Sigma Research
TwitterFacebookVimeo

EMIS-2017: Planned international journal articles

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

The following data access requests for international papers have been approved by the EMIS Editorial Board.

Title: Changes of protective sexual behaviours with non-steady sexual partners among MSM from 11 European countries between 2010 and 2017

Lead Author: Susanne B. Schink, Dr. Ulrich Marcus

Data sets: EMIS-2010 and EMIS-2017 (11 countries: CH, DE, ES, FR, IT, NO, PL, RU, SE, TR, UK)

Research question and objectives: There is widespread perception that sexual behaviour of MSM has changed in recent years towards less condom use and more sero-adaptive and HIV-specific protective behaviours. We explore changes in protective behaviours based on sex with the last non-steady partner from EMIS 2010 and 2017. The set of questions that has been asked identically allows for comparisons. To check for relevant differences in the national sample compositions we will restrict the analysis to several larger country samples for which we intend to analyse sample differences in the following country samples: France, Germany, Italy, Norway, Poland, Russia, Spain, Sweden, Switzerland, Turkey, UK, which represent different patterns of sample changes between 2010 and 2017.

Analytic plan: The main outcome is condom use with the last non-steady partner. If there are relevant differences in the proportion of respondents from the 2010 and 2017 surveys that report no anal sex with the last non-steady partner, a combined binary variable differentiating between anal sex without condom, and anal sex with condom including no anal sex will be explored in a sensitivity analysis. We plan to control for the following variables: HIV testing history, recency of last HIV test (for those not diagnosed with HIV), undetectable viral load (for those diagnosed with HIV), HIV serostatus disclosure to the last non-steady partner, knowledge of HIV-status of the last non-steady partner, whether ejaculation into the rectum of the partner took place (if no condoms were used), setting where the last non-steady partner was met (i.e. online, gay sex venue, gay social venue), whether the respondent had sex with his partner before, substances use during last sex with a non-steady partner, and general HIV- and STI-related knowledge. We also analyse the following demographic variables to explore differences between the 2010 and 2017 samples: age, education level, settlement size, partnership status, migration status, outness. Changes of the sample composition are explored by country. Factors associated with condom use are explored with bivariate, multivariate analysis and a multilevel hierarchical multivariate regression model with countries as additional level.

Target Journal: PLOS Medicine

Date of approval: 11.10.19

Title: Changes in sexual mixing patterns of men who have sex with men 2010-2017. Do they affect STI transmission?
Lead AuthorNicola Low
Data set: EMIS-TREND-2010-2017 (12 countries: AT, BE, CH, DK, FR, DE, IE, LU, NL, NO, SE, UK)
Research question and objectives: How have sexual mixing patterns between men with diagnosed HIV and those without diagnosed HIV changed over time? Objective one: Describe patterns of sexual mixing in 2010 and 2017. Objective two: Examine statistical evidence for a change in patterns of sexual mixing between 2010 and 2017. Objective three: Examine associations between changes in sexual mixing patterns and changes in bacterial STI diagnoses between 2010 and 2017.

Analytic plan: Objective one: Describe patterns of sexual mixing in 2010 and 2017: Proportion of serodiscordancy in sex with steady and non-steady partners; the same for condomless intercourse. Contrast last HIV-test results versus Q309 among HIV- negatives (there might be men with a last negative test who assume to be already positive). Objective two: Show trends of sexual mixing over time: compare 2010 and 2017, change per year. Objective three: If there is a trend, how is this related to and could it possibly affect STI diagnoses? Look at diagnoses of bacterial STIs, separate for syphilis, NG, CT, controlling for recency of blood test (for syphilis), and, for NG and CT, recency and comprehensiveness of swabbing. Sensitivity analysis: exclusion of French language, or controlling for French language. We suggest to work on data representing Northern/Western European countries: AT, CH, DE, LU (largely German-speaking); BE, FR (French- and Dutch-speaking), SE, NO, and DK (large-sample Nordic countries), and IE, UK (English-speaking countries), in order to minimise confounding resulting from differences in STI testing policies and/or sexual minority climate.
Target Journal: PLOS Medicine
Date of approval: 11.10.19

Title: Sexual and mental health across gender identity and sex-assigned-at-birth among men-who-have-sex-with-men in Europe: findings from EMIS 2017
Lead Author: Ford Hickson
Data set: EMIS-2017 (48 countries)
Research question and objectives: MSM suffer a disproportionate burden of sexual and mental ill health, as well as drug related harms. However, health risks and precautions are not evenly distributed among MSM and health inequalities in the general population are reproduced among sexual minorities. A primary research objective of EMIS was to identify subgroups of MSM who show disproportionate unmet sexual health promotion need across a range of domains. The population of men-who-have-sex-with-men (MSM) includes people who were assigned-female-at-birth (AFB) and who now identify as men or as trans men. The current analysis compares the impact of sex-assigned-at-birth and current gender identity on a wide range of variables.
Analytic plan: The paper is descriptive. We will count gender identity and sex at birth and describe demographic variations in gender identity and sex at birth. We will then compare measures of morbidity, behaviours, needs and interventions using cross-tabs. Test for significance will include logistic regressions controlling for age, country of residence and other confounders. We will identify the largest differences between groups to help focus health promotion efforts.
Target Journal: International Journal of Transgenderism
Date of approval: 11.10.19

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