Category: EMIS 2017

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EMIS 2017 Journal Articles 2017

Sexual and mental health inequalities across gender identity and sex-assigned-at-birth among men-who-have-sex-with-men in Europe: findings from EMIS-2017

International Journal of Environmental Research & Public Health, 2020; 17(20): 7379 (doi: 10.3390/ijerph17207379).

Authors: Ford Hickson, Max Appenroth, Uwe Koppe, Axel J. Schmidt, David Reid and Peter Weatherburn

Abstract

Some men who have sex with men (MSM) were assigned female at birth (AFB) and/or identify as trans men. Little is known about how these men differ from other MSM. We compared sexual and mental health indicators from the European MSM Internet Survey (EMIS-2017), comparing men AFB and/or currently identifying as trans men with those assigned male at birth (AMB) who identified as men. EMIS-2017 was an opportunistic 33-language online sexual health survey for MSM recruiting throughout Europe. We used regression models adjusting for age, country of residence and employment status to examine differences across groups. An analytic sample of 125,720 men living in 45 countries was used, of which 674 (0.5%) were AFB and 871 (0.7%) identified as trans men. The two sub-groups were not coterminous, forming three minority groups: AFB men, AFB trans men and AMB trans men. Minority groups were younger and more likely unemployed. Anxiety, depression, alcohol dependence and sexual unhappiness were more prevalent in sex/gender minority men. Conversely HIV and STI diagnoses were less common. AMB trans men were most likely to have sexual risk behavior with steady partners and to have unmet health promotion needs, and were least likely to be reached by interventions. Sex assigned at birth and trans identification were associated with different sexual and mental health needs. To facilitate service planning and to foster inclusion, sex-assigned-at-birth and current gender identity should be routinely collected in health surveys.

Keywords: trans men; homosexuality; transgender; LGBT; anxiety; depression; STIs; HIV; community survey

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EMIS 2017 Journal Articles 2017

HIV test and knowledge of U=U: insights from MSM living in Portugal and participating in EMIS 2017

European Journal of Public Health, Volume 30, Issue Supplement_5, September 2020, ckaa165.996, https://doi.org/10.1093/eurpub/ckaa165.996

Authors: J P Costa, P Meireles, A Aguiar, A J Schmidt, H Barros

Abstract

Recently, it became clear that undetectable equals untransmittable (U=U), stressing the importance of engaging in medical care and adhering to antiretroviral therapy. HIV testing and counselling (HTC) are offered in different settings and can be an opportunity to inform people. We aimed to understand if HIV testing history, including recency, place and, result, was associated with U=U knowledge.

We used data from 2242 MSM living in Portugal participating in EMIS 2017 that answered if they already knew that “A person with HIV who is on effective treatment (called ‘undetectable viral load’) cannot pass their virus to someone else during sex”, opting of 5 possible answers, dichotomized in “I already knew” vs. any other option. Regarding HIV testing history, participants were categorized as follows:1. HIV positive; 2. HIV negative and last test ≤12 months in a community setting; 3. HIV negative and last test ≤12 months in a medical setting, and 4. never tested for HIV or last test >12 months or tested in other settings (reference). Logistic regression models were fitted to estimate crude and city size and education-adjusted associations.

The median (P25; P75) age of participants was 34 (25; 43) years. No significant statistical association was found with age or current occupation. Those with more years of education and living in a big or very big city were more likely to know that U=U (aOR:1.55; 95%CI:1.20-1.99 and aOR:1.26; 95%CI:1.04-1.53, respectively). Considering HIV testing history and diagnosis, men with diagnosed HIV (aOR:6.33; 95%CI:4.50-8.90), those who had the last test in community setting (aOR:2.44; 95%CI:1.87-3.17) and those who had the last test in a medical setting (aOR: 1.57; 95%CI:1.26-1.95) were more aware of U=U than those not tested in the last 12 months.

Our results suggest that there is a gradient of U=U knowledge associated with HIV testing history among MSM. Efforts should focus on improving counselling about U=U at all HIV testing settings.

Key messages

  • The knowledge of U=U seems to be associated with the place, recency and result of the last HIV test.
  • Counselling should focus on the best evidence available at all HIV testing settings, to inform and empower the individuals.

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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 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 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