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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, Cyprus, Czechia, Denmark, Estonia, Greece, Ireland, Moldova, Norway, Spain, Sweden, 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 coordinator@emis-project.eu.

The following data access requests for national journal articles have been approved by the EMIS Editorial Board.

Title: Sexual behaviour among MSM in Ireland: A latent class analysis.

Lead authors: Michael Tavolieri and Martin Davoren
Dataset: EMIS-IE (2017)
Research question and objectives: Previous research has noted the association between social support, mental health, and acceptance of one’s sexual identity with sexual health outcomes among MSM internationally. Recently, typologies have been utilised to define intervention models when developing public health policies for complex behaviours. However, previous research often fails to consider the associations and interconnected nature of risk-taking activities. The aim of this study is to identify latent classes of MSM in Ireland with distinctive patterns relating to their sexual behaviour, knowledge and support service use. Predictors of class membership in relation to social support, mental health and outness/internalised homonegativity will be examined. We hypothesise that better performance on these three categories of variables will correlate with membership in lower risks classes (ie. greater social support will predict belonging to a lower risk group).

Data analysis plan: We intend to conduct a latent class analysis (LCA), which will provide distinct patterns of behaviour across and within latent groups. Based on the Individual Social Material model, the latent class analysis will focus on data pertaining to knowledge, behaviour and service use. First, we will include data regarding individuals’ behaviour at the time of sexual intercourse, such as whether the individual uses condoms or if they have/have had a discussion regarding HIV status. Second, we will include data regarding individuals’ engagement with sexual health services, such as whether they receive regular STI testing. Finally, we will include data regarding their understanding of HIV and hepatitis A & B. We propose to analyse the data to determine what association exist between class structures and (i) mental health, and (ii) one’s internal homonegativity. We believe that an individual’s approach towards sexual health is impacted by their mental health and internal homonegativity. We believe that these findings will support the design and implementation of novel intervention strategies designed at addressing the impact of mental health and internal homonegativity on sexual health.

Target journals: Sexually Transmitted Infection; BMC Public Health; Sexuality Research and Social Policy

Date of approval: 07.08.2021

 

Title: Drug use among Men who have Sex with Men (MSM) in Ireland – Findings from the European MSM Internet Survey (EMIS-2017)
Lead author: Dr. Peter Barrett & Fionn Daly
Dataset: EMIS-IE (2017)
Research question and objectives: Previous literature suggests that MSM worldwide may be disproportionately impacted by substance abuse, including recreational drugs. In Ireland, prior research from the national MSM Internet Survey 2015 (MISI 2015) reported a high prevalence of illicit drug use among MSM in the previous 12 months, with an estimated prevalence of 36% for overall use of illicit drugs, and 7% for drugs commonly used in chemsex [2]. This is a cause for concern since MSM experience substantial health inequalities in society, many of which may be compounded by substance use [2]. The recently published Irish national report of the EMIS-2017 suggests very high levels of illicit drug use in the last year among MSM residing in Ireland, reporting a possible prevalence as high as 41%. We propose to undertake an updated review of the factors associated with drug use among MSM in Ireland, which will allow key partner organisations, working to promote the wellbeing of MSM, to understand how new trends in substance use may have emerged or changed over the years. This may inform new harm reduction campaigns and facilitate the identification of MSM sub-groups who may benefit from targeted interventions. The specific objectives of this paper are the following:

  1. To measure prevalence of chemsex, popper use, cannabis use, and any other drug use in the previous 12 months among MSM in Ireland.
  2. To identify and explore the demographic factors which may be associated with chemsex among MSM in Ireland.
  3. To identify and explore the behavioural and psycho-social factors which may be associated with chemsex among MSM in Ireland.
  4. To assess how these factors may be related to popper use in the previous 12 months, cannabis use in the previous 12 months, as well as any other drug use in the same time period.

Analytic plan: Firstly, descriptive statistics will be presented to compare baseline characteristics of the Irish sample of EMIS-2017. For categorical variables, we will report absolute numbers and percentages/proportions, and Pearson’s chi-square will be used for tests of bivariate associations. Bar charts may also be used to visualise categorical data. For continuous variables, we will use either means + standard deviations or medians + ranges, depending on the distribution of the data – the distribution will be assessed through graphical diagnostics (histograms) and significance testing. Engagement in chemsex (use of ecstasy/MDMA, cocaine, amphetamine, crystal methamphetamine, mephedrone and/or ketamine before/during sex) in the previous 12 months will be our primary outcome. Our secondary outcomes will include any drug use in the last year, popper use in the last year, as well as cannabis use in the same time period. We will conduct multivariable-adjusted logistic regression analysis which will allow us to identify factors that are significantly associated with our outcome variables after taking account of other potentially confounding covariates. A scoping literature review will be carefully considered when choosing the final list of covariates to be entered into our regression models. We will also select our final list of covariates through a consensus decision-making process between co-authors and relevant clinical and community partners. Two-sided significance tests will be used throughout, wherein all p-values will be judged against a pre-set alpha level of significance which will be set at 5%.
Target journals: International Journal of Drug Policy; Drug and Alcohol Dependence; BMC Public Health
Date of approval: 16.04.2021

 

Title: PrEP use in relation to PrEP awareness and willingness to take it among Belgian MSM at high risk of HIV infection: secondary analysis of the Belgian EMIS-2017 data
Lead authorDr. Veerle Buffel
Dataset: EMIS-BE (2017)
Research question and objectives: The proposed study is part of the larger FWO-funded (Fund for scientific research Flanders) project named ‘PROMISE’ (see link: University of Antwerp/Institute of Tropical Medicine, Antwerp collaboration with the support of Sciensano (Public Health Belgium)) with the overall aim ‘learning how PrEP roll-out can be optimized to result in a maximum impact on HIV and sexual health in general’. To achieve this aim the first step is to examine actual PrEP use in relation to PrEP awareness and willingness to take it among Belgian MSM at high risk of HIV infection. A secondary aim is to explore which sociodemographic, structural, cognitive and psychosocial factors are related to: ‘unaware of PrEP’, ‘unwilling to use PrEP’ and ‘no current use of PrEP’, all while being eligible to use PrEP, according to Belgian guidelines. These insights will be particularly useful to tailor strategies for improving PrEP uptake among those at highest risk, whether it should focus on improving awareness, willingness to take it or eliminating other potential barriers.
Analytic plan: We will estimate the proportion of MSM aware of PrEP, willing to use PrEP and currently using PrEP (via formal or informal circuits) among the MSM at high risk for HIV (= MSM who are considered as eligible to use PrEP, see table below) as well as the overlap between these groups. We rely therefore on a cascade approach. Steps (bars) in the cascade are quantified using unconditional probabilities with a fixed denominator (= all MSM eligible to use PrEP across all stages of the cascade) and conditional probabilities with a denominator that changes with each step of the cascade. In the conditional and unconditional cascade the MSM who are eligible to use PrEP are the first bar (=100%). Thereafter, the drops in the cascade are quantified (conditionally) as outcome variables of the bivariate analyses: unaware; unwilling; and not using PrEP. We use Chi-square or Fisher’s Exact Tests to determine the relationships between the drops and potentially associated factors. Statistical significance is set at p < 0.05.
Target journals: AIDS and Behavior
Date of approval: 15.02.2020

 

Title: Factors associated with low levels of HIV testing among young men who have sex with men (MSM) participating in EMIS 2017 in Spain
Lead authorVictoria Hernando
Dataset: EMIS-ES (2017)
Research question and objectives: Research questions: What is the prevalence of HIV testing among young MSM? /  What factors are associated with HIV testing uptake among young MS?
Hypothesis: There is a positive relationship between HIV testing and knowledge of HIV and other STIs among young MSM / There is a negative relationship between HIV testing and poor mental health, substance use, and homonegativity among young MSM
Main objective: To estimate the prevalence and the profile of young MSM who have never been tested for HIV in EMIS 2017 in Spain.
Secondary objective: To assess factors associated with never having been testing for HIV among young MSM participating in EMIS 2017 in Spain.
Analytic plan: We will describe the socio-demographic profile of the MSM population under the age of 25 among EMIS-2017 participants in Spain. This will include factors such as age, country of residence, settlement size, education, employment, sexual orientation, and relationship status. We will use a multivariable logistic regression model to explore what factors are associated with HIV testing uptake. We will also carry out a wide descriptive analysis of the following factors: HIV and STI prevalence, awareness and knowledge; PrEP and PEP awareness, knowledge, and use; sexual behaviors and HIV risk behaviors; drug use and mental health issues and access to support resources; internalized homonegativity; and experiences of homophobia. We believe that these characteristics, captured in the variables requested, can influence the decision to get an HIV test. Participants will be included in this analysis if they between the ages of 16 and 24 (inclusive).
Target journals: Journal of Adolescent Health
Date of approval: 20.11.2020

 

Title: Sexual happiness and satisfaction with sexual safety among trans and cis MSM in Germany using data from EMIS-2017
Lead authorMax Appenroth & Uwe Koppe
Dataset: EMIS-DE (2017)
Research question and objectives: Quantitative analyses on sexual happiness and satisfaction with sexual safety are missing for assigned-female-at-birth (AFAB) (trans) men-who-have-sex-with-men (MSM) in Germany. The data of the EMIS 2017 is the largest sample of AFAB (trans) MSM in Germany to date. With this analysis, we would like to:
1. Describe the overall satisfaction with sexual life and satisfaction with sexual safety among AFAB (trans) MSM in Germany and compare them to assigned-male-at-birth (AMAB) MSM
2. Analyse how satisfaction with sexual life and satisfaction with sexual safety differs across demographic data as well as strata of sexual behaviours (numbers of sexual partners, engagement in condomless intercourse, being paid for sex), precautionary behaviours (e.g. condom and PrEP use), needs (e.g. PrEP knowledge), and intervention coverage (e.g. HIV/STI screening, accessing services) in AFAB MSM and compare the results to AMAB MSM
3. Describe factors influencing sexual happiness and satisfaction with sexual safety in AFAB (trans) MSM in comparison to AMAB MSM where sufficient data is available.
Target journals: AIDS and Behavior
Date of approval: 28.10.2020

 

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 authorMartin 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 authorIbrahim 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[1]. 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 authorXenie 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.

  1. To test whether chemsex users in CZ significantly differ in demographic characteristics from other MSM.
  2. To test whether chemsex users in CZ significantly differ in internalized homonegativity from other MSM.
  3. 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:

  1. ANALYSIS 1. What are the correlates of never having been tested for HIV among Filipino MSM?
  2. 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)?
  3. 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: The changing ways MSM in Denmark negotiate safer sex practices in the age of TasP and PrEP
Lead authorSusan 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: 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:

  1. 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?
  2. 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:

  1. What is the relationship between sexual identity and mental health outcomes?

  2. What is the relationship between experiencing distal minority stressors and mental health outcomes?

  3. What is the relationship between experiencing proximal minority stressors and mental health outcomes?

  4. What is the relationship between experiencing social support and mental health outcomes?

  5. 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