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Blondeel K, Mirandola M, Gios L, Folch C, Noestlinger C, Cordioli M, De Sutter P, Temmerman M, Toskin I. Sexual satisfaction, an indicator of sexual health and well-being? Insights from STI/HIV prevention research in European men who have sex with men. BMJ Glob Health 2024; 9:e013285. [PMID: 38789276 PMCID: PMC11129029 DOI: 10.1136/bmjgh-2023-013285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 03/31/2024] [Indexed: 05/26/2024] Open
Abstract
INTRODUCTION Although sexual health has been holistically defined to include sexual satisfaction, it has been largely absent in health services and sexual and reproductive health and rights programmes in many parts of the world. We propose sexual satisfaction as a useful indicator, as one of the proxy measures for sexual health and well-being and as a component of well-being in general. METHODS The Sialon II project is a multicentre biological and behavioural cross-sectional community-based survey implemented across 13 European cities during 2013-2014 among men who have sex with men. Sexual satisfaction was explored using one single item: 'How satisfied are you with your sex life?' A multivariable multilevel logistic random-intercept model was estimated to identify factors associated with reporting positive sexual satisfaction versus negative sexual satisfaction. RESULTS Age, the number of partners and self-reported HIV status were not significantly associated with sexual satisfaction in the multivariate model. Participants reporting an insertive role or reported both an insertive and receptive role during the last anal intercourse were more likely to be sexually satisfied, compared with a receptive role. Participants reporting anal intercourse with a condom were more likely to be satisfied than those declaring no anal intercourse in the last 6 months, but no significant association was found compared with anal intercourse without condom. Knowledge of HIV-serostatus concordance with the last sexual partner was positively correlated with sexual satisfaction. Having had sexual intercourse with non-steady partners only in the last 6 months was negatively correlated. The more positive participants perceived their work/school, parents and friends/acquaintances' attitudes towards gay or bisexual persons, the higher the odds they were satisfied with their sexual life. CONCLUSION Using a single item on sexual satisfaction in a bio-behavioural study, our analysis has shown that it is associated with individual, interpersonal and social/structural factors and has proven its usefulness as a sexual health indicator among men who have sex with men.
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Affiliation(s)
- Karel Blondeel
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Cinta Folch
- Centre Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT) Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Petra De Sutter
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
| | - Marleen Temmerman
- Ghent University Faculty of Medicine and Health Sciences, Gent, Belgium
- Centre of Excellence in Women, Adolescents and Child Health, The Aga Khan University, Nairobi, Kenya
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
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Gios L, Mirandola M, Cordioli M, Zorzi A, Sherriff N, Vera J, Wlazly D, Hassan-Ibrahim MO, Padovese V, Anabel Darmanin, Peeling RW, Unemo M, Blondeel K, Toskin I. A multi-country comparative study of two treponemal tests for the serodiagnosis of syphilis amongst men who have sex with men (MSM): Chemo-luminescent assay vs Treponema pallidum particle agglutination assay. BMC Infect Dis 2024; 24:313. [PMID: 38486194 PMCID: PMC10941351 DOI: 10.1186/s12879-024-09100-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 02/02/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION International guidelines recommend routine screening for syphilis (aetiological agent: Treponema pallidum subspecies pallidum) amongst key populations and vulnerable populations using tests detecting treponemal and non-treponemal antibodies. Whilst treponemal tests have high sensitivities and specificities, they differ regarding subjective or objective interpretation, throughput and workload. Chemiluminescence immunoassays (CLIAs) are cost- and time-effective automated methods for detecting treponemal antibodies. The Treponema pallidum particle agglutination assay (TPPA) has been considered the "gold standard" treponemal assay, however, this includes a highly manual procedure, low throughput and subjective interpretation. The present multi-country study evaluated the ADVIA Centaur® Syphilis CLIA (Siemens Healthcare) assay compared to the reference SERODIA-TP·PA® (Fujirebio Diagnostics) for the serodiagnosis of syphilis amongst men who have sex with men (MSM). METHOD 1,485 MSM were enrolled in Brighton (UK), Malta, and Verona (Italy) as part of a larger WHO multi-country and multi-site ProSPeRo study. Ethical approval was obtained. Serum was tested with the ADVIA Centaur® Syphilis CLIA assay and SERODIA-TP·PA®, in accordance with the manufacturers' instructions, for a first round of validation. A second round of validation was carried out for discrepant results that were additionally tested with both Western Blot (Westernblot EUROIMMUN®) and an Immunoblot (INNO-LIA, Fujirebio Diagnostics). Sensitivity, specificity, positive and negative predictive value (PPV and NPV), likelihood ratios (positive/negative), and the Diagnostic Odds Ratio (DOR)/pre-post-test probability (Fagan's nomogram) were calculated. RESULTS Out of 1,485 eligible samples analysed in the first phase, the SERODIA-TP·PA® identified 360 positive and 1,125 negative cases. The ADVIA Centaur® Syphilis CLIA assay (Siemens) identified 366 positives, missclassifying one TPPA-positive sample. In the second phase, the ADVIA Centaur® Syphilis CLIA resulted in 1 false negative and 4 false positive results. Considering the syphilis study prevalence of 24% (95% CI: 22-26.7), The sensitivity of the ADVIA Centaur® Syphilis CLIA assay was 99.7% (95% CI: 98.5-100), and the specificity was 99.4% (95% CI: 98.7-99.7). The ROC area values were 0.996 (95% CI: 0.992-0.999), and both the PPV and NPV values were above 98% (PPV 98.1%, 95% CI: 96.1-99.2; NPV 99.9%, 95% CI: 99.5-100). CONCLUSIONS The ADVIA Centaur® Syphilis CLIA assay showed similar performance compared to the SERODIA-TP·PA®. Considering the study is based on QUADAS principles and with a homogeneous population, results are also likely to be generalisable to MSM population but potentially not applicable to lower prevalence populations routinely screened for syphilis. The automated CLIA treponemal assay confirmed to be accurate and appropriate for routine initial syphilis screening, i.e. when the reverse testing algorithm is applied.
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Affiliation(s)
- Lorenzo Gios
- Infectious Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy.
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy.
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Piazzale L. Scuro, 10, 37134, Verona, Italy.
| | - Massimo Mirandola
- Infectious Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Maddalena Cordioli
- Infectious Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
| | - Antonella Zorzi
- WHO Collaborating Centre for Sexual Health and Vulnerable Populations - Epidemiology Unit - Division of Infectious Diseases, Department of Medicine, Verona University Hospital, Verona, Italy
- Virology and Microbiology Unit, Department of Pathology and Diagnostics, Verona University Hospital, Verona, Italy
| | - Nigel Sherriff
- School of Sport and Health Sciences, University of Brighton, Brighton, UK
| | - Jaime Vera
- Brighton & Sussex Medical School, University of Sussex and University of Brighton, Brighton, UK
| | - Dominika Wlazly
- Brighton & Sussex Medical School, University of Sussex and University of Brighton, Brighton, UK
| | - Mohammed Osman Hassan-Ibrahim
- Department of Microbiology & Infection, Royal Sussex County Hospital, University Hospitals Sussex NHS Foundation Trust (Brighton & Haywards Heath Sites), Brighton, UK
| | - Valeska Padovese
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta, L-Imsida, Malta
| | - Anabel Darmanin
- Genitourinary Clinic, Department of Dermatology and Venereology, Mater Dei Hospital, Msida, Malta, L-Imsida, Malta
| | - Rosanna W Peeling
- Clinical Research Department, London School of Hygiene & Tropical Medicine, London, UK
- Medical Microbiology Department, University of Manitoba, Winnipeg, MB, Canada
| | - Magnus Unemo
- WHO Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Örebro University, Örebro, Sweden
- Institute for Global Health, University College London (UCL), London, UK
| | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research (includes the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction [HRP]), World Health Organization, Geneva, Switzerland
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Politi J, Donat M, Guerras JM, Ayerdi O, Palma D, García JN, Barrio G, Belza MJ. Gaps in HIV and Hepatitis C Testing Among 3486 HIV-Negative Men Who have Sex with Men in Spain in the Era of Highly Effective Antiviral Therapies. J Community Health 2024; 49:139-155. [PMID: 37561245 DOI: 10.1007/s10900-023-01259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2023] [Indexed: 08/11/2023]
Abstract
High uptake of HIV and hepatitis C (HCV) testing in Gay, bisexual, and other men who have sex with men (GBMSM) is needed to interrupt transmission. The objective was to identify subgroups with increased probability of lack of testing among HIV-negative GBMSM in Spain. Cross-sectional study including 3486 HIV-negative GBMSM attending prevention facilities in Madrid and Barcelona, 2018-2020. Data came from self-administered online sociodemographic, health, and risk behaviors questionnaires. Outcomes were lack of HCV (lifetime) and HIV (lifetime, last year) testing. Crude and adjusted prevalences and prevalence ratios were assessed for each outcome using negative binomial regression models. Lifetime lack of HIV and HCV testing prevalence was 6.3% and 35.8%, respectively, while lack of HIV testing in the last year was 22.4%. Prevalences were also substantial in GBMSM with high-risk behaviors. After sociodemographic adjustment, the highest probability of lack of HCV testing (lifetime) and HIV (last year) was among GBMSM with insufficient viral hepatitis knowledge, no history of STI, or HCV (or HIV) testing, aged < 25, non-outness about sex life with men, and less high-risk behaviors. Lack of HCV (lifetime) and HIV testing (last year) among HIV-negative GBMSM in Spain is still high, despite high-risk behaviors.
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Affiliation(s)
- Julieta Politi
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029, Madrid, Spain
| | - Marta Donat
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Juan Miguel Guerras
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029, Madrid, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Oskar Ayerdi
- Centro Sanitario Sandoval, Instituto de Investigación Sanitaria San Carlos, Hospital Clínico San Carlos, Madrid, Spain
| | - David Palma
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Servicio de Epidemiología, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Jorge Néstor García
- Unidad de ITS de Vall d'Hebron-Drassanes, Hospital Vall d'Hebron, Barcelona, Spain
| | - Gregorio Barrio
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María José Belza
- Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Av. Monforte de Lemos, 5, 28029, Madrid, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
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Ortiz-Saavedra B, Montes-Madariaga ES, Cabanillas-Ramirez C, Alva N, Ricardo-Martínez A, León-Figueroa DA, Barboza JJ, Mohanty A, Padhi BK, Sah R. Epidemiologic Situation of HIV and Monkeypox Coinfection: A Systematic Review. Vaccines (Basel) 2023; 11:246. [PMID: 36851124 PMCID: PMC9965118 DOI: 10.3390/vaccines11020246] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/13/2023] [Accepted: 01/19/2023] [Indexed: 01/26/2023] Open
Abstract
The most recent monkeypox (Mpox) outbreak is mostly affecting men who have sex with men (MSM) who participate in high-risk sexual behaviors, which is typically the case among human immunodeficiency virus (HIV) carriers, according to clinical and epidemiological statistics. The objective of this research is to determine the epidemiological situation of HIV and smallpox co-infection. Until 1 October 2022, a thorough evaluation of the literature was conducted utilizing the databases PubMed, Embase, Scopus, and Web of Science. Studies were evaluated based on the criteria for selection. Fifty-three studies met the selection criteria. A total of 6345 confirmed cases of monkeypox were recorded, and 40.32% (n = 2558) of these cases also had HIV co-infection. In addition, 51.36% (n = 3259) of the men (91.44%; n = 5802), whose ages ranged from 18 to 71 years, exhibited MSM-specific sexual behaviors. Co-infection with these two viruses can be especially dangerous because it can exacerbate the symptoms of both diseases and make them more difficult to treat. People with HIV are more vulnerable to certain infections, including monkeypox, because their immune systems are weakened. Therefore, it is important that they take measures to prevent infection, such as avoiding contact with infected animals, risky behaviors, and maintaining good hygiene.
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Affiliation(s)
- Brando Ortiz-Saavedra
- Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13001, Peru
| | - Elizbet S. Montes-Madariaga
- Universidad Nacional de San Agustín de Arequipa, Arequipa 04000, Peru
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13001, Peru
| | | | - Niza Alva
- Escuela de Medicina, Universidad Peruana de Ciencias Aplicadas, Lima 15023, Peru
| | | | - Darwin A. León-Figueroa
- Unidad de Revisiones Sistemáticas y Meta-Análisis, Tau-Relaped Group, Trujillo 13001, Peru
- Facultad de Medicina Humana, Universidad de San Martín de Porres, Chiclayo 14012, Peru
| | - Joshuan J. Barboza
- Vicerrectorado de Investigación, Universidad Norbert Wiener, Lima 15046, Peru
| | - Aroop Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Gorakhpur 273001, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine, School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu 44600, Nepal
- Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune 411018, India
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Sönmez İ, Berg RC, Yazıcılaroğlu SS, Thurlby N, Schmidt AJ. Comparison of the Influence of Internalized Homonegativity on Sexual Risk Behavior of Men Who Have Sex with Men in Spain and Turkey. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2022; 34:644-657. [PMID: 38596388 PMCID: PMC10903703 DOI: 10.1080/19317611.2022.2094043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/25/2022] [Accepted: 05/27/2022] [Indexed: 04/11/2024]
Abstract
Objectives: This study aimed to understand how the association between internalized homonegativity (IH) and sexual risk behavior differed in Spain (N = 3,336) and Turkey (N = 550). Methods: We used multigroup structural equation modeling. Results: HIV and pre-exposure prophylaxis (PrEP) knowledge mediated the relationship between IH and sexual risk behavior among MSM in Spain, but not among men in Turkey. Higher HIV/PrEP knowledge was associated with higher sexual risk behavior among MSM in Spain, while among MSM in Turkey the association was in the opposite direction. Conclusions: The meaning of safe-sex may differ across contexts, and this should be taken into consideration when tailoring HIV prevention programs.
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Affiliation(s)
- İbrahim Sönmez
- Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | | | | | | | - Axel J. Schmidt
- London School of Hygiene and Tropical Medicine, Sigma Research, London, UK
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Stengaard AR, Combs L, Supervie V, Croxford S, Desai S, Sullivan AK, Jakobsen SF, Santos Q, Simões D, Casabona J, Lazarus JV, de Wit JBF, Amort FM, Pharris A, Nerlander L, Raben D. HIV seroprevalence in five key populations in Europe: a systematic literature review, 2009 to 2019. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2021; 26. [PMID: 34823636 PMCID: PMC8619876 DOI: 10.2807/1560-7917.es.2021.26.47.2100044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background In Europe, HIV disproportionately affects men who have sex with men (MSM), people who inject drugs (PWID), prisoners, sex workers, and transgender people. Epidemiological data are primarily available from national HIV case surveillance systems that rarely capture information on sex work, gender identity or imprisonment. Surveillance of HIV prevalence in key populations often occurs as independent studies with no established mechanism for collating such information at the European level. Aim We assessed HIV prevalence in MSM, PWID, prisoners, sex workers, and transgender people in the 30 European Union/European Economic Area countries and the United Kingdom. Methods We conducted a systematic literature review of peer-reviewed studies published during 2009–19, by searching PubMed, Embase and the Cochrane Library. Data are presented in forest plots by country, as simple prevalence or pooled across multiple studies. Results Eighty-seven country- and population-specific studies were identified from 23 countries. The highest number of studies, and the largest variation in HIV prevalence, were identified for MSM, ranging from 2.4–29.0% (19 countries) and PWID, from 0.0–59.5% (13 countries). Prevalence ranged from 0.0–15.6% in prisoners (nine countries), 1.1–8.5% in sex workers (five countries) and was 10.9% in transgender people (one country). Individuals belonging to several key population groups had higher prevalence. Conclusion This review demonstrates that HIV prevalence is highly diverse across population groups and countries. People belonging to multiple key population groups are particularly vulnerable; however, more studies are needed, particularly for sex workers, transgender people and people with multiple risks.
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Affiliation(s)
- Annemarie Rinder Stengaard
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Lauren Combs
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Virginie Supervie
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France
| | | | | | - Ann K Sullivan
- Directorate of HIV and Sexual Health, Chelsea and Westminster Hospital NHS Foundation Trust, London, United Kingdom
| | - Stine Finne Jakobsen
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Quenia Santos
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Daniel Simões
- EPIUnit-Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas, n° 135, Porto, Portugal.,Grupo de Ativistas em Tratamentos (GAT), Lisboa, Portugal
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - John B F de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, Netherlands
| | - Frank M Amort
- FH JOANNEUM, University of Applied Sciences, Bad Gleichenberg, Austria
| | - Anastasia Pharris
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Lina Nerlander
- European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
| | - Dorthe Raben
- Centre of Excellence for Health, Immunity and Infections (CHIP), Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Johnston LG, McLaughlin KR, Gios L, Cordioli M, Staneková DV, Blondeel K, Toskin I, Mirandola M. Populations size estimations using SS-PSE among MSM in four European cities: how many MSM are living with HIV? Eur J Public Health 2021; 31:1129-1136. [PMID: 34626188 DOI: 10.1093/eurpub/ckab148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Although men who have sex with men (MSM) are considered at high risk for transmission of sexually transmitted infections, including HIV, there are few studies estimating the population size of MSM in Europe. We used network data from a survey of MSM in four cities to perform successive sampling-population size estimations (SS-PSE) to estimate MSM population sizes. METHODS Data were collected in 2013-14 in Bratislava, Bucharest, Verona and Vilnius using respondent-driven sampling (RDS). SS-PSE uses a Bayesian framework to approximate the RDS sampling structure via a successive sampling model and uses the selection order of the sample to provide information about the distribution of network sizes over the population members of MSM. RESULTS We estimate roughly 4600 MSM in Bratislava, 25 300 MSM in Bucharest, 7200 in Verona and 2900 in Vilnius. This represents 2.9% of the estimated adult male population in Bratislava, 2.3% in Bucharest, 2.7% in Verona and 1.5% in Vilnius. The number of MSM living with HIV would roughly be 200 in Bratislava, 4554 in Bucharest, 690 in Verona and 100 in Vilnius. CONCLUSIONS Benefits of this method are that no additional information from an RDS survey needs to be collected, that the sizes can be calculated ex post facto a survey and that there is a software programme that can run the SS-PSE models. However, this method relies on having reliable priors. Although many countries are estimating the sizes of their vulnerable populations, European countries have yet to incorporate similar and novel methods.
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Affiliation(s)
| | | | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Karel Blondeel
- Department of Sexual and Reproductive Health and Research, SRH, World Health Organization, Geneva, Switzerland.,Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium
| | - Igor Toskin
- Department of Sexual and Reproductive Health and Research, SRH, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
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Sherriff NS, Jones AM, Mirandola M, Gios L, Marcus U, Llewellyn C, Rosinska M, Folch C, Dias S, Toskin I, Alexiev I, Kühlmann-Berenzon S. Factors related to condomless anal intercourse between men who have sex with men: results from a European bio-behavioural survey. J Public Health (Oxf) 2021; 42:e174-e186. [PMID: 31090894 PMCID: PMC7251420 DOI: 10.1093/pubmed/fdz052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 04/17/2019] [Indexed: 12/11/2022] Open
Abstract
Background Relationship status is an important factor associated with condomless anal intercourse (CAI) amongst men who have sex with men (MSM). Methods A multi-centre bio-behavioural survey with MSM was conducted in 13 European cities (n = 4901) exploring factors associated with CAI via bivariate and multivariate multilevel logistic regression analyses. Results Likelihood of CAI with casual partners was associated with being ‘out’ to a majority (AOR = 1.19;95% CI 1,1.42); knowing their HIV status (AOR = 1.86; 95% CI 1.25,2.76); using substances (1–2 AOR = 1.39; 95% CI 1.16,1.63, 2+ AOR = 1.81; 95% CI 1.35,2.42); being older (AOR = 0.98; 95% CI 0.97,0.99); successful sero-communication (AOR = 0.79; 95% CI 0.67,0.94); and, not having a recent HIV test (AOR = 0.78; 95% CI 0.66,0.92). CAI with steady partners was associated with successful sero-communication (AOR = 2.72; 95% CI 2.72,3.66); not having a recent HIV test (AOR = 1.26; 95% CI 1.09,1.46), and; being older (AOR = 0.99; 95% CI 0.98,0.99). Conclusions Understandings of partner type and/or relationship status in relation to CAI amongst MSM can potentially play an important role in the development of culturally appropriate HIV/STI prevention and risk-reduction efforts targeting at-risk MSM. Our results speak to the need to consider segmented and tailored public health and health promotion initiatives for MSM with differing CAI behaviours and relationship profiles.
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Affiliation(s)
- N S Sherriff
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Centre for Transforming Sexuality & Gender, University of Brighton, Brighton, Brighton, BN1 9PH, UK
| | - A M Jones
- School of Health Sciences, University of Brighton, Brighton, BN1 9PH, UK.,Research and Development Department, Sussex Partnership NHS Foundation Trust, Worthing, United Kingdom, BN13 3EP, UK
| | - M Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - L Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - U Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | - C Llewellyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - M Rosinska
- National Institute of Public Health-National Institute of Hygiene, Warsaw, Poland
| | - C Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya / CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - S Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública & GHTM, Universidade NOVA de Lisboa, Portugal
| | - I Toskin
- Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - I Alexiev
- National Reference Laboratory of HIV, National Centre of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - S Kühlmann-Berenzon
- Department of Public Health Analysis and Data Management, Public Health Agency of Sweden, Solna, Sweden
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9
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Gios L, Mirandola M, Sherriff N, Toskin I, Blondeel K, Dias S, Staneková D, Folch C, Schink SB, Nöstlinger C, Berghe WV, Naseva E, Alexiev I. Being in the Closet. Correlates of Outness Among MSM in 13 European Cities. JOURNAL OF HOMOSEXUALITY 2021; 68:415-433. [PMID: 31483215 DOI: 10.1080/00918369.2019.1656033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Data for MSM continue to show a high risk of acquiring HIV-STIs. Within this population, outness seems to have an impact on both risk-taking and on health seeking behaviors. The objective of this study was to assess the relationship between socio-demographic, behavioral characteristics, testing behaviors, and outness level among MSM using data from a multi-center bio-behavioral cross-sectional study carried out in 13 EU cities. A multilevel analysis was conducted to identify factors associated with being open ("out") versus not being open ("in"). A total of 4,901 MSM were enrolled in the study and were classified as "out" in 71% of the cases. MSM "out" were more likely to report HIV testing and being reached by HIV prevention programs compared to MSM who were "in." The results confirm the key role of outness in relation to different healthy and risky behavior, ranging from testing to party-drug use.
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Affiliation(s)
- Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona , Verona, Italy
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton , Brighton, UK
| | - Igor Toskin
- Department of Reproductive Health and Research, World Health Organization , Geneva, Switzerland
| | - Karel Blondeel
- Department of Reproductive Health and Research, World Health Organization , Geneva, Switzerland
- Faculty of Medicine and Health Sciences, Ghent University , Ghent, Belgium
| | - Sonia Dias
- Escola Nacional de Saúde Pública Universidade, Universidade NOVA de Lisboa, Centro de Investigação em Saúde Pública , Lisboa, Portugal
| | - Danica Staneková
- NRC for HIV/AIDS, Slovak Medical University , Bratislava, Slovak Republic
| | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Department Salut, Generalitat de Catalunya/CIBER Epidemiologia y Salud Pública (CIBERESP) , Barcelona, Spain
| | | | - Christiane Nöstlinger
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
- Faculty of Psychology, University of Vienna , Vienna, Austria
| | - Wim Vanden Berghe
- Department of Public Health, Institute of Tropical Medicine , Antwerp, Belgium
- Scientific Institute of Public Health , Brussels, Belgium
| | - Emilia Naseva
- Faculty of Public Health, Medical University of Sofia , Sofia, Bulgaria
| | - Ivailo Alexiev
- National Reference Laboratory of HIV, National Center of Infectious and Parasitic Diseases , Sofia, Bulgaria
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10
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Dias S, Gama A, Sherriff N, Gios L, Berghe WV, Folch C, Marcus U, Staneková DV, Pawlęga M, Caplinskas S, Naseva E, Klavs I, Velicko I, Mirandola M, Nöstlinger C. Process evaluation of a bio-behavioural HIV research combined with prevention among GBMSM in 13 European countries. Glob Public Health 2021; 17:672-687. [PMID: 33460361 DOI: 10.1080/17441692.2021.1874469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Comparative European data using Second Generation Surveillance System (SGSS) are scarce among gay, bisexual and other men who have sex with men. This study evaluated the implementation of Sialon II, a bio-behavioural HIV research combined with targeted HIV prevention in 13 European cities conducted in collaboration with community partners. A mixed-methods process evaluation assessed the project's coverage, outputs, quality, challenges and opportunities for improvement. Data collected through structured questionnaire from 71 data collectors from community-based organisations and semi-structured interviews with 17 managers of participating gay venues were analysed. Overall implementation was successful, achieving 4901 valid behavioural questionnaires and obtaining 4716 biological samples. Challenges in conducting bio-behavioural research in gay venues related to strict research protocols and unfavourable characteristics of venues. Formative research, collaboration with community gay venues, and offering HIV prevention emerged as facilitators. Community researchers' training was crucial for fidelity to research protocols, increased trust amongst communities and enabled data collectors to effectively address practical problems in the field. Scientifically sound SGSS with community participation is feasible and allows for including 'hard-to-reach' populations. Prevention benefits include awareness raising, capacity building and sexual health promotion in gay venues. The findings are beneficial for epidemiological research among other HIV key populations.
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Affiliation(s)
- Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Universidade NOVA de Lisboa, Lisboa, Portugal.,Comprehensive Health Research Centre (CHRC), Lisboa, Portugal
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | | | - Cinta Folch
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Dept Salut, Generalitat de Catalunya/CIBER Epidemiologia y Salud Pública (CIBERESP), Barcelona, Spain
| | - Ulrich Marcus
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | | | - Saulius Caplinskas
- Centre for Communicable Diseases and AIDS, Mykolas Romeris University, Vilnius, Lithuania
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and Control of HIV/AIDS", Sofia, Bulgaria
| | - Irena Klavs
- National Institute of Public Health, Ljubljana, Slovenia
| | - Inga Velicko
- Public Health Agency of Sweden, Stockholm, Sweden
| | - Massimo Mirandola
- Epidemiology Unit - UOC Infectious Diseases, Verona University Hospital, Verona, Italy
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- Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
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11
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Cordioli M, Gios L, Huber JW, Sherriff N, Folch C, Alexiev I, Dias S, Nöstlinger C, Gama A, Naseva E, Valkovičová Staneková D, Marcus U, Schink SB, Rosinska M, Blondeel K, Toskin I, Mirandola M. Estimating the percentage of European MSM eligible for PrEP: insights from a bio-behavioural survey in thirteen cities. Sex Transm Infect 2021; 97:534-540. [PMID: 33441447 DOI: 10.1136/sextrans-2020-054786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/31/2020] [Accepted: 11/08/2020] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This paper aims to estimate the percentage of European men who have sex with men (MSM) who may benefit from pre-exposure prophylaxis (PrEP), applying the three most widely used HIV risk indices for MSM (MSM Risk Index, Menza score, San Diego Early Test (SDET) score) and drawing on a large-scale multisite bio-behavioural survey (Sialon II). METHODS The Sialon II study was a bio-behavioural survey among MSM implemented in 13 European cities using either time-location sampling or respondent-driven sampling. Biological and behavioural data from 4901 MSM were collected. Only behavioural data of HIV-negative individuals were considered. Three widely used risk indices to assess HIV acquisition risk among MSM were used to estimate individual HIV risk scores and PrEP eligibility criteria. RESULTS 4219 HIV-negative MSM were considered. Regardless the HIV risk score used and the city, percentages of MSM eligible for PrEP were found to range between 5.19% and 73.84%. Overall, the MSM Risk Index and the Menza score yielded broadly similar percentages, whereas the SDET Index provided estimates constantly lower across all cities. Although all the three scores correlated positively (r>0.6), their concordance was highly variable (0.01<CCC<0.62). CONCLUSION Our findings showed the impact of different scoring systems on the estimation of the percentage of MSM who may benefit from PrEP in European cities. Although our primary aim was not to compare the performance of different HIV risk scores, data show that a considerable percentage of MSM in each city should be offered PrEP in order to reduce HIV infections. As PrEP is highly effective at preventing HIV among MSM, our findings provide useful, practical guidance for stakeholders in implementing PrEP at city level to tackle HIV infections in Europe.
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Affiliation(s)
- Maddalena Cordioli
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Lorenzo Gios
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jörg W Huber
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Nigel Sherriff
- School of Health Sciences, University of Brighton, Brighton, UK
| | - Cinta Folch
- Centre for Epidemiological Studies on Sexually Transmitted Infections and HIV/AIDS of Catalonia (CEEISCAT), Catalonia Public Health Agency (ASPCAT), Badalona, Spain - Biomedical Research Networking Centre in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ivailo Alexiev
- National Reference Confirmatory Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Sónia Dias
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal
| | | | - Ana Gama
- NOVA National School of Public Health, Public Health Research Centre, Comprehensive Health Research Centre, Universidade Nova de Lisboa, Lisboa, Lisboa, Portugal
| | - Emilia Naseva
- Ministry of Health, Program "Prevention and control of HIV/AIDS", Sofia, Bulgaria
| | | | - Ulrich Marcus
- Department of Infectious Diseases Epidemiology, Robert Koch Institute, Berlin, Germany
| | | | - Magdalena Rosinska
- Department of Infectious Disease Epidemiology and Surveillance, National Institute of Public Health-National Institute of Hygiene, Warszawa, Poland
| | - Karel Blondeel
- Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium.,UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Igor Toskin
- UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Massimo Mirandola
- Infectious Diseases Section, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.,School of Health Sciences, University of Brighton, Brighton, UK
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12
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Molecular Epidemiology of the HIV-1 Subtype B Sub-Epidemic in Bulgaria. Viruses 2020; 12:v12040441. [PMID: 32295123 PMCID: PMC7232140 DOI: 10.3390/v12040441] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/09/2020] [Accepted: 04/11/2020] [Indexed: 12/30/2022] Open
Abstract
HIV-1 subtype B is the predominant strain in Bulgaria, yet little is known about the molecular epidemiology of these infections, including its origin and transmissibility. We used a phylodynamics approach by combining and analyzing 663 HIV-1 polymerase (pol) sequences collected from persons diagnosed with HIV/AIDS between 1988-2018 and associated epidemiologic data to better understand this sub-epidemic in Bulgaria. Using network analyses at a 1.5% genetic distance threshold (d) we found several large phylogenetic clusters composed mostly of men who have sex with men (MSM) and male heterosexuals (HET). However, at d = 0.5%, used to identify more recent transmission, the largest clusters dissociated to become smaller in size. The majority of female HET and persons with other transmission risks were singletons or pairs in the network. Phylogenetic analysis of the Bulgarian pol sequences with publicly available global sequences showed that subtype B was likely introduced into Bulgaria from multiple countries, including Israel and several European countries. Our findings indicate that subtype B was introduced into Bulgaria multiple times since 1988 and then infections rapidly spread among MSM and non-disclosed MSM. These high-risk behaviors continue to spread subtype B infection in Bulgaria as evidenced by the large clusters at d = 0.5%. Relatively low levels of antiretroviral drug resistance were observed in our study. Prevention strategies should continue to include increased testing and linkage to care and treatment, as well as expanded outreach to the MSM communities.
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