EMIS-2017: Planned national journal articles
To September 2020, we have provided EMIS-2017 national data to 39 partners, some of which have already published a national report (Belarus, Canada, Czech Republic, Estonia, Ireland, Moldova, Norway, Spain, Switzerland, and Ukraine). Once these reports are published they are available as PDFs here. National 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 firstname.lastname@example.org.
The following data access requests for national journal articles have been approved by the EMIS Editorial Board.
Title: Substance use patterns among gay, bisexual and other men who have sex with men (gbMSM): a latent class analysis of Canadian responses from EMIS-2017
Lead author: Martin Blais
Dataset: EMIS-CA (2017)
Research question and objectives: The objective of this analysis was to describe substance use patterns among gbMSM and determine opportunities and gaps for interventions, making use of the Canadian subset of the European MSM Internet Survey (EMIS-2017). Much of the analysis has already been completed at the Public Health Agency of Canada (PHAC), under Martin Blais’ guidance. Due to resources being diverted to the COVID-19 pandemic response effort, PHAC no longer has the short-term capacity to further refine and finalize this analysis and draft the manuscript. This request is to allow Martin to access the dataset in order to finalize the analysis.
Analytic plan: Measures of recency of use of 13 drugs were collapsed to use in the last six months, excluding alcohol and substances with low prevalence. Latent class analysis (LCA) was used to describe substance use patterns. Latent classes were then further analysed to assess the relationship with service use, including current PrEP (pre-exposure prophylaxis) use, HIV testing, full STI screening (HIV infection, blood test, anal swab, urethral swab (or vaginal swab or urine test)) and use of drug treatment services in the last 12 months.
Target journals: Substance use and misuse
Date of approval: 25.08.2020
Title: "Dude, I am more of a normal-gay, not like gay-gay:” Exploring the Influence of Internalized Homonegativity on Sexual Risk Behaviour of Men Who Have Sex with Men in Spain / Turkey (two national articles)
Lead author: Ibrahim Sönmez
Dataset: EMIS-ES (2017) and EMIS-TK (2017)
Research question and objectives: With restricting our sample to men in Spain/Turkey who are not using PrEP, or are HIV diagnosed with detectable or unknown viral load; we propose the following research question, “Is internalised homonegativity associated with the number of non-steady male partners with condomless intercourse (as a proxy of sexual risk behaviour) of MSM in Spain?” With this research question, as the main objective, we seek to reveal whether MSM with higher levels of IH are less likely to be exposed to information (i.e. PrEP, ART) regarding safer sex practices targeted to MSM, likewise are more likely to use substances to enhance their sexual experience, perhaps to repress their present feelings of internalised homonegativity. Using a structural equation modelling (SEM), we propose to test following three hypotheses; “IH will be positively associated with sexual risk behaviour,” “HIV / PrEP knowledge will fully mediate the relationship between IH and sexual risk behaviour,” and, “Substance use during sex will fully mediate the relationship between IH and sexual risk behaviour."
Analytic plan: Primarily, the analytical plan for answering the proposed research question will include restricting our sample those who are at risk in terms of getting infected with HIV. For this reason, we will exclude HIV-diagnosed men with undetectable viral load (with using the variable Q088bin) and those who take PrEP daily or when needed (with using the variable Q114_modified). Second, data preparation for SEM will take place. We will incorporate the observed variables, in other words, variables available from the dataset, to construct the latent variables of SEM. To be able to interpret the reliability and fit of the latent variable for the IH scale in the SEM, we will need to include single items. Confirmatory model estimation on the items of this IH scale has shown a good fit, internal consistency, and reliability on EMIS 2010 data. However, these results apply for scale’s validation across samples from different countries. To be able to provide confirmatory factor analysis, model fit, and reliability in the framework of the SEM, we will need the single items of this scale. We will include each the 7 items as the observed indicators of IH latent variable for the SEM analysis. Similarly, HIV / PrEP knowledge latent variable will be created using each of the 12 items (Q049 – Q055 / Q102 – Q105) (In Figure 1, only referred as HIV knowledge). Observed variables for time since last substance use latent variable will be added in two categories, via using Q332 for use of alcohol, and using Q338, Q339, Q340, Q341, Q342, Q343, Q345, Q347, Q348, Q350 for use of drugs. Finally, the unidimensional latent variables, the dependent variable and substance use during sex, will be added via parcelling technique. The proper SEM analysis will first consist in specifying the model with its observed and latent variables.This proposed analytical plan will allow us to demonstrate the associations among these latent variables and, therefore, help us to identify possible mediators of the relationship between IH and sexual risk behaviour. If confirmed, the outcome of our hypotheses will demonstrate the vigour of internalised homonegativity as a barrier for vital information targeted to men who are at high risk position, and likewise as it leads men to seek to use substances in a quest for a better sexual experience. To be able to demonstrate so, a confirmatory factor analysis will then be performed to see whether abovementioned choices of variables and measurement model is a good fit for the data. And finally, the following paths within the SEM will be estimated: (1) direct relationship between IH and sexual risk behaviour; (2) indirect relationship between IH and sexual risk behaviour through HIV / PrEP knowledge; (3) indirect relationship between IH and sexual risk behaviour through substance use during sex; and (4) indirect relationship between IH and substance use during sex through time since substance use.
Target journals: LGBT Health, Journal of Gay & Lesbian Mental Health, Sexuality & Culture
Date of approval: 9.06.2020
Title: Where were we before PrEP approval? Knowledge, use and willingness to use and eligibility for PrEP among EMIS-2017 participants in Spain
Lead author: Asunción Díaz Franco
Dataset: EMIS-ES (2017)
Research question and objectives:
The primary objective is to describe knowledge, use, willingness to use and PrEP eligibility among MSM resident in Spain and participating in EMIS-2017. Secondary objectives include describing PrEP knowledge and associated factors; describing PrEP eligibility according to national guidelines and its determinants; and describing the use and willingness to use of PrEP and associated factors. We hypothesize that MSM with higher education and living in bigger cities are more aware of PrEP;MSM living in bigger cities are more likely to meet eligibility criteria; and MSM willing to use PrEP are more likely to meet eligibility criteria (they are correctly identifying PrEP as a suitable preventive tool).
Target journals: HIV Medicine, PLoS One
Date of approval: 21.03.2020
Title: Characteristics of chemsex users in the Czech Republic
Lead author: Xenie Uholyeva
Dataset: EMIS-CZ (2017)
Research question and objectives: In the project we will explore characteristics of chemsex users in comparison with those who do not engage in chemsex, in order to better describe and understand the group’s needs. We are interested in age, occupation, sexual behaviour, recent HIV/STI diagnoses, access to PrEP, difficulties with being out, sober sex among of chemsex users in comparison with those who do not engage in chemsex. Our intention is to map the needs of chemsex users.
- To test whether chemsex users in CZ significantly differ in demographic characteristics from other MSM.
- To test whether chemsex users in CZ significantly differ in internalized homonegativity from other MSM.
- To explore self-rated anxiety/depression sypmtoms, suicidal ideation and substance abuse in chemsex users in CZ.
Analytic plan: Mostly, we will use t-test (or Mann-Whitney and Kruskal-Wallis test) to compare characteristics of location of continuous and ordinal variables (in such cases like age, number of non-steady partners, years of education) and χ² to compare nominal variables (like sexual happiness, sober sex, PrEP using).
Date of approval: 11.03.2020
Title: Correlates of HIV testing among Filipino gay men and other men who have sex with men
Lead author: Mikael N. Navarro
Dataset: EMIS-PH (2017)
Research question and objectives:
- ANALYSIS 1. What are the correlates of never having been tested for HIV among Filipino MSM?
- ANALYSIS 2. What are the correlates of never having been tested for HIV despite being aware of testing access points and having been offered an HIV test previously (test-objectors)?
- ANALYSIS 3. What are the correlates of never having been tested for HIV among men who have never been offered an HIV test?
Analytic plan: Never testers will be categorized as HIV test objectors (i.e. those who know where to test and had already been offered a test; includes those who have been offered a test but still do not know where to get a test, n=426); and MSM who have never been offered an HIV test (n=998). Multiple logistic regression will be conducted for each type of never testers with recent testing as the reference group.
Target journals: BMC Public Health
Date of approval: 13.01.2020
Title: Factors associated with alcohol dependence among MSM in Ireland – Findings from the European MSM Internet Survey 2017
Lead author: Peter Barrett
Dataset: EMIS-IE (2017)
Research question and objectives: Ireland is an international outlier in terms of alcohol consumption. According to the World Health Organization (WHO), the total alcohol per capita consumption of all people aged 15+ in Ireland was 13.0 litres of pure alcohol in 2016. This was in sharp contrast to the WHO’s European Region value of 9.8 litres. Males drank almost four times as much as females. The possible alcohol dependence in the same year was 3.8% for both sexes combined, with males at 5.8% and females at 1.8%. However, an even greater cause for concern is the unequal distribution of this alcohol dependence in other specific subgroups. The Irish national report of EMIS-2017 suggests high levels of alcohol consumption, and disproportionately high reporting of possible alcohol dependence, among MSM in Ireland. To date, this issue has not been explored in detail. With that, the objectives of this paper are the following:
- To measure the recency of alcohol consumption and possible alcohol dependence among MSM in Ireland.
- To describe socio-demographic factors associated with possible alcohol dependence among MSM in Ireland.
- To explore sexual characteristics and risk behaviours among MSM who report alcohol dependence.
- To assess whether experiences of adverse mental health or homophobic abuse are associated with recency of alcohol consumption and/or possible alcohol dependence among MSM.
Analytic plan: We will firstly present descriptive statistics for the Irish sample of respondents to EMIS-2017, based on the variables available to us. We will present the data using absolute numbers, proportions, and bar charts for categorical variables, and means (+ standard deviation, if normally distributed), medians (+ range, if skewed data) and histograms for continuous variables. We will quantify the prevalence of possible alcohol dependence (using a recorded variable which gives a binary indicator of alcohol dependence based on a score of 2 or more on CAGE-4 questionnaire) and the use of alcohol during sex in the sample. Our primary outcome will be possible alcohol dependence, while secondary outcomes will include recency of alcohol consumption and alcohol consumption during sex. We will use chi-squared statistics for bivariate associations, to identify factors which may be significantly associated with alcohol-related outcome variables. We will conduct multivariable-adjusted logistic regression analysis, where alcohol dependence is the outcome.The final exposure variables to be entered in the regression models will be decided a priori, based on a literature review (currently in progress) and clinical/service priorities (to be determined through consensus among co-authors and relevant clinical and community partners). All analysis will be undertaken in Stata version 15.0. A two-sided significance level of p<0.05 will be applied. We acknowledge that temporality will be a key limitation of this analysis of the EMIS-2017 dataset, as is often the case for cross-sectional data analysis. This issue will be carefully considered in the final selection of covariates for inclusion in our regression models.
Target journals: European Journal of Public Health
Date of approval: 10.01.2020
Title: The changing ways MSM in Denmark negotiate safer sex practices in the age of TasP and PrEP.
Lead author: Susan Cowan
Dataset: EMIS-DK (2010-2017)
Research question and objectives:To describe the changes in how MSM in Denmark negotiate safer sex practices in the age of TasP and PrEP. We want to set up a new paradigm for safe sex using not just condom-based protection but also TasP as a measure of protection against transmission of HIV, and analyse what factors (demographic and behavioural) that predict safe/unsafe sex practices. Unsafe sex practice is here understood as practices that pose a risk of HIV-transmission. I.E. not using condoms, not being on PrEP (for HIV-negative)/ART (for HIV-positive)
Analytic plan: Using logistic regression and bivariate analyses in STATA 14 we plan to analyse the predictors of safe/unsafe sex. Outcome variable: HIV-transmission-risk-sex yes or no.
Target journals: Eurosurveillance (delayed to COVID)
Date of approval: 03.12.2019
Title: Cross-sectional analysis of the associations of substance use and common sexually transmitted infections among MSM in the UK. Cross-sectional analysis of the associations of substance use and diagnosis with viral hepatitis among MSM in the UK
Lead author: Louis MacGregor
Dataset: EMIS-UK (2017)
Research question and objectives: To assess the association between substance use and chemsex (the use of substances including mephedrone, GHB and crystal meth around sexual intercourse) and diagnosis with (1) Gonorrhoea, syphilis, chlamydia and human papillomavirus and (2) hepatitis A, B and C within the men who have sex with men community in the UK.
Analytic plan: We will use logistic regression to build statistical models, inclusive of factors which are likely to be associated with the acquisition of included sexually transmitted infections (STIs). This work will split the STIs into two different groups consisting of (1) Gonorrhoea, syphilis, chlamydia and human papillomavirus and (2) hepatitis A, B and C. For each group we aim to publish a research article, with this data request therefore totalling data for two papers. In each paper, although we will be examining a list of multiple factors and their associations with STI acquisition, we will be paying special attention to chem-sex and substance use. Including use of individual substances and combinations of substances, plus route of ingestion. We will give demographics of our dataset population and use variables which are directly linked to sexual behaviours as our input variables for the models. We will both look at crude odd ratios and adjusted odds ratios.Within the paper on viral hepatitis, we also aim to comment on the prevalence of immunity and vaccination for hepatitis A and B, plus giving more detail on hepatitis C infections using variables listed in ‘Vaccinations and hepatitis’ in Q7.
Target journals: Sexually Transmitted Infections (submitted)
Date of approval: 29.11.2019
Title: Sexual health disparities related to bisexual attraction among men who have sex with men in Ireland
Lead author: Chris Noone
Dataset: EMIS-IE (2017)
Research question and objectives: The primary objective of this paper is to investigate the sexual health of (1) men who identify as bisexual and (2) other men who have sex with men and women in Ireland in comparison to gay men. Our analyses will focus on risky sexual behaviour, preventative behaviours and morbidities. This objective will be achieved by answering the following research questions:
- Are there differences in sexual health morbidities between exclusively homosexual men who have sex with men and those who are bisexual in terms of identity or behaviour?
- Are there differences in sexual health behaviours between exclusively homosexual men who have sex with men and those who are bisexual in terms of identity or behaviour?
The second question will focus on common determinants of sexual health including engagement with preventive interventions such as condom use and PrEP and testing.
Analytic plan: The data will first be described using means, standard deviations, proportions, cross-tabulation and correlation coefficients, where appropriate. The analyses will be conducted in R Studio using the psych package to describe the data and the BRMS package to carry out logistic regressions. The analyses will be visualised using Ggplot2. The specific details of all analyses will be pre-registered on the Open Science Framework.
Target journals: Sexually Transmitted Infections (BMJ); Journal of Sexual Medicine
Date of approval: 29.11.2019
Title: The effects of minority stress on depression and anxiety symptoms among men who have sex with men in Ireland
Lead author: Chris Noone
Dataset: EMIS-IE (2017)
Research question and objectives: The primary objective of this paper is to investigate the effects of minority stress on the health of gay, bisexual and other men who have sex with men in Ireland. This objective will be met by answering the following five research questions:
What is the relationship between sexual identity and mental health outcomes?
What is the relationship between experiencing distal minority stressors and mental health outcomes?
What is the relationship between experiencing proximal minority stressors and mental health outcomes?
What is the relationship between experiencing social support and mental health outcomes?
To what extent does the intersection of marginalised identities affect mental health outcomes?
Analytic plan: The data will first be described using means, standard deviations and correlation coefficients, where appropriate. Each of the research questions will be answered using structural equation modelling. The analyses will be conducted in R Studio using the psych package to describe the data and the lavaan package for structural equation modelling. The analyses will be visualised using Ggplot2. The specific details regarding all analyses will be pre-registered on the Open Science Framework.
Target journals: Social Science and Medicine; Psychology of Sexual Orientation and Gender Diversity; LGBT Health
Date of approval: 29.11.2019
Title: Are PrEP services in France reaching all those exposed to HIV who want to take PrEP? MSM respondents who are eligible but not using PrEP (EMIS 2017)
Citation: Margot Annequin, Virginie Villes, Rosemary M. Delabre, Tristan Alain, Stéphane Morel, David Michels, Axel Jeremias Schmidt, Annie Velter & Daniela Rojas Castro (2020) Are PrEP services in France reaching all those exposed to HIV who want to take PrEP? MSM respondents who are eligible but not using PrEP (EMIS 2017), AIDS Care, 32:sup2, 47-56, DOI: 10.1080/09540121.2020.1739219
Date of approval: 29.03.2019; Published online first: 19.03.2020