Author: aj s

BMC Public Health 13, 826 (2013). https://doi.org/10.1186/1471-2458-13-826

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

Abstract

Background: Behavioural data from MSM are usually collected in non-representative convenience samples, increasingly on the internet. Epidemiological data from such samples might be useful for comparisons between countries, but are subject to unknown participation biases.

Methods: Self-reported HIV diagnoses from participants of the European MSM Internet Survey (EMIS) living in the Czech Republic, Germany, the Netherlands, Portugal, Sweden and the United Kingdom were compared with surveillance data, for both the overall diagnosed prevalence and for new diagnoses made in 2009. Country level prevalence and new diagnoses rates per 100 MSM were calculated based on an assumed MSM population size of 3% of the adult male population. Survey-surveillance discrepancies (SSD) for survey participation, diagnosed HIV prevalence and new HIV diagnoses were determined as ratios of proportions. Results are calculated and presented by 5-year age groups for MSM aged 15–64.

Results: Surveillance derived estimates of diagnosed HIV prevalence among MSM aged 15–64 ranged from 0.63% in the Czech Republic to 4.93% in the Netherlands. New HIV diagnoses rates ranged between 0.10 per 100 MSM in the Czech Republic and 0.48 per 100 in the Netherlands. Self-reported rates from EMIS were consistently higher, with prevalence ranging from 2.68% in the Czech Republic to 12.72% in the Netherlands, and new HIV diagnoses rates from 0.36 per 100 in Sweden to 1.44 per 100 in the Netherlands. Across age groups, the survey surveillance discrepancies (SSD) for new HIV diagnoses were between 1.93 in UK and 5.95 in the Czech Republic, and for diagnosed prevalence between 1.80 in Germany and 4.26 in the Czech Republic.

Internet samples of MSM were skewed towards younger age groups when compared to an age distribution of the general adult male population. Survey-surveillance discrepancies (SSD) for EMIS participation were inverse u-shaped across the age range. The two HIV-related SSD were u- or j-shaped with higher values for the very young and for older MSM. The highest discrepancies between survey and surveillance data regarding HIV-prevalence were observed in the oldest age group in Sweden and the youngest age group in Portugal.

Conclusion: Internet samples are biased towards a lower median age because younger men are over-represented on MSM dating websites and therefore may be more likely to be recruited into surveys. Men diagnosed with HIV were over-represented in the internet survey, and increasingly so in the older age groups. A similar effect was observed in the age groups younger than 25 years. Self-reported peak prevalence and peak HIV diagnoses rates are often shifted to higher age groups in internet samples compared to surveillance data. Adjustment for age-effects on online accessibility should be considered when linking data from internet surveys with surveillance data.

Available online

British HIV Association doi.org/10.1111/hiv.12058

Authors: C Carvalho, R Fuertes, R Lucas, A Martins, M J Campos, L Mendão, A J Schmidt, H Barros

Abstract

Objectives: To describe HIV testing behaviour and context of MSM in Portugal participating in the European MSM Internet Survey (EMIS).

Methods: Data for the Portuguese sample were extracted and those for 5187 participants were analysed. Multivariate logistic regression models were fitted to quantify the association between participants’ characteristics and HIV testing behaviour and context.

Results: Seventy-two percent of the participants had ever been tested for HIV and among those ever tested, 11% were diagnosed with HIV. Primary care was the most common testing setting for HIV-negative men (37%). Compared to those never tested, men who had ever taken an HIV test had higher educational level (aOR 1.89, 95% CI 1.67-2.14) and identified themselves as gay/homosexual more frequently (aOR 1.94 , 95% CI 1.70-2.20). HIV testing odds significantly increased with the number of sexual partners in the previous 12 months. Those who reported unprotected anal intercourse (UAI) with a partner of unknown or serodiscordant HIV status in the previous 12 months were less likely to report an HIV test (aOR 0.38, 95% CI 0.33–0.44). Among those never tested or who tested negative, 41% and 22% reported UAI with a partner of unknown or serodiscordant status in the previous 12 months, respectively. Among men with diagnosed HIV, 72% were currently on antiretroviral therapy and 58% reported an undetectable viral load. More than one third (38%) of those who had detectable or unknown/undisclosed viral load reported at least one episode of UAI with a partner of unknown or serodiscordant HIV status in the last 12 months.

Conclusions: Actual interventions should focus on: improving testing uptake and counselling; increasing treatment coverage; achieving and maintaining an undetectable viral load; and intensifying prevention efforts focused on consistent condom use.

Available online

Sex Res Soc Policy 10, 243–257 (2013). https://doi.org/10.1007/s13178-013-0119-4

Authors: Peter Weatherburn; Axel J. Schmidt; Ford Hickson; David Reid; Rigmor C. Berg; Harm J. Hospers; Ulrich Marcus

Abstract

Community-based opportunistic self-completion surveying for sexual health programming is common among men-who-have-sex-with-men (MSM) in Europe, being used to generate evidence of unmet prevention need, for behavioural surveillance and as a platform for advocating HIV precautions. However, comparing survey findings across Europe is difficult because of varying measures and recruitment designs, and surveying has not occurred in all countries. EMIS (the European Men-who-have-sex-with-men Internet Survey) aimed to develop a pan-European Internet survey on HIV-related male homosexual behaviours and prevention needs both to increase research capacity and to move towards harmonisation of existing systems. Six associated partners (APs) recruited another 77 collaborating partners from academia, public health and civil society across 35 countries. Partners’ existing MSM surveys were collected and collated, producing a meta-survey which was discussed by all partners through rotating round-tables at a 2-day summit. Survey development continued iteratively through user piloting and partner feedback until the English language content was agreed. Transfer to an online survey application was followed by further testing before on-screen translation into 24 other languages, final testing and sign-off. The project’s visual identity and promotional materials were developed in close collaboration with national leads, tailoring products to match country specific needs while maintaining an overall project identity. Five international MSM dating websites were contracted to send carefully crafted instant messages to members in a series of waves. The survey sought common ground with stakeholders and respondents by endorsing ‘the best sex with the least harm’ for MSM. Real-time monitoring of responses allowed targeted spending of the advertising budget to maximise coverage and depth of responses. Fieldwork occurred during June–August 2010. Over 184,469 responses were submitted of which 94.4 % were eligible. Partners in 38 countries were supplied with a national database of 100 or more respondents for national analysis and outputs, while the AP team proceeded on international comparisons among 174,209 respondents in 38 countries. EMIS demonstrated the feasibility of multi-country community-based MSM Internet surveying with limited public funding. The concept of ‘the best sex with the least harm’ provided a common ground for a diverse range of stakeholders to collaborate. Meaningful involvement of a large number of collaborators in the survey design, its visual identity and in promotional strategies ensured unprecedented coverage and depth of recruitment. Flexible planning was essential and a patchwork of recruitment was required across a range of commercial and community partners. Careful design, piloting and presentation ensured the survey was acceptable and had both authority and perceived community benefit.

Available online

Scandinavian Journal of Public Health. 2013;41(4):398-404. doi:10.1177/1403494813483216

Authors: Rigmor C. Berg

Abstract

Background: HIV testing among persons at risk of infection has become a cornerstone in prevention and control of the HIV/AIDS epidemic. Understanding factors related to HIV testing is thus fundamental for informing prevention and testing initiatives. Aims: This study aims to identify prevalence of, and factors that are associated with, HIV testing. 

Methods: This study analysed data from 2011 HIV-negative and untested MSM collected in a national, online survey. Results: More than a third (35.3%) of MSM had never received an HIV test result. Multivariate logistic regression results showed that compared with men ever tested, untested men were younger (odds ratio, OR 0.95), closeted about same sex attractions (OR 3.84), had low educational level (OR 0.47), low HIV transmission and testing knowledge (OR 0.98), did not believe that HIV testing is free (OR 0.27), had never taken a test for sexually transmitted infection (OR 0.08), and had not engaged in sex abroad in the past year (OR 0.69).

Conclusions: These results underscore the urgency in efforts to reduce testing delay among especially young MSM and point to the need for additional public health resources and prevention marketing efforts to be directed towards increasing awareness of HIV testing.

Available online

Social Science & Medicine, February 2013, Pages 61-69, doi.org/10.1016/j.socscimed.2012.11.033

Authors: Rigmor C. Berg, Michael W. Ross, Peter Weatherburn, Axel J. Schmidt

Abstract

Internalised homonegativity refers to a gay person’s negative feelings about homosexuality and is believed to stem from negative societal stereotypes and attitudes towards homosexuality. Surprisingly, little research has centred on this link. In this research, we aimed to examine the associations between internalised homonegativity and structural forces, cultural influence, and access to sexual health promotion measures among a sample of 144,177 men who have sex with men (MSM) in 38 European countries. Participants were recruited as part of the European MSM Internet Survey (EMIS) during 2010. It was a self-completion, multilingual Internet-based survey for men living in Europe who have sex with men and/or feel attracted to men. Assumed causal relations were tested through multiple regression models. Variables at the structure of rule-systems (macro-level) that were significantly and negatively associated with internalised homonegativity were the presence of laws recognising same-sex relationships and same-sex adoption. In the meso-level model, greater proportions of the population expressing that they would not like to have homosexuals as neighbours predicted higher internalised homonegativity. In the last model, five variables were significantly and negatively associated with internalised homonegativity: being exposed to HIV/STI information for MSM, access to HIV testing, access to STI testing, access to condoms, and experience of gay-related hostility. In turn, men who had tested for HIV in the past year evidenced lower internalised homonegativity. This is the largest and certainly most geographically diverse study to date to examine structural and environmental predictors of internalised homonegativity among MSM. Our results show that one insidious consequence of society’s stigma towards homosexuals is the internalisation of that stigma by gay and bisexual men themselves, thus, drawing attention to the importance of promoting social equity for self-acceptance around gay identity in building a positive sense of self.

Highlights

This is the largest study to date to examine structural and environmental predictors of internalised homonegativity among MSM. The presence of laws recognising same-sex relationships and same-sex adoption was associated with lower levels of internalised homonegativity. This 38-country study demonstrates the importance of promoting social equity for self-acceptance around gay identity.

Available online

BMJ Open 2013;3:e001928. doi: 10.1136/bmjopen-2012-001928

Authors: Michael W. Ross, Rigmor C. Berg, Axel J. Schmidt, Harm J. Hospers, Michele Breveglieri, Martina Furegato, Peter Weatherburn, The EMIS Network

Abstract

Objectives Internalised homonegativity (IH) is hypothesised to be associated with HIV risk behaviour and HIV testing in men who have sex with men (MSM). We sought to determine the social and individual variables associated with IH and the associations between IH and HIV-related behaviours.

Design and setting We examined IH and its predictors as part of a larger Internet-delivered, cross-sectional study on HIV and health in MSM in 38 European countries.

Participants 181 495 MSM, IH data analysis subsample 144 177. All participants were male, over the age of consent for homosexual activity in their country of domicile, and have had at least one homosexual contact in the past 6 months.

Methodology An anonymous Internet-based questionnaire was disseminated in 25 languages through MSM social media, websites and organisations and responses saved to a UK-based server. IH was measured using a standardised, cross-culturally appropriate scale.

Results Three clusters of European countries based on the level of experienced discrimination emerged. IH was predicted by country LGB (lesbian, gay and bisexual) legal climate, Gini coefficient and size of place of settlement. Lower IH was associated with degree the respondent was ‘out’ as gay to others and older age. ‘Outness’ was associated with ever having an HIV test and age, education and number of gay friends, while IH (controlling for the number of non-steady unprotected sex partners and perceived lack of control over safe sex) was associated with condom use for anal intercourse.

Conclusions IH is associated with LGB legal climate, economic development indices and urbanisation. It is also associated with ‘outness’ and with HIV risk and preventive behaviours including HIV testing, perceived control over sexual risk and condom use. Homonegative climate is associated with IH and higher levels of HIV-associated risk in MSM. Reducing IH through attention to LGB human rights may be appropriate HIV reduction intervention for MSM.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

Available online

Scandinavian Journal of Public Health. 2012;40(8):738-745. doi:10.1177/1403494812465032

Authors: Rigmor C. Berg 

Abstract

Unprotected sexual contact between men remains the predominant means of HIV transmission in men. 
Aim: To ascertain predictors of unprotected anal intercourse between non-primary partners among a sample of 2096 men who have sex with men in Norway and to characterise the sociosexual profile of men who have sex with men who engage in this behaviour. 
Methods: A cross-sectional survey, using an anonymous self-administered questionnaire, was conducted in 2010. 
Results: Multivariate logistic regression showed that the likelihood of engaging in unprotected anal intercourse with non-primary partners was lower for men over 30 years (OR = 0.60), those with higher education (OR = 0.58), and higher HIV-related knowledge (OR = 0.98). The likelihood of engaging in unprotected anal intercourse with non-primary partners was higher among men who have sex with men reporting that condoms had not been available (OR = 1.58), who had a higher number of non-primary anal intercourse partners (OR = 1.20), and who reported use of party drugs (OR = 2.34). These men were not more likely to test for HIV/sexually transmitted infections, but they were more likely to have been diagnosed with sexually transmitted infections, engage in serosorting, and various other sexual behaviours. 
Conclusions: As we enter the fourth decade of the HIV epidemic, the results for Norwegian men who have sex with men underscore the need for a scaling-up of prevention campaigns, highlighting messages and behavioural strategies that encourage safer sex strategies.

Available online

BMC Public Health 2012, 12:978 http://www.biomedcentral.com/1471-2458/12/978

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

Abstract

Background: Country level comparisons of HIV prevalence among men having sex with men (MSM) is challenging for a variety of reasons, including differences in the definition and measurement of the denominator group, recruitment strategies and the HIV detection methods. To assess their comparability, self-reported data on HIV
diagnoses in a 2010 pan-European MSM internet survey (EMIS) were compared with pre-existing estimates of HIV prevalence in MSM from a variety of European countries.
Methods: The first pan-European survey of MSM recruited more than 180,000 men from 38 countries across Europe and included questions on the year and result of last HIV test. HIV prevalence as measured in EMIS was compared with national estimates of HIV prevalence based on studies using biological measurements or modelling approaches to explore the degree of agreement between different methods. Existing estimates were taken from Dublin Declaration Monitoring Reports or UNAIDS country fact sheets, and were verified by contacting the nominated contact points for HIV surveillance in EU/EEA countries.
Results: The EMIS self-reported measurements of HIV prevalence were strongly correlated with existing estimates based on biological measurement and modelling studies using surveillance data (R2
=0.70 resp. 0.72). In most countries HIV positive MSM appeared disproportionately likely to participate in EMIS, and prevalences as measured in EMIS are approximately twice the estimates based on existing estimates.
Conclusions: Comparison of diagnosed HIV prevalence as measured in EMIS with pre-existing estimates based on biological measurements using varied sampling frames (e.g. Respondent Driven Sampling, Time and Location Sampling) demonstrates a high correlation and suggests similar selection biases from both types of studies. For comparison with modelled estimates the self-selection bias of the Internet survey with increased participation of men diagnosed with HIV has to be taken into account. For most countries self-reported EMIS prevalence is higher than measured prevalence, which is likely due to a combination of different time points of measurement, measurement errors for small sample sizes, different sampling methods, and an indicator-inherent overestimate of
prevalence among the untested fraction of MSM.

Available online

Bundesgesundheitsbl 2012 · 55:535–542 DOI 10.1007/s00103-012-1451-1

Authors: Rolf Rosenbrock, Axel J. Schmidt

Abstract

Anti-retroviral therapy (ART) produces spectacular improvements in life expectancy and quality of life for people infected with HIV, and contributes to primary prevention in the wider population by reducing the viral load. Many people infected with HIV begin therapy later than indicated, while, despite ongoing prevention efforts, the number of new HIV diagnoses is increasing, along with the incidence of other STIs and, in identifiable subgroups, of hepatitis C, above all among men who have sex with men (MSM). The prevention consequences of this complex situation are discussed in the context of the alternative between control and containment (Suchstrategie) and inclusion and cooperation (Lernstrategie), arguing for HIV prevention to be integrated in the broader paradigm of sexual health and sub-group-specific efforts to increase the willingness to undergo testing both through community-based campaigns and in the health care context on the basis of informed consent and counseling. Above all ethical considerations mitigate against an undifferentiated test-and-treat approach. The contribution identifies research gaps and institutional obstacles that stand in the way of achievable advances and productive linkage of social and medical prevention.

Aids. New challenges for social and medical prevention

Etnolog, 21: 77-100.
Authors: Ales Lamut

ABSTRACT

The article describes the Internet survey, conducted for public health purposes, on the sexual behaviour of men who have sex with men (MSM). It describes the usefulness of qualitative surveys for research into the sexual behaviour of MSM in the context of the HIV/aids pandemic. The article expands the description of the social situation of MSM with a discussion of the importance the Internet has for their communication and for the research into sexual behaviour. It presents the results of the author’s analysis of an openend question on respondents’ ideas of the best sex life and discusses the implications for public health efforts.

Ideas of the best sex life among Slovene MSM. [in Slovenian]