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EMIS-2017: Planned Scientific Articles

As the end of August 2019, we have provided EMIS-2017 data to partners to produce 38 National Reports. They will be provided as PDFs elsewhere on this website.

International EMIS data for scientific articles can now be requested by members of the EMIS network. Merged 2010 and 2017 data is now available. Data request form are available via e-mail. Please contact coordinator@emis-project.eu.

The following data access for publication requests have been approved by the EMIS editorial board.

Title: Structural stigma and mental health among MSM migrants to and within Europe. Results from the European MSM Internet Survey 2017
Lead author: John Pachankis
Data set: EMIS-2017 (48 countries)
Research question and objectives: Virtually no information exists regarding the influence of home-country and current-country structural stigma on MSM migrants’ mental health. We therefore propose to utilize EMIS-2017 data to investigate associations between country-level structural stigma and MSM migrants’ mental health. We propose to use a parallel approach from our EMIS-2010 migrant-related analyses, except this time we propose to model mental health symptoms as the outcome rather than HIV-prevention needs (Pachankis et al., 2017, JAIDS).  Specifically, we plan to examine MSM migrant mental health as a function of home-country structural stigma toward sexual minorities, current-country structural stigma toward sexual minorities and immigrants, length of time since migrating, linguistic minority status, migration motivations, and their interactions to predict symptoms of depression, anxiety, and suicidality.
Analytic plan: Analyses will utilize the sub-sample of respondents who indicate having moved from their country-of-origin. We will perform cross-classified models in which structural stigma in respondents’ country-of-residence and in respondents’ country-of-origin will both serve as between-country (Level 2) predictors. These variables will consist of an objective index of country-level climate relevant to sexual minorities. Number of years living in one’s current country-of-residence, linguistic status, migration motivations, and their interactions will serve as our primary person-level (Level 1) predictors.  In order to test moderation of structural stigma in one’s country-of-origin by structural stigma in one’s current country-of-residence, we will examine the cross-level interaction of these two variables.  Assuming significant associations, we will then probe the interaction to calculate simple slopes of country-of-residence structural stigma at +/- 1.0 standard deviation of our country-of-origin structural stigma index.
Target journal: Lancet Psychiatry
Date of approval: 23.08.2019

Title: Structural stigma and mental health among MSM in Europe. Results from the European MSM Internet Survey 2017
Lead author: John Pachankis
Data set: EMIS-2017 (48 countries)
Research question and objectives: Depression, anxiety, and suicidality represent a significant public health burden disproportionately borne by sexual minority populations. Examining associations between country-level structural stigma and these mental health symptoms would potentially establish structural stigma as a key source of adverse mental health outcomes among European sexual minority men, thereby supporting policy changes such as reductions in structural forms of discrimination and increased access to mental health services. Identifying mechanisms of this association such as sexual orientation concealment, homophobic victimization, social support, and internalized homophobia can provide researchers and clinicians with plausible targets of psychosocial interventions to improve sexual minorities’ mental health.
Analytic plan: We will create a best-fitting measurement model, including latent variables. We will control for country-level clustering by employing multilevel modelling. Structural stigma toward sexual minority individuals will serve as the between-country (Level 2) predictor and will consist of an objective index of country-level climate relevant to sexual minorities, including laws, policies, and attitudes aggregated to the country level. Sexual orientation concealment (outness), social support, and homophobic victimization will serve as primary within-country (Level 1) predictors. For those models in which mediators are associated with outcomes and structural stigma, we will test for full and partial mediation using the mediation approach outlined by MacKinnon and colleagues (2002). The size and significance of the potential indirect mediation effects of each mediator will be tested using multilevel multiple mediation analyses (Heck & Thomas, 2015)
Target journal: Lancet Psychiatry
Date of approval: 23.08.2019

Title: Knowledge of hepatitis A and B among men-who-have-sex-with-men (MSM) in Europe and opportunities to decrease vulnerabilities. Results from the European MSM Internet Survey (EMIS) 2017
Lead author: Sandra Dudareva (RKI) & Erika Duffel (ECDC)
Data set: EMIS-2017 (48 countries)
Research question and objectives: What is the knowledge around hepatitis A and B among MSM in Europe? Do MSM in Europe know where to get vaccinated against hepatitis A and B? Objectives: Analyse the responses provided around knowledge of hepatitis A and B and accessibility of vaccinations among MSM
Analytic plan: Descriptive analysis of questions Q135-Q139, Q142, Q144, Q140 and building of cascade of knowledge for uptake of hepatitis A and B vaccination, e.g. all vaccinated Proportion that are aware of hepatitis A and B vaccination recommendations. Proportion that is aware where to get vaccinated. Proportion vaccinated. Uni- and Multivariable analysis of factors associated with knowledge on hepatitis A and B.
Target journal: Eurosurveillance
Date of approval: 23.08.2019

Title: What factors are associated with the vulnerability towards hepatitis A and B among men-who-have-sex-with-men (MSM) in Europe? An update from the European MSM Internet Survey (EMIS) 2017
Lead author: Sandra Dudareva (RKI) & Erika Duffel (ECDC)
Data set: EMIS-2017 (48 countries)
Research question and objectives: Which factors are associated with the vulnerability of MSM in Europe towards hepatitis A and B and have these factors changed over time? Objectives: Analyse proportion of MSM vulnerable towards hepatitis A and B by possible explanatory factors including country, age, settlement size, educational level, outness, access to vaccination, hepatitis/STI knowledge, homosexual disclosure at last STI test and other relevant information collected through EMIS, as well as by national vaccination recommendations for MSM in their country of residence. Describe changes of hepatitis B vulnerability since 2010 by taking into account changes in explanatory factors.
Analytic plan: Update literature research on national vaccination guidelines to create variable for MSM-specific and universal vaccination programs for analyses. Investigate the legal climate for LGBTI citizens (for example Homophobic Climate Index (Lamontagne et al 2018)) and if applicable incorporate in analysis. Descriptive analysis of all variables on country level. Univariable and multivariable (multilevel model) analysis with outcome ‘hepatitis A and B vaccination history’. Multivariate model with 4 possible outcomes (“not vaccinated”, “vaccinated only towards hepatitis A”, “vaccinated only towards hepatitis B” and “vaccinated towards hepatitis A and B” will be investigated. Discuss differences in results from EMIS 2010 and EMIS 2017 (Analysis of changes over time in outcome and explanatory variables).
Target journal: Eurosurveillance
Date of approval: 23.08.2019

Title: Prevalence of PrEP use and modes of access in 42 European countries, Lebanon, Israel and Canada
Lead author: Axel J. Schmidt
Data set: EMIS-2017
Research question and objectives: Comparable country-level data on how men-who-have-sex with-men (MSM) access HIV pre-exposure prophylaxis (PrEP), and the extent to which they use it is scarce. For Europe and Israel, the European Centre for Disease Prevention and Control (ECDC) has published a map on PrEP implementation based on information received from national representatives. We aim at estimating the proportion of MSM who ever used PrEP, as well as the predominant mode of access.
Analytic plan: After excluding respondents with largely inconsistent answers (e.g. age), or respondents with diagnosed HIV, we establish the proportion of MSM reporting ever having used PrEP. All these men were asked how they accessed PrEP. We set a cut-off of 1% to determine if PrEP was implemented or not (as some men might have used PrEP while living abroad). We then look at the predominant mode of PrEP access, excluding countries where <10 men had used PrEP. Finally, in multivariable regression analysis, we determine which access modes were most strongly affected by age and financial coping.
Abstract presented at: AIDS Impact (oral)
Target journal: Lancet HIV or AIDS
Date of approval: 30.7.2019

Title: An update on the comparison of the performance of STI screening services for gay and bisexual men across 40 European cities: Results from the 2017 European MSM Internet Survey (EMIS-2017)
Lead authorAxel J. Schmidt (Jason Doran)
Data set: EMIS-2017
Research question and objectives: Rectal manifestations of sexually transmitted infections (STIs) compromise the health of gay and bisexual men. In 2010 across 40 cities among men screened for STIs, anal swabbing was highest in London and Amsterdam with rates of more than 72%, but low across most other European cities. We apply the same methodology for comparing diagnostic procedures for MSM across the same European cities for 2017, in order to see if the gap between London/Amsterdam and other European cities has narrowed.
Analytic plan: See https://sti.bmj.com/content/89/7/575.info. As sexual healthcare for MSM in most countries is organised locally, we choose cities for comparison and focus on a sub-sample of 38,439 men living the same 40 European cities. We use the same multivariable regression model as in 2012 to compare the odds of having received anal swabbing in the 12 months, controlling for age, HIV diagnosis, and the number of sexual partners. We plan to have an online appendix where all 105 EMIS-2017 cities are included, sorted by country.
Abstract presented at: STI and HIV Vancouver (oral)
Target journal: STI
Date of approval: 16.5.2019 

Title: Level and description of MSM who are eligible but not using PrEP: French results from a nationwide internet survey (EMIS 2017)
Lead author: Margot Annequin
Data set: EMIS-FR (2017)
Research question and objectives: In France, PrEP was implemented in January 2016, has been fully reimbursed by the French national health insurance system since March 2017 and is recommended for men who have sex with men (MSM) with high risk of HIV infection. MSM represent 42% of new HIV diagnoses in France, thus it has been estimated that 50 000 MSM would be in PrEP need. However according to French social security data, 10 000 people have been reimbursed for PrEP as of the first semester of 2018. In order to increase PrEP coverage, we need to better characterise individuals who may benefit from PrEP but are not using it. Objectives of this study are to assess the percentage and describe MSM eligible to PrEP but non-users and to assess factors associated with being an eligible non PreP-user (ENPU).
Analytic plan: This analysis will be restricted to participants living in France, who declared being HIV-negative or never tested for HIV. Adapted to French guidelines, we will define PrEP eligibility as meeting at least one of three criteria: having condomless intercourse with ≥ 2 different partners in the last 12 months, having a history of post-exposure prophylaxis use or engaging in chemsex in the last 12 months We will assess the percentage of PrEP users and Eligible non PrEP-user (ENPU) amongst all French EMIS respondents, excluding those declaring HIV positive status. Socio-demographic characteristics, sexual behaviours and HIV knowledge will be compare between PrEP users and ENPU and factors associated with ENPU will assess using logistic regression models, comparing ENPU to PrEP users. This analysis will be restricted to participants living in France, who declared being HIV-negative or never tested for HIV. Adapted to French guidelines, we will define PrEP eligibility as meeting at least one of three criteria: having condomless intercourse with ≥ 2 different partners in the last 12 months, having a history of post-exposure prophylaxis use or engaging in chemsex in the last 12 months. We will assess the percentage of PrEP users and Eligible non PreP-user (ENPU) amongst all French EMIS respondents, excluding those declaring HIV positive status. Socio-demographic characteristics, sexual behaviours and HIV knowledge will be compare between PrEP users and ENPU and factors associated with ENPU will assess using logistic regression models, comparing ENPU to PrEP users. This analysis will be restricted to participants living in France, who declared being HIV-negative or never tested for HIV. Adapted to French guidelines, we will define PrEP eligibility as meeting at least one of three criteria: having condomless intercourse with ≥ 2 different partners in the last 12 months, having a history of post-exposure prophylaxis use or engaging in chemsex in the last 12 months. We will assess the percentage of PrEP users and Eligible non PreP-user (ENPU) amongst all French EMIS respondents, excluding those declaring HIV positive status. Socio-demographic characteristics, sexual behaviours and HIV knowledge will be compare between PrEP users and ENPU and factors associated with ENPU will assess using logistic regression models, comparing ENPU to PrEP users.
Abstract presented at: AIDS Impact (oral)
Target journal: AIDS
Date of approval: 28.3.2019