaron de relativamente pocos contactos de riesgo, lo que refuerza el argumento de que existe poca evidencia para la existencia de un importante “puente bisexual” en Alemania.

Les résultats d’une enquête en ligne (2010) sur la santé sexuelle des hommes qui ont des rapports avec des hommes ont été utilisés pour évaluer la situation des hommes bisexuels sexuellement actifs dans le contexte de l’épidémie de VIH/sida en Allemagne. Cette étude s’est plus précisément intéressée aux taux de recours au dépistage du VIH, d’usage du préservatif et de contacts à risque parmi les groupes suivants: a) hommes bisexuels sexuellement actifs et vivant seuls b) hommes bisexuels sexuellement actifs et ayant une partenaire régulière c) hommes bisexuels sexuellement actifs et ayant un partenaire régulier d) hommes sexuellement actifs, exclusivement homosexuels. 12 % des 54,387 répondants à l’enquête ont déclaré avoir eu des contacts sexuels à risque aussi bien avec des hommes qu’avec des femmes dans l’année précédente. La statistique descriptive a été utilisée pour explorer les caractéristiques sociodémographiques de l’échantillon et identifier les différences pertinentes entre les groupes pour les questions d’attirance sexuelle, d’identité, de sensibilité parmi les répondants (lors des contacts) à leur attirance pour les hommes, de nombre de partenaires sexuels, d’histoire de rapports sexuels anaux, de rencontres de partenaires en ligne, d’histoire de dépistage du VIH et d’usage de drogues. Les analyses par régression multivariée ont été employées pour évaluer les associations potentielles entre ces variables et les « contacts à risque » (c’est‐à‐dire « avoir eu des rapports anaux non protégés avec des partenaires masculins de statut sérologique vis‐à‐vis du VIH inconnu ou différent dans l’année précédente »). Dans les groupes d’hommes bisexuels sexuellement actifs, les déclarations de contacts à risque sont relativement peu nombreuses – ce qui vient étayer l’argument selon lequel une « bisexualité‐passerelle pour le VIH » conséquente en Allemagne n’a pas de réel fondements.

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Med Clin (Barc). 2014. http://dx.doi.org/10.1016/j.medcli.2014.04.030

Authors: Cinta Folch, Percy Fernández-Dávila, Laia Ferrera, Raúl Soriano, Mercedes Díez, Jordi Casabona

ABSTRACT

Basis and objective: To describe the pattern of drug use among men who have sex with men (MSM) living in Spain and its association with sexual risk practices.

Material and method: The European MSM Internet Survey was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behavior, and other sexual health variables. The association between unprotected anal intercourse (UAI) with casual partners and drug consumption was evaluated using multivariate logistic regression models.

Results: Among the 13,111 participants, most consumed drugs were cannabis (30.1%), popper (28.4%) and cocaine (18.7%). The risk of UAI with casual partners was 1.5 among those who had used drugs in relation to the other participants. The proportion of MSM who had injected drugs at least once in life was 2.5%, and 1.4% in the last 12 months. The prevalence of UAI with casual partners (53.4%), human immunodeficiency virus (HIV) (23%), hepatitis C (8.2%) and sexually transmitted infections (STI) (15.8%) was higher in MSM injectors related to those who had not used injected drugs (P < .05).

Conclusions: The results of this study confirm a high prevalence of drug use in MSM and their relationship to sexual risk behavior. Although the use of injected drugs in MSM is a minority, this group reported a higher level of sexual risk behaviors, self-reported HIV, hepatitis C and other STI.

Alto consumo de drogas recreativas y conductas sexuales de riesgo en hombres que tienen relaciones sexuales con hombres

International Journal of STD & AIDS. 2014;25(7):496-503. doi:10.1177/0956462413515193

Authors: Gabriele Prati, Michele Breveglieri, Raffaele Lelleri, Martina Furegato, Lorenzo Gios, Luca Pietrantoni

Abstract

The objective of this study was to understand the psychosocial correlates of men having sex with men (MSM) who have never been tested (never testers), MSM who have been tested in the last 12 months (recent testers), and MSM who have been tested before (remote testers). A sample of 14,409 Italian HIV-negative adult MSM was recruited via instant messages to the members of five international commercial websites and through clickable banner advertisements on different websites. The most important correlates of never testers compared to recent testers were younger age, sexual orientation concealment, unawareness of free HIV services, having had a partner of unknown serostatus, and lower levels of HIV testing self-efficacy (i.e. the belief in one’s own ability to get a test for HIV). The most important correlates of remote testers compared to recent testers were older age, homosexual orientation, having had a partner of unknown serostatus, unawareness of free HIV services, and lower level of HIV testing self-efficacy. There are different psychosocial correlates of MSM based on HIV testing history. Based on the findings of this study, prevention efforts should be directed toward increasing awareness about the availability of HIV testing services and HIV testing self-efficacy among MSM.7

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Bundesgesundheitsblatt 56: 1609-1618. DOI 10.1007/s00103-013-1855-6

Authors: Axel J. Schmidt, Ulrich Marcus

ABSTRACT

Background. Sexually transmitted infections (STIs) such as anal/genital warts, syphilis, and genital/rectal gonorrheal/chlamydial infections compromise the health of men who have sex with men (MSM), and increase the per-contact risk of HIV infection. Early detection of asymptomatic STIs requires regular screening including physical examinations and collection of clinical specimens that allow for the detection of infections at sites common to men’s same-sex practices.

Methods. From June to August 2010, the European MSM Internet Survey (EMIS) recruited 174,209 MSM from 38 European countries to an anonymous online questionnaire in 25 languages. As sexual health care for MSM in most countries is organized locally, we chose cities for comparison. Multivariable regression models were used to compare accessibility of services and applied diagnostic procedures across 1 Dutch, 1 Swiss, 1 Austrian, 3 English, and 19 German cities (N=29,962). Results. The proportion of respondents tested for STIs in the last 12 months in the absence of symptoms ranged from 13% in Magdeburg to 48% in Amsterdam. At a city level, low STI screening correlated with inaccessible services (R2 =0.72). At an individual level, anal/penile inspection and anal swabbing was most common in English cities and in Amsterdam. Compared to London, MSM in German-speaking cities had an adjusted odds ratio (AOR) of 0.06–0.20 for anal/penile inspection, and of 0.05–0.17 for anal swabbing (p<0.001).

Conclusions. Anal/genital warts and rectal infections are likely to be profoundly underdiagnosed among MSM in all German-speaking cities. This has implications for the sexual health of MSM, for HIV prevention, and for comparing European surveillance data. There is an urgent need to implement or improve sexual health care tailored to MSM at risk for STIs.

Defizite in den Angeboten zur STI-Diagnostik für Männer mit gleichgeschlechtlichen Sexualkontakten in deutschsprachigen Städten

BMC Public Health 2013 13:1083 doi:10.1186/1471-2458-13-1083

Authors: Adam Bourne, Ford Hickson, David Reid, Gary Hammond, Axel J. Schmidt, Peter Weatherburn, The EMIS Network

Abstract

Background: While a large body of research has sought to understand HIV transmission risk behaviours among gay men, bisexual men and other men who have sex with men (MSM), less attention has been paid to the wider sexual health and well-being of this population. While some community-based organisations aim to support a more holistic sense of sexual well-being there is little evidence to draw on to inform their interventions. The current study sought to explore gay and bisexual men’s conceptions of what constitutes the ‘best sex’.

Method: The EMIS survey of 2010 recruited more than 180,000 respondents from 38 European countries to complete an online questionnaire about sexual health and behaviour. The 12,942 English language, UK-based responses to the open ended question, “What’s your idea of the best sex life?” were subjected to a detailed content
analysis. A framework was devised to reflect and describe the key themes emerging from the data, which was then used to code all responses to one (or more) of these themes. Further statistical analysis sought to establish if and how responses differed according to key demographic variables.

Results: Eight themes emerged that capture the diversity of gay and bisexual men’s sexual desires. Most common among responses was a desire for sex within committed relationships, followed by a desire for sex which is emotionally or psychologically connected. Men also expressed a desire for volume and variety in their sexual lives,
and for sex that is free from physical, social or psychological harm. Comparative analysis identified that older men were less likely to idealise a relationship or emotional connection, but were more likely to specify the sexual acts or behaviours they wished to engage in.

Conclusions: Attending to what men value or aspire to can help ensure interventions are engaging and meaningful to the target population. HIV prevention interventions need to attend to the broad range of sexual
desires held by gay and bisexual men in delivery of holistic sexual health promotion that can help them to have the best sex with the least harm.

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Authors: Percy Fernández-Dávila, Cinta Folch, Laia Ferrer, Raúl Soriano, Mercedes Diez, Jordi Casabona

Abstract

Objectives: The aims of the study were to describe the sociodemographic profile of men who have sex with men (MSM) who have never been tested for HIV and to analyse factors associated with never having been tested.

Methods: The European MSM Internet Survey (EMIS) was implemented in 2010 in 38 European countries on websites for MSM and collected data on sociodemographics, sexual behaviour, and other sexual health variables. A logistic regression analysis was conducted to assess variables associated with never having been tested for HIV.

Results: Of the 13 111 respondents living in Spain, 26% had never been tested for HIV. Those who had never been tested were significantly more likely to live in a settlement with fewer than 100 000 inhabitants, be younger than 25 years old, have a lower education level, be a student, and identify themselves as bisexual. In the multivariate analysis, to have never been tested for HIV was associated with being born in Spain [odds ratio (OR) 1.35; 95% confidence interval (CI) 1.192–1.539], living outside large settlements (OR 1.37; 95% CI 1.216–1.534), being younger than 25 years old (OR 2.94; 95% CI 2.510–3.441), being out to no one or only a few people (OR 2.16; 95% CI 1.938–2.399), having had no nonsteady partners in the last 12 months (OR 1.26; 95% CI 1.109–1.422), and being not at all confident to access HIV testing (OR 3.66; 95% CI 2.676–5.003), among others factors.

Conclusions: The profile of the MSM who had never been tested for HIV indicates that most of them were men who were hard to reach (young, bisexual men, in the closet). Interventions should aim to improve access to and the convenience of testing.

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BMC Public Health 13, 968 (2013). https://doi.org/10.1186/1471-2458-13-968

Authors: Wim vanden Berghe, Christiana Nöstlinger, Harm Hospers, Marie Laga

Abstract

Background: European men who have sex with men (MSM) continue to be disproportionally affected by the human immunodeficiency virus (HIV). Several factors are contributing to the rates of new HIV infections among MSM. The aim of this study was to investigate the potential role of travel behaviour and sexual mobility in the spread of HIV and sexually transmitted infections (STI) among European MSM.

Methods: Belgian data from the first pan-European MSM internet survey EMIS was used (n=3860) to explore individual and contextual determinants of sexual behaviour among MSM, who resided in Belgium at the time of data collection and who reported having had sexual contact abroad in the last 12 months. Descriptive and bivariate analyses were performed. Odds ratios and 95% confidence intervals were calculated by means of logistic regression.

Results: MSM who practiced unprotected anal intercourse UAI during their last sexual encounter abroad were less likely to be living in a large city (OR:0.62, 95% CI:0.45-0,86, p<0.01) and more likely to be HIV positive (OR:6.20, 95% CI:4.23-9.06, p<0.001) ), to have tested HIV positive in the last 12 months (OR:3.07, 95% CI:1.07-8.80, p<0.05), to have been diagnosed with any STI in the last 12 months (OR:2.55; 95% CI:1.77-3.67, p<0.05), to have used party drugs (OR:2.22, 95% CI:1.59-3.09, p<0.001), poppers (OR:1.52, 95% CI:1.07-2.14, p<0.001) and erection enhancing substances (OR:2.23, 95% CI:1.61-3.09, p<0.001) compared to MSM who did not have UAI with their last sexual partner abroad. Men having had UAI in the last 12 months were more likely to have done so in a neighbouring country of Belgium (OR:1.66, 95% CI:1.21-2.29, p<0.001). Different sexual behavioural patterns related to condom use and drug use were identified according to HIV test status among travelling men.

Conclusions: The results of this study provide evidence for the role of international mobility and sexual behavior while travelling, in the spread of HIV and STI among MSM in Europe. Further, the findings underline the need for development of European cross-border HIV and STI interventions with coherent messages and prevention policies for MSM.

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exually Transmitted Infections 2013;89:575-582.

Authors: Axel J. Schmidt, Ford Hickson, Peter Weatherburn, Ulrich Marcus, The EMIS Network

Abstract

Objectives Sexually transmitted infections (STIs) such as anal/genital warts, syphilis and genital/rectal gonorrhoeal/chlamydial infections compromise the health of men who have sex with men (MSM). Rectal bacterial STIs increase the per-contact risk of HIV infection. Early detection of asymptomatic STIs requires regular screening including collection of clinical specimens (or, for warts: physical examinations) that allow for the detection of infections at sites common to men’s same sex practices.

Methods From June to August 2010, the European MSM Internet Survey recruited 174 209 men from 38 European countries to an anonymous online questionnaire in 25 languages. As sexual healthcare for MSM in most countries is organised locally, we chose cities for comparison. Multivariable regression models were used to compare accessibility of services and applied diagnostic procedures across 40 cities.

Results The proportion of respondents tested for STIs in the last 12 months in the absence of symptoms ranged from 8.9% in Istanbul to 48.0% in Amsterdam. At city level, low STI screening correlated with inaccessible services (R²=44.1%). At individual level, anal/penile inspection and anal swabbing was most common in UK cities, Amsterdam, Dublin and Stockholm. Compared to London, MSM in 30 cities had an adjusted OR (AOR) of (0.02 to 0.18) for anal swabbing; and (0.06 to 0.25) for anal/penile inspection (p<0.001).

Conclusions Anal/genital warts and rectal infections are likely to be profoundly underdiagnosed among MSM in most European cities. This has implications for the sexual health of MSM, HIV prevention and comparing national surveillance data. There is an urgent need to improve sexual healthcare tailored to MSM at risk for STIs.

Available online

BMC Public Health 13, 919 (2013). https://doi.org/10.1186/1471-2458-13-919

Authors: Ulrich Marcus, Ford Hickson, Peter Weatherburn, Axel J. Schmidt,The EMIS Network

Abstract

Background

Comparison of rates of newly diagnosed HIV infections among MSM across countries is challenging for a variety of reasons, including the unknown size of MSM populations. In this paper we propose a method of triangulating surveillance data with data collected in a pan-European MSM Internet Survey (EMIS) to estimate the sizes of the national MSM populations and the rates at which HIV is being diagnosed amongst them by calculating survey-surveillance discrepancies (SSD) as a measure of selection biases of survey participants.

Methods

In 2010, the first EMIS collected self-reported data on HIV diagnoses among more than 180,000 MSM in 38 countries of Europe. These data were compared with data from national HIV surveillance systems to explore possible sampling and reporting biases in the two approaches. The Survey-Surveillance Discrepancy (SSD) represents the ratio of survey members diagnosed in 2009 (HIVsvy) to total survey members (Nsvy), divided by the ratio of surveillance reports of diagnoses in 2009 (HIVpop) to the estimated total MSM population (Npop). As differences in household internet access may be a key component of survey selection biases, we analysed the relationship between household internet access and SSD in countries conducting consecutive MSM internet surveys at different time points with increasing levels of internet access. The empirically defined SSD was used to calculate the respective MSM population sizes (Npop), using the formula Npop = HIVpop*Nsvy*SSD/HIVsvy.

Results

Survey-surveillance discrepancies for consecutive MSM internet surveys between 2003 and 2010 with different levels of household internet access were best described by a potential equation, with high SSD at low internet access, declining to a level around 2 with broad access. The lowest SSD was calculated for the Netherlands with 1.8, the highest for Moldova with 9.0. Taking the best available estimate for surveillance reports of HIV diagnoses among MSM in 2009 (HIVpop), the relative MSM population sizes were between 0.03% and 5.6% of the adult male population aged 15–64. The correlation between recently diagnosed (2009) HIV in EMIS participants and HIV diagnosed among MSM in 2009 as reported in the national surveillance systems was very high (R² = 0.88) when using the calculated MSM population size.

Conclusions

Npop and HIVpop were unreliably low for several countries. We discuss and identify possible measurement errors for countries with calculated MSM population sizes above 3% and below 1% of the adult male population. In most cases the number of new HIV diagnoses in MSM in the surveillance system appears too low. In some cases, measurement errors may be due to small EMIS sample sizes. It must be assumed that the SSD is modified by country-specific factors.

Comparison of community-based survey data with surveillance data suggests only minor sampling biases in the former that – except for a few countries – do not seriously distort inter-country comparability, despite large variations in participation rates across countries. Internet surveys are useful complements to national surveillance systems, highlighting deficiencies and allowing estimates of the range of newly diagnosed infections among MSM in countries where surveillance systems fail to accurately provide such data.

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