Category: Journal Articles 2017

AIDS and Behavior, published online first 24 November 2021 (doi: 10.1007/s10461-021-03526-z).

Authors: Veerle Buffel, Thijs Reyniers, Caroline Masquillier, Estrelle Thunissen, Christiana Nöstlinger, Marie Laga, Edwin Wouters, Wim Vanden Berghe, Jessika Deblonde, Bea Vuylsteke

Abstract

We examined PrEP awareness, willingness to take it and early PrEP use among men who have sex with men (MSM) at increased risk of HIV acquisition in Belgium. This analysis of the Belgian EMIS online data of 2017–2018 adopts a cascade approach, with the following steps quantified as conditional probabilities: being eligible for, aware of, willing to take PrEP, and PrEP use. One out of three MSM was eligible to use PrEP according to the operationalized Belgian reimbursement criteria. PrEP awareness was lower among socioeconomically vulnerable MSM, MSM living outside large cities, MSM who were less open about their sexuality and those who did not identify as gay or homosexual. A lack of PrEP knowledge, a higher self-efficacy regarding safe sex, having a steady partner and reporting more symptoms of depression were related to unwillingness to use PrEP. Among those willing to take PrEP, less than one third were actually using PrEP. Not using PrEP was associated with living in small cities and experiencing financial problems.

Keywords: Awareness of and willingness to use PrEP; Cascade approach; Eligibility criteria; Men who have sex with men (MSM); Pre-exposure prophylaxis (PrEP) use.

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Sexually Transmitted Infections, 2021; 97:282-289. (doi: 10.1136/sextrans-2020-054629).

Authors: Louis MacGregor, Manik Kohli, Katharine J Looker, Ford Hickson, Peter Weatherburn, Axel J Schmidt, Katy M Turner

Abstract

Introduction: In the last decade diagnoses of most STIs have risen among men who have sex with men (MSM). Although a significant proportion of this is likely due to increased STI screening, understanding the role of behavioural drivers remains critical. We measure the associations between stimulant use to enhance and prolong sexual experiences (chemsex) and bacterial STI diagnoses in UK MSM, individually considering HIV-diagnosed MSM, pre-exposure prophylaxis (PrEP) users and other MSM.

Methods: We used the UK 2017-2018 European MSM Internet Survey data (n=9375). We constructed causal inference models using multivariable logistic regression, calculating adjusted OR (aOR) and 95% CI of the associations between participation in recent (≤12 months) exclusively dyadic or multipartner chemsex versus no chemsex and recent self-reported diagnoses of syphilis, gonorrhoea and chlamydia.

Results: Among MSM with an HIV diagnosis, 25% of users indicated recent multipartner chemsex, vs 28% of PrEP users and 5% of other MSM. Adjusting for age, ethnicity, UK birth, cis-trans status, sexual identity, education, settlement size and relationship status, participation in recent multipartner chemsex versus no chemsex was associated with greater odds of recent syphilis, gonorrhoea and chlamydia diagnosis. aORs for recent syphilis, gonorrhoea and chlamydia diagnoses were 2.6 (95% CI 1.7 to 4.1), 3.9 (95% CI 2.6 to 5.8) and 2.9 (95% CI 1.9 to 4.3), respectively, in HIV-diagnosed MSM; 1.9 (95% CI 1.1 to 3.3), 2.9 (95% CI 2.0 to 4.2) and 1.9 (95% CI 1.3 to 2.8), respectively, in PrEP users; and 4.0 (95% CI 2.3 to 6.9), 2.7 (95% CI 1.9 to 3.8) and 2.3 (95% CI 1.6 to 3.4), respectively, in other MSM. Conversely, exclusively dyadic chemsex had no significant associations with bacterial STI diagnoses among HIV-diagnosed MSM, only gonorrhoea (aOR 2.4, 95% CI 1.2 to 4.7) among PrEP users and syphilis (aOR 2.8, 95% CI 1.4 to 5.6) among other MSM.

Discussion: Multipartner chemsex may drive the association between chemsex and bacterial STI diagnoses and thus should be the focus of future tailored chemsex interventions. Additionally, PrEP acceptability among MSM and particularly chemsex participants has generated an emergent group suitable for such interventions.

Keywords: Chlamydia trachomatis; gay men; gonorrhoea; sexual behaviour; syphilis.

© Author(s) (or their employer(s)) 2021. No commercial re-use. Published by BMJ.

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Drug and Alcohol Dependence, 2021; 223: 108698 (doi: 10.1016/j.drugalcdep.2021.108698).

Authors: Fionn P. Daly, Kate O’Donnell, Martin P. Davoren, Chris Noone, Peter Weatherburn, Mick Quinlan, Bill Foley, Derval Igoe, Peter M. Barrett

Abstract

Background: Alcohol consumption is a major public health concern in Ireland. Alcohol use disorder (AUD) disproportionately affects men who have sex with men (MSM). However, little is known about the prevalence of AUD in this group in Ireland specifically, and the characteristics of MSM who may struggle with this.

Methods: The European MSM Internet Survey 2017 was an online, self-completed, anonymous questionnaire among MSM in Ireland. Standardised questions were used to explore a variety of topics. The validated CAGE-4 questionnaire was used to screen for potential AUD, defined as a CAGE-4 score of ≥2 out of 4. Multivariable-adjusted logistic regression analysis was used to identify factors associated with potential AUD.

Results: In total, 1793 MSM met inclusion criteria. 31 % screened positive for AUD. We observed higher odds of possible AUD among MSM who were bisexual (vs. gay/homosexual) (aOR 1.48 95 %CI 1.01–2.18), native to Ireland (vs. non-native) (aOR 1.49 95 %CI 1.12–1.96), unemployed (vs. employed) (aOR 1.80 95 %CI 1.02–3.16), had used illicit drugs in the previous year (vs. none) (cannabis only, aOR 1.74 95 %CI 1.14–2.63) (other illicit drugs, aOR 2.28 95 %CI 1.67–3.09), reported anxiety/depression (vs. none) (aOR 1.73 95 %CI 1.12–2.66), and MSM who experienced homophobic abuse (vs. never) (aOR 1.55 95 %CI 1.09–2.22). Student MSM were less likely to screen positive for AUD (vs. employed) (aOR 0.65 95 %CI 0.46−0.93).

Conclusions: The prevalence of AUD appears to be higher in the MSM population compared to the general male population in Ireland. Targeted interventions may be warranted to reduce the burden of AUD among MSM.

Keywords: Men who have sex with men (MSM); Alcohol use disorder (AUD); Drug use; Depression/Anxiety; Homophobia; HIV / AIDS

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Journal of Abnormal Psychology, 2021; 130(7):713-726 (doi: 10.1037/abn0000693)

Authors: John E Pachankis, Mark L Hatzenbuehler, Richard Bränström, Axel J Schmidt, Rigmor C Berg, Kai Jonas, Michal Pitoňák, Sladjana Baros, Peter Weatherburn

Abstract

Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (eg. laws), interpersonal (eg. discrimination), and individual (eg. self-stigma). Although the literature on stigma and mental health has focused on interpersonal and individual forms of stigma, emerging research has shown that structural stigma is also associated with adverse mental health outcomes. However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association. To address these questions, we use data from the 2017/18 European Men-who-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health (ie. Patient Health Questionnaire) and psychosocial mediators (ie. sexual orientation concealment, internalized homonegativity, and social isolation). We linked these data to an objective indicator of structural stigma related to sexual orientation-including 15 laws and policies as well as aggregated social attitudes-in respondents’ countries of origin (N = 178) and receiving countries (N = 48). Among respondents who still live in their country of birth (N = 106,883), structural stigma was related to depression and suicidality via internalized homonegativity and social isolation. Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators. This study provides additional evidence that stigma is a sociocultural determinant of mental health.

© 2021 American Psychological Association 2021, ISSN: 0021-843X

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AIDS and Behavior, 2021; 25:3638–3650 (doi: 10.1007/s10461-021-03336-3).

Authors: Sean Colyer, Nathan J Lachowsky, Axel J Schmidt, Barry D Adam, Dana Paquette, Trevor A Hart, David J Brennan, Martin Blais, Abigail E Kroch

Abstract

HIV pre-exposure prophylaxis (PrEP) is an effective prevention tool being scaled up in Canada. We describe PrEP uptake and identify demographic correlates of uptake among gay, bisexual, and other men who have sex with men (gbMSM) at elevated HIV risk using data from an online survey of gbMSM residing in Canada between Oct 2017 and Jan 2018. Among the 969 participants at elevated HIV risk who had recently tested for HIV, 96.0%, 83.3%, 72.6%, and 39.7% reported awareness, knowledge, acceptability, and pursuit of PrEP, respectively; 27.1% had ever and 24.6% were currently taking PrEP. The strongest correlate of PrEP uptake was living in a city of ≥ 500,000 inhabitants; others included being out to all or almost all family, friends, and colleagues regarding sexual attraction to men, greater financial coping, and being 30–49 years of age. Improved upscaling of PrEP in Canada may be accomplished through consideration of these disparities.

Keywords: MSM; pre-exposure prophylaxis (PrEP); PrEP eligibility; PrEP access; PrEP delivery

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Bundesgesundheitsblatt – Gesundheitsforschung – Gesundheitsschutz (doi: 10.1007/s00103-021-03429-3)

Authors: Ulrich Marcus & Susanne B. Schink

Abstract

Background: Sexual minorities are highly vulnerable to sexually transmitted infections (STIs), mental health problems such as depression and suicidality, and substance use- associated health and social problems. 

Research question: We describe selected findings from the European MSM Internet Survey (EMIS) 2017, one of the largest online surveys of men who have sex with men, and discuss their implications for prevention in MSM in Germany.

Materials and methods: The overall aim of EMIS-2017 was to collect data for planning HIV and STI prevention and treatment programs. The target population were men living in Europe who have sex with men and/or are attracted to men. The questionnaire contained questions on demography, morbidities, beha- viour, needs and interventions. Participants were recruited mainly via two popular online dating platforms from 10/2017 to 01/2018.

Results and discussion: EMIS-2017 shows that MSM are severely affected by psychological stress and STIs. In terms of psychological stress, younger MSM suffer in particular from depressive disorders and suicidality, while the use of alcohol and other psychoactive substances is of concern among older MSM. MSM are more often affected by STIs than the heterosexual majority population. Many STIs are a- or pauci-symptomatic; thus, screening based on risk-assessment is favoured to detect infections. However, for the time being, for some STIs there is no medical and/or public health evidence to support treatment of asymptomatic infections. EMIS-2017 identified needs by subgroups as far as knowledge gaps on PEP (HIV post-exposure prophylaxis) and PrEP (HIV pre-exposure prophylaxis), being reached by information and prevention offers as well as insufficient uptake of such offers.

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