2,007 research outputs found
Trends in risk taking and risk reduction among German MSM: results of follow-up surveys "Gay men and AIDS" 1991-2007
"Objectives: To calculate estimates for group level trends among German men who have sex with men (MSM) regarding parameters related to HIV epidemiology: frequency of anal intercourse, consistency in condom use, risk-taking, numbers of sex partners, incident bacterial STIs, and HIV-testing behaviour. Methods: Data derived from six large cross-sectional national follow-up surveys among MSM, conducted between 1991 and 2007. Questionnaires were circulated with German magazines for gay men; in 2003/2007, online recruitment was added. 23,878 anonymously self-administered questionnaires were analyzed in multiple regression models for five subgroups. Results: With the normalization of AIDS, restriction of anal intercourse to primary partnerships has lost its relevance as a risk avoidance strategy for MSM. Other traditional risk reduction strategies among MSM in Germany showed a high degree of time stability: Between 1991 and 2007, condom use in anal intercourse has been relatively stable; numbers of sex partners have been rather constant. No positive trends in the use of Nitrite inhalants were seen, party drugs were increasingly used by a minority of gay men during the 1990s. The syphilis epidemic seen after 1999 among German gay men is well reflected in the survey data. No evidence was found for a concurrent rise in urethral gonorrhoea. The proportion of MSM with a recent HIV test has been continuously increasing. Conclusions: We found no evidence for increasing 'carelessness' or 'prevention fatigue'. However, given the increasing proportions of MSM who frequently engage in anal intercourse with casual partners, a rise in HIV incidence is likely; especially if accompanied by a syphilis epidemic. Time trend analyses of these large behavioural follow-up surveys suggest that the rise in new HIV diagnoses among MSM in Germany may partially reflect an increased uptake of HIV-testing, rather than new infections due to the erosion of condom use or increased numbers of sex partners." (author's abstract
Self-reported history of sexually transmissible infections (STIs) and STI-related utilization of the German health care system by men who have sex with men: data from a large convenience sample
<p>Abstract</p> <p>Background</p> <p>In Germany, testing and treatment of sexually transmissible infections (STIs) services are not provided by one medical discipline, but rather dispersed among many different providers. Common STIs like gonorrhoea or Chlamydia infection are not routinely reported. Although men who have sex with men (MSM) are particularly vulnerable to STIs, respective health care utilization among MSM is largely unknown.</p> <p>Methods</p> <p>A sexual behaviour survey among MSM was conducted in 2006. Questions on self-reported sexual behaviour, STI-related health care consultation and barriers to access, coverage of vaccination against hepatitis, screening for asymptomatic STIs, self-reported history of STIs, and partner notification were analysed. Analysis was stratified by HIV-serostatus (3,511 HIV-negative/unknown versus 874 positive).</p> <p>Results</p> <p>General Practitioners, particularly gay doctors, were preferred for STI-related health care. Low threshold testing in sex-associated venues was acceptable for most respondents. Shame and fear of homophobic reactions were the main barriers for STI-testing. More than half of the respondents reported vaccination against hepatitis A/B. HIV-positive MSM reported screening offers for STIs three to seven times more often than HIV-negative or untested MSM. Unlike testing for syphilis or hepatitis C, screening for asymptomatic pharyngeal and rectal infections was rarely offered. STIs in the previous twelve months were reported by 7.1% of HIV-negative/untested, and 34.7% of HIV-positive respondents.</p> <p>Conclusions</p> <p>Self-reported histories of STIs in MSM convenience samples differ significantly by HIV-serostatus. Higher rates of STIs among HIV-positive MSM may partly be explained by more testing. Communication between health care providers and their clients about sexuality, sexual practices, and sexual risks should be improved. A comprehensive STI screening policy for MSM is needed.</p
Trends in risk taking and risk reduction among German MSM: Results of follow-up surveys Gay men and AIDS 1991 - 2007
Objectives: To calculate estimates for group level trends among German men who have sex with men (MSM) regarding parameters related to HIV epidemiology: frequency of anal intercourse, consistency in condom use, risk-taking, numbers of sex partners, incident bacterial STIs, and HIV-testing behaviour. Methods: Data derived from six large cross-sectional national follow-up surveys among MSM, conducted between 1991 and 2007. Questionnaires were circulated with German magazines for gay men; in 2003/2007, online recruitment was added. 23,878 anonymously self-administered questionnaires were analyzed in multiple regression models for five subgroups. Results: With the normalization of AIDS, restriction of anal intercourse to primary partnerships has lost its relevance as a risk avoidance strategy for MSM. Other traditional risk reduction strategies among MSM in Germany showed a high degree of time stability: Between 1991 and 2007, condom use in anal intercourse has been relatively stable; numbers of sex partners have been rather constant. No positive trends in the use of Nitrite inhalants were seen, party drugs were increasingly used by a minority of gay men during the 1990s. The syphilis epidemic seen after 1999 among German gay men is well reflected in the survey data. No evidence was found for a concurrent rise in urethral gonorrhoea. The proportion of MSM with a recent HIV test has been continuously increasing. Conclusions: We found no evidence for increasing 'carelessness' or 'prevention fatigue'. However, given the increasing proportions of MSM who frequently engage in anal intercourse with casual partners, a rise in HIV incidence is likely; especially if accompanied by a syphilis epidemic. Time trend analyses of these large behavioural follow-up surveys suggest that the rise in new HIV diagnoses among MSM in Germany may partially reflect an increased uptake of HIVtesting, rather than new infections due to the erosion of condom use or increased numbers of sex partners. -- Hintergrund: In vielen europĂ€ischen LĂ€ndern hat die Zahl der HIV-Neudiagnosen in den letzten Jahren zugenommen. In Deutschland konnte ein solcher Trend beobachtet werden fĂŒr die Gruppe der MĂ€nner, die Sex mit MĂ€nnern haben (MSM). WĂ€hrend die Zahl der HIV-Neudiagnosen, die vom Robert-Koch-Institut ausgewiesen wird, sich in den Jahren 1993 bis 2000 bei etwa 700 FĂ€llen jĂ€hrlich bewegte, stieg diese Zahl auf 1.540 im Jahr 2007. HĂ€ufig werden die steigenden HIV-Neudiagnosen in dieser Gruppe mit einer zunehmenden Sorglosigkeit erklĂ€rt, die zu einer Abnahme der Kondomverwendung beim Analverkehr fĂŒhre. Empirische Daten fĂŒr eine solche Deutung lagen jedoch bislang nicht vor. TatsĂ€chlich ist weitgehend unklar, ob und in welchem AusmaĂ die Zunahme der HIVNeudiagnosen auf einer Ănderung des Testverhaltens in dieser Gruppe beruht (wie es beispielsweise fĂŒr GroĂbritannien gezeigt werden konnte), oder ob sich immer mehr schwule und bisexuelle MĂ€nner mit HIV infiziert haben. Dieser Bericht stellt die deutschsprachige Kurzfassung einer derzeit zur Publikation eingereichten umfassenderen Analyse dar. Methodik: Seit 1991 werden in Deutschland im Auftrag der Bundeszentrale fĂŒr gesundheitliche AufklĂ€rung alle zwei bis drei Jahre Querschnitterhebungen bei schwulen und bisexuellen MĂ€nnern durchgefĂŒhrt. In einer sekundĂ€ren Datenauswertung dienten diese sechs Studien als empirische Grundlage, um Verhaltenstrends bei MSM in Deutschland zu beschreiben. Verwendet wurden Daten aus vier Printbogen-Erhebungen (1991, 1993, 1996, 1999) sowie aus zwei Befragungen, fĂŒr die Teilnehmer zusĂ€tzlich ĂŒber das Internet gewonnen wurden (2003, 2007). Insgesamt wurden 23.878 anonym und selbst auszufĂŒllende Fragebögen mithilfe multivariater logistischer Regressionsanalysen ausgewertet; aufgrund der zwei verschiedenen Erhebungsmethoden getrennt fĂŒr die ZeitrĂ€ume 1991 bis 1999 und 2003 bis 2007. Dabei wurden jĂ€hrliche Odds Ratios berechnet, die - kontrolliert fĂŒr Alter, Bildung, WohnortgröĂe und sexuelle Selbstbezeichnung - als SchĂ€tzer fĂŒr zeitliche Trends verwendet werden können. FĂŒr den Zeitraum 2003 bis 2007 wurde zusĂ€tzlich fĂŒr die Erhebungsmethode (online vs. offline) kontrolliert. Zur weiteren Minimierung von Sampling-Effekten wurden diese Trendanalysen nicht fĂŒr das Gesamtsample, sondern fĂŒr jeweils fĂŒnf Untergruppen durchgefĂŒhrt: Zum einen wurde nach Alter und HIV-Serostatus stratifiziert: Nicht-positive 15- bis 24-JĂ€hrige, nicht-positive 25- bis 59- JĂ€hrige, positive 25- bis 59-JĂ€hrige. Zum anderen wurden zusĂ€tzlich MSM betrachtet, die mehr als zehn Sexpartner pro Jahr angeben und gleichzeitig mehrmals pro Monat schwule Saunen, Pornokinos, Sexclubs (Orte mit potentiell hoher Fluktuation der Sexualpartner) besuchen und somit unter epidemiologischen Gesichtspunkten als Kerngruppen fĂŒr die Ausbreitung sexuell ĂŒbertragbarer Infektionen gelten können; sowie 25- bis 59-jĂ€hrige MSM, die nicht oder nur selten schwule Szene-Orte (einschlieĂlich schwuler CafĂ©s etc.) aufsuchen und daher als szenefern bezeichnet werden. Ergebnisse: Einhergehend mit der Normalisierung von AIDS - Martin Dannecker spricht im Zusammenhang mit der EinfĂŒhrung nachhaltig wirksamer antiretroviraler Medikamente auch vom Neuen AIDS - hat eine frĂŒher bedeutsame Risikovermeidungsstrategie schwuler und bisexueller MĂ€nner in Deutschland kaum noch eine Relevanz: die BeschrĂ€nkung des Analverkehrs auf feste Partnerschaften. In allen Untergruppen lieĂen sich in beiden ZeitrĂ€umen signifikante jĂ€hrliche Steigerungsraten derjenigen finden, die auch mit anderen MĂ€nnern als dem festen Partner hĂ€ufig oder regelmĂ€Ăig Analverkehr praktizierten. Weniger stark ausgeprĂ€gt, aber ebenso durchgĂ€ngig, war die Zunahme des hĂ€ufigen oder regelmĂ€Ăigen Analverkehrs mit dem festen Partner. Andere Risikominderungsstrategien bei MSM in Deutschland zeigten eine hohe ZeitstabilitĂ€t: Nach 2003 konnte in keiner Untergruppe eine Zunahme der MĂ€nner mit nicht-durchgĂ€ngigem 4 Kondomgebrauch festgestellt werden, bis 1999 erfolgte ein solcher Anstieg lediglich in den Kerngruppen und bei szenefernen MSM. Entsprechendes gilt fĂŒr die Anteile derer, die ĂŒber Episoden ungeschĂŒtzten Analverkehrs mit Sexpartnern berichteten, deren HIV-Serostatus ihnen unbekannt (oder diskordant) war. FĂŒr keine Untergruppe lieĂ sich eine Zunahme des Anteils derer beobachten, die Kondome als störend beim Sex empfinden. Umgekehrt stieg der Anteil derer, die Kondome als nicht-störend beim Sex betrachten, in den meisten Untergruppen deutlich an - auĂer in Kerngruppen und bei HIV-Positiven. Die beschriebene Zunahme des Analverkehrs innerhalb und auĂerhalb fester Partnerschaften wurde nicht von einer entsprechenden Zunahme des Gebrauchs inhalativer Nitrate (Poppers) begleitet, obwohl diese bei einem erheblichen Anteil schwuler und bisexueller MĂ€nner beim Analverkehr verwendet wurden. Zwischen 1996 und 1999 lieĂ sich eine leichte Zunahme des Gebrauchs von Partydrogen (Ecstasy, Speed/Amphetamine/Crystal, LSD/Ketamin, Kokain) beobachten; dieser Trend war jedoch nicht in allen Untergruppen vorhanden bzw. nach 2003 wieder rĂŒcklĂ€ufig. Die Zahl der Sexualpartner bei MSM in Deutschland blieb zwischen 1991 und 2007 eher stabil. Mitte der 1990er Jahre nahm der Anteil derer, die fĂŒr die vorangegangen zwölf Monate mehr als zehn bzw. mehr als zwanzig Sexualpartner angeben, leicht zu, um zwischen 2003 und 2007 wieder zu sinken. Dabei ist hervorzuheben, dass der Anstieg in die Zeit vor der Verbreitung des Internets fiel und somit nicht auf online-dating zurĂŒckzufĂŒhren ist, sondern - Ă€hnlich der Zunahme des Analverkehrs - eher auf die Normalisierung von AIDS verweist, möglicherweise auch auf eine gewisse Re-Normalisierung schwuler SexualitĂ€t. FĂŒr die ValiditĂ€t der hier gezeigten Trendanalysen spricht, dass die Syphilis-Epidemie bei schwulen MĂ€nnern, die vor allem in den deutschen Metropolen nach 1999 stattfand, sich in den vorliegenden Survey-Daten widerspiegelt. Erhebliche Anstiege fanden sich in allen Untergruppen zwischen 2003 und 2007 (in den Kerngruppen hat dieser Anstieg vermutlich bereits vorher stattgefunden und war nach 2003 daher nicht mehr als Steigerung sichtbar). Kein entsprechender Anstieg lieĂ sich fĂŒr die urethrale Gonorrhö feststellen, obgleich aufgrund des hohen Bekanntheitsgrades des Trippers und der Seltenheit asymptomatischer VerlĂ€ufe kaum von einer Untererfassung auszugehen ist. In allen untersuchten Untergruppen konnten signifikante Zunahmen kĂŒrzlich durchgefĂŒhrter HIV-Tests festgestellt werden, die sich in all diesen Gruppen auch nach 2003 nicht nur fortsetzen, sondern weiter verstĂ€rken. Besonders ausgeprĂ€gt war dies bei Kerngruppen (Zunahme der Testfrequenz) sowie bei unter 25-jĂ€hrigen und szenefernen MSM (Ausweitung des Testens). Es zeigte sich somit auch bei MSM in Deutschland ein breiter und fortgesetzter Anstieg des HIV-Testverhaltens. Schlussfolgerungen: Wir fanden keine Hinweise fĂŒr zunehmende Sorglosigkeit, PrĂ€ventions- oder KondommĂŒdigkeit bei MSM in Deutschland. In Anbetracht der fortgesetzten deutlichen Zunahme der Frequenz anal-genitaler Kontakte, insbesondere mit nicht-festen und daher hĂ€ufig weniger gut bekannten Sexualpartnern, muss auch bei relativ konstanter Kondomverwendung von einer Zunahme der HIV-Inzidenz ausgegangen werden, die jedoch nicht wesentlich auf eine Erosion des Kondomgebrauchs zurĂŒckzufĂŒhren ist. Vielmehr wird durch den zusĂ€tzlichen Einbruch einer Syphilisepidemie in eine ohnehin fĂŒr STI vulnerable Population die pro-Kontakt-Wahrscheinlichkeit einer HIV-Ăbertragung zusĂ€tzlich erhöht. Die hier vorgestellten zeitlichen Trendanalysen, die auf groĂen bundesweit erhobenen empirischen VerhaltensdatensĂ€tzen basieren, zeigen jedoch ebenfalls, dass der Anstieg der HIVNeudiagnosen bei MSM in Deutschland zu einem nicht unerheblichen Anteil auch eine Ausweitung des Testverhaltens widerspiegeln: Sowohl ein vermehrtes Testen bei MSM, die bei sexuellen Kontakten vergleichsweise hohe Risiken eingehen, als auch eine Ausweitung des Testens bei denen, die wenig Kontakt zur schwulen Szene haben.
"Das schnelle Date" - InternetgestĂŒtzte Sexualkontakte und HIV-Infektionsrisiko: Ergebnisse einer 2006 durchgefĂŒhrten Internetbefragung
Der seit Ende der 1990er Jahre diskutierten Frage, ob bei Sexualkontakten, die ĂŒber Kontaktseiten im Internet hergestellt werden, in geringerem Umfang prĂ€ventive Vorkehrungen in Hinblick auf HIV-Ăbertragungen erfolgen als bei andernorts angebahnten Kontakten, sollte in einer im FrĂŒhjahr 2006 durchgefĂŒhrten Online-Umfrage nachgegangen werden. Die Umfrage erfolgte ĂŒber vier Dating-Portale fĂŒr heterosexuelle Frauen und MĂ€nner und ĂŒber vier Portale fĂŒr homound bisexuelle MĂ€nner. Von den berĂŒcksichtigten 5.050 Fragebögen entfielen 76 Prozent auf MĂ€nner, die ausschlieĂlich gleichgeschlechtliche Sexualkontakte in den 12 Monaten vor der Befragung angaben, 11 Prozent der MĂ€nner wurden aufgrund ihrer Angaben als bisexuell und weitere 11 Prozent als heterosexuell definiert. Frauen stellten lediglich 2 Prozent der BefragungsteilnehmerInnen. Etwa drei Viertel aller Befragten schĂ€tzten an Kontaktseiten, das sie darĂŒber Menschen mit gleichen Vorlieben kennenlernen können, dabei muss es sich nicht um sexuelle Vorlieben handeln: So haben etwa 22 Prozent der Frauen, 12 Prozent der homosexuellen, 9 Prozent der heterosexuellen und 6 Prozent der bisexuellen MĂ€nner ĂŒberhaupt keine(n) Sexpartner(in) in den 12 Monaten vor der Befragung gesucht. Online gesucht aber keine(n) Partner(in) gefunden haben 18 Prozent der Frauen, 21 Prozent der homosexuellen, 24 Prozent der bisexuellen und 45 Prozent der heterosexuellen MĂ€nner. Etwa die HĂ€lfte der homo- und bisexuellen MĂ€nner haben ihre SexualpartnerInnen mehrheitlich oder ausschlieĂlich ĂŒber das Internet kennengelernt, wĂ€hrend dies nur auf 39 Prozent der heterosexuellen MĂ€nner zutrifft (zwei Drittel geben dies in der kleinen Gruppe der Frauen an). Dass heterosexuelle MĂ€nner die geringsten Erfolge beim Anbahnen von Sexualkontakten ĂŒber das Internet haben, zeigen auch andere erhobene Daten. Unter den Befragungsteilnehmern erfolgte regelmĂ€Ăiger Kondomgebrauch bei Vaginal- oder Analverkehr - je nach Gruppenzugehörigkeit - zu sehr unterschiedlichen Anteilen. 55 Prozent der homosexuellen und 47 Prozent der bisexuellen MĂ€nner benutzten grundsĂ€tzlich Kondome, 38 Prozent der heterosexuellen MĂ€nner und 34 Prozent der Frauen gaben dies an. Hinsichtlich des Risikos, sich mit HIV zu infizieren (ungeschĂŒtzter Anal- oder Vaginalverkehr mit PartnerInnen mit unbekanntem oder diskordantem Serostatus - Expositionsrisiko), bestanden nur geringe Unterschiede zwischen homo- (27%), bi- (31%) und heterosexuellen MĂ€nnern (26%) bzw. Frauen (27%). Ein Transmissionsrisiko konnte lediglich in der Teilgruppe der homosexuellen (8%) und bisexuellen (1%) MĂ€nner festgestellt werden, da in den anderen beiden Gruppen niemand HIV-positiv war. Es zeigt sich, dass bei der ĂŒberwiegenden Mehrheit aller Befragten das HIV-bezogene sexuelle Risikoverhalten bei online- und offline-Dates gleich ist. -- Are people more likely to risk an HIV infection with sex partners they meet online as compared to those whom they meet offline? This question has been the subject of research since the late 1990s in several post-industrialized countries. This paper presents the results of a study conducted in Germany in 2006. A link to an anonymous, self-administered online questionnaire was posted on four dating websites for heterosexual men and women and on four dating websites for men who have sex with men. Of the 5,050 respondents included in the analysis, 76 per cent were men who reported sexual contacts in the previous twelve months exclusively with other men; 11 per cent could be classified as bisexual men (sexual contacts with men and women), and 11 per cent as heterosexual men (sexual contact with women only).. Two per cent of all respondents were women; because of the small number of respondents this group was not further stratified in the analysis. Finding persons with similar interests was the most frequently expressed positive aspect of dating websites (78% among homosexual men, 80% among bisexual men, 74% among heterosexual men, and 73% among women). This did not necessarily mean similar sexual interests: 22 per cent of the women, 12 per cent of the homosexual men, 6 per cent of the bisexual men, and 9 per cent of the heterosexual men claimed they had not been looking for sex partners during their visits to the sites in the previous twelve months. Many respondents reported being unsuccessful in finding a sex partner online: 18 per cent of the women, 21 per cent of the homosexual men, 24 per cent of the bisexual men, and 45 per cent of the heterosexual men. While during the previous twelve months half of the homo- and bisexual men found most (if not all) of their sex partners on the Internet, the respective proportions were 39 per cent among heterosexual men, and 67% in the small group of female respondents. Taken together, heterosexual men were the least successful in finding sex partners on the Internet. Regular use of condoms for every anal or vaginal intercourse was reported by 55 per cent of the homosexual men, 47 per cent of the bisexual men, 38 of the heterosexual men, and 34 per cent of the women. However, regarding unprotected anal or vaginal intercourse with a sex partner of unknown or discordant HIV serostatus, the proportions among the different subgroups were very similar (homosexual men: 27%; bisexual men: 31%; heterosexual men: 26%; women: 27%). The risk of transmitting a known HIV infection to sex partners was only present among homosexual (8%) and bisexual (1%) men, primarily because only respondents from these two subgroups identified as HIV-positive. For the large majority (83-86%) of men, HIV risk behaviours are the same, regardless if sex partners are met online or offline.
The denominator problem: Estimating MSM-specific incidence of sexually transmitted infections and prevalence of HIV using population sizes of MSM derived from Internet surveys
<p>Abstract</p> <p>Background</p> <p>Measuring prevalence and incidence of sexually transmitted infections in hard to reach populations like men who have sex with men (MSM) is hampered by unknown size and regional distribution of this population. Community sample â and study-based measurements are often fraught with participation biases and do not allow generalization of the results for other regions or the whole population group of MSM.</p> <p>Methods</p> <p>We used the proportional regional distribution of participants of large internet-based surveys among MSM from Germany together with a general population survey-derived estimate of the MSM population to estimate regional population sizes. Based on transmission group category from surveillance data and regional MSM population size we calculated regional population-specific incidence rates of newly diagnosed HIV infection and syphilis. For HIV prevalence we compared estimates of prevalent HIV infections in MSM from a surveillance data-based model with a mixed model in which we used the proportional regional distribution of HIV positive participants from surveys and the estimated total number of prevalent HIV infections from the surveillance based model.</p> <p>Results</p> <p>Assuming a similar regional distribution of survey participants and the MSM population as a whole, the regional proportion of MSM in the general population can be estimated. Regional incidence calculated with the estimated MSM population as denominator and national surveillance data as numerator results in regional peak incidence rates of 7â8 per 1,000 MSM for newly diagnosed HIV infection and syphilis. The gradient between metropolitan and rural areas narrows considerably compared with calculations which use the total (male) population as denominator. Regional HIV prevalence estimates are comparable in the two models.</p> <p>Conclusion</p> <p>Considering the difficulties to obtain regionally representative data by other sampling methods for MSM, in Western post-industrialized countries internet-based surveys may provide an easy and low cost tool to estimate regional population distributions. With national surveillance data, which categorize transmission groups, regional population-specific incidence rates for reportable sexually transmitted infections can be estimated. HIV prevalence estimates for regional MSM populations show differences related to the level of urbanization, MSM concentration, and starting points of the HIV epidemic in western and eastern Germany.</p
Blood donor deferral policies across Europe and characteristics of men whohave sex with men screened for human immunodeficiency virus in bloodestablishments: data from the European Men-who-have-sex-with-men Internet Survey (EMIS).
BACKGROUND: The predominant mode of transmission of human immunodeficiency virus (HIV) in Europe is male-to-male transmission. Men who have sex with men (MSM) are deferred from donating blood in many countries, but nevertheless do donate blood. Based on data from 34 countries, we estimated the proportion of MSM screened for HIV in the context of a blood donation and identified individual factors associated with this HIV screening in order to propose possible public health interventions. MATERIALS AND METHODS: In 2010, the first European MSM Internet Survey (EMIS) collected self-reported data on HIV testing from >180,000 MSM in 38 European countries. Using logistic regression, demographic and behavioural factors associated with screening for HIV in blood establishments were identified. Stratified by European sub-region, we analysed the proportion of MSM screening in blood establishments by time elapsed since last negative HIV test. RESULTS: Donor eligibility criteria for MSM vary across Europe with most countries using permanent deferral. The Western region had the lowest (2%) proportion of MSM screened in blood establishments and the Northeastern region had the highest (14%). Being <25 years old, not disclosing sexual attraction to men, never having had anal intercourse with a man, having a female partner, living in a rural area, and certain European sub-regions or countries of residence increased the likelihood of being screened in blood establishments. DISCUSSION: In spite of deferral policies, MSM are screened for HIV in the context of blood donations. Gay-friendly testing services are rare in rural areas, and young men might be reluctant to disclose their sexual orientation. Recent developments, such as home sampling, might offer new testing possibilities for those not reached by established services yet wishing to know their HIV status. Donor selection procedures should be improved. Both interventions might help to further reduce the risk of transfusion-transmitted infections
Lack of HIV testing and dissatisfaction with HIV testing and counselling among men having sex with men in Hungary.
Background: Using data from a large internet-based survey of European men having sex with men (MSM), we assessed factors associated with HIV testing and reasons for dissatisfaction with HIV testing and counselling among Hungarian MSM. Methods: A total of 2052 Hungarian MSM provided evaluable data for the European MSM Internet Survey (EMIS) in 2010. Ï2 tests and Poisson regression with a robust variance estimator were used to assess factors associated with HIV testing and dissatisfaction with HIV testing and counselling. Results: A total of 42.1% of MSM reported never being testing for HIV. Over one-half of men (54.1%) who reported condomless anal intercourse (CAI) in the prior 12 months with a person of unknown or sero-discordant HIV status reported no lifetime HIV testing. The factor most strongly associated with dissatisfaction with HIV testing and counselling was test site with increased dissatisfaction with inpatient hospital settings vs. community-based organizations. Both lack of HIV testing and dissatisfaction with testing were independently associated with MSM who reported that no one, or only a few people, knew they were attracted to men. Conclusions: Lack of HIV testing was strongly associated with CAI. MSM reported that community-based organizations better supported confidentiality and were more respectful during HIV testing
Transactional Sex: Supply and Demand Among European Men Who have Sex with Men (MSM) in the Context of Local Laws.
Objectives: Transactional sex (TS) is generally defined as the trading of sex for material goods. Cast within the broader context of prostitution laws, we examined variations in the sociodemographic profile of men who have sex with men engaging in TS by payment direction (buying/selling). Methods: The data were collected as part of the 38-country European Men who have sex with men Internet Survey project, conducted in 2010. Results: About 12% of respondents reported engaging in TS in the past year. TS was associated with laws, age, education, employment, and residence. Conclusions: The striking sociodemographic differences in TS by payment direction suggest a power differential and a leading role of socioeconomic factors in TS
Age biases in a large HIV and sexual behaviour-related internet survey among MSM.
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
The Relationship of Internalized Homonegativity to Sexual Health and Well-Being Among Men in 38 European Countries Who Have Sex With Men.
The objective of this article is to examine internalized homonegativity (IH) in relation to aspects of well-being and several measures of clinical importance among men-who-have-sex-with-men (MSM) in 38 countries. The data were collected as part of the EMIS project. The multivariable regression analysis identified independent associations with IH for nongay identity, younger age, being closeted, limited gay social affiliation, and sexual unhappiness. IH was also positively associated with loneliness, inability to decline unwanted sex, and being less knowledgeable about HIV and HIV testing. These results provide evidence that homonegative internalization merits consideration as a predisposing factor in several aspects of ill health. There are also several clinical implications of this project, including: (1) Treatment of lesbian, gay, and bisexual (LGB) persons should address gay self-acceptance, as internalized homonegativity seems to be a predisposing factor in several aspects of ill health among this population, and (2) therapy that is used to help LGB persons accept and integrate a gay or lesbian identity seems particularly important for younger, nongay identified persons
- âŠ