HIDDEN LIVES -HIDDEN STRESS FINDINGS FROM EMIS-2017 EUROPE AND

PRESENTATION TO THE LGBTQ+ ASYLUM SEEKERS ONLINE CONFERENCE DUBLIN CITY UNIVERSITY 9TH/10TH APRIL 2021

• MICK QUINLAN ( GHN-EMIS-2017 COMMUNITY REPORT 2) &

• DR. AXEL J. SCHMIDT (STUDY LEAD EMIS-2017)

• DANIEL MCCARTNEY: (RESEARCHER GHN AND DR. PH STUDENT,

• LONDON SCHOOL OF HYGIENE & TROPICAL MEDICINE, UNITED KINGDOM) PRESENTATION FORMAT

PRESENTATION FORMAT

1ST HALF: MICK QUINLAN ‘MIGRANCY INEQUALITIES’ OUTLINE OF EMIS-2017 FINDINGS

2ND HALF: DANIEL MCCARTNEY ‘MEN NOT BORN IN ’ OUTLINE OF EMIS-2017 IRELAND COMMUNITY REPORT 4 EMIS-2010 REPORT (2013) EMIS-2017 REPORT (2019)

Questionnaire in 25 languages

Questionnaire in 33 languages EMIS-2017 COMMUNITY REPORTS VOL.1 AUGUST 2019 WWW.EMIS2017.EU VOL.2 Nov 2020 OVERVIEW OF EMIS-2017 SAMPLE

127 792 Men in 48 European Countries completed the survey between December 2017 and end January 2018. Of these:

• 13% WERE MIGRANT MEN 19 COUNTRIES HAD HIGHER THAN 13%, WITH 11 OVER 20% (IRELAND, LUXEMBOURG, MALTA, ICELAND, SWITZERLAND, SWEDEN, AND LEBANON HAD OVER 24%)

• 0.6% OF TOTAL SAMPLE WERE REFUGEES OR ASYLUM SEEKERS 13 COUNTRIES HAD HIGHER THAN 0.6% , WITH 8 OF THESE OVER 1% AND 3 OF THESE HAD OVER 2% (SWEDEN, SERBIA AND LEBANON WITH 7%)

• 13% OF TOTAL SAMPLE HAD A SELF-PERCEIVED ETHNICITY 22 HAD HIGHER THAN 13% WITH 8 OF THESE OVER 20% AND OF THESE TURKEY, LEBANON AND MOLDOVA HAD OVER 30%)

• 4.5% OF ALL MIGRANT MEN WERE REFUGEES OR ASYLUM SEEKERS WHERE BORN (3.6 Migration History EMIS-2017 Report Page 60)

COUNTRY OF BIRTH % OF % OF RECODED TO CONTINENTS ALL MEN MIGRANT MEN (Table 3.4) (n=127,403, (n=17,050, missing missing 389) 226)

Europe 95 62 (including Russia, Turkey and Israel)

South America 2 13 Asia (incl. Lebanon) 2 10

North America & Caribbean 1 8

Africa 1 5 Oceania 0.2 1 HOW MANY YEARS LIVING IN COUNTRY NOT BORN IN

Of the 17 180 men not born in the country they lived in, the following % had lived in that country for;

9% LESS THAN ONE YEAR

32% LESS THAN FIVE YEARS

48%(Figure 3.3 EMIS-2017 LESS Report THAN illustrates TENthe responses. YEARS P31) WHY CAME TO PRESENT COUNTRY N=17 180

44% To work

27% To study

20% I was brought as a child

16% To live more openly as /bisexual/trans

13% To be with a partner

3% I came as a refugee

2% To seek asylum

1% I was brought against my will

9% Other answer EMIS-2017 IRELAND PROMOTION MIGRANCY INEQUALITIES (Chapter 8.6 EMIS-2017 page125)

indicators for three migrancy groups Of those who came to their current country of residence;  as a refugee or asylum seeker

 to live more openly as a gay or bisexual man

 for other reasons (other migrants)

• Men who reported seeking refuge or asylum and desiring to live more openly as gay or bisexual, or any other reason were assigned to the asylum and refugee category first.

• Men who reported desiring to live more openly as gay or bisexual and another reason were assigned to the category ‘live more openly as a gay or bisexual’.

• We might assume that all the other migrants came to their current country of residence for work, or to study but we did not ask this. INDICATORS FOR THIS PRESENTATION

• The indicators and following tables cover the migrants vs. non- migrants and total sample (ALL).

• The notes and tables from chapter 8 are available in the pdf of this presentation and in main EMIS-2017 Report

• indicators will outline migrant men in 1st three columns followed by non-migrants and total sample (ALL)

REFUGEES/ DESCRIPTION TO LIVE AS OTHER NON- ASYLUM All GAY/BI MIGRANTS MIGRANTS SEEKERS MIGRANCY STATUS & WHERE BORN

REFUGEES/ All DESCRIPTION LIVE AS ASYLUM MIGRANT GAY/BI ALL SEEKERS MEN

Europe (including, Russia, Turkey and 35 65 62 95 Israel)

South America 11 12 13 2

Asia, incl. Lebanon 40 10 10 2

North America & Caribbean 5 6 82

Africa 9 5 51

Oceania 0 1 1 0.2 OUTNESS

REFUGEES/ LIVE AS OTHER NON- DESCRIPTION ASYLUM ALL GAY/BI MIGRANTS MIGRANTS SEEKERS

% out to almost all of friends, family & work 25 41 44 41 59 colleagues SEX WITH MEN IN LAST 12 MONTHS

REFUGEES/ DESCRIPTIONS LIVE AS OTHER NON- ASYLUM ALL GAY/BI MIGRANTS MIGRANTS SEEKERS

Number (median) of non-steady sex 3 5 5 34 partners

% having had condomless intercourse with non- steady partners of unknown 27 28 26 23 24 HIV status

% with 2+ condomless steady sex partners 12 11 9 9 9 TESTING & VACCINATIONS LAST 12 MONTHS

REFUGEES NON- LIVE AS OTHER DESCRIPTION /ASYLUM MIGRANTS ALL GAY/BI MIGRANTS SEEKERS % with full course of HEPATITIS A vaccination, 34 47 50 43 43 excluding men with a history of hepatitis A

% with full course of 39 53 55 49 49 HEPATITIS B vaccination, excluding men with a history of hepatitis B

% with full STI SCREEN (HIV, STI blood test, rectal swab, 14 26 19 12 13 urethral swab or urine) excluding men with diagnosed HIV more than 12 months ago

% TESTED FOR HIV, 56 70 63 54 56 last 12 months, excluding men diagnosed prior to this STI DIAGNOSES IN PREVIOUS YEAR

REFUGEES/ DESCRIPTIONS LIVE AS OTHER NON- ASYLUM ALL GAY/BI MIGRANTS MIGRANTS SEEKERS

% HAD 6 7 5 4 4 SYPHILIS

% HAD GONORRHOEA 6 12 7 55

% HAD 6 8 6 45 CHLAMYDIA LIVING WITH HIV

Descriptions REFUGEES OTHER LIVE AS NON- /ASYLUM MIGRANTS ALL GAY/BI MIGRANTS SEEKERS

% ever diagnosed with HIV 13 15 13 10 10

% with HIV monitoring ever, among HIV- diagnosed 91 99 99 99 99

% taking ART, among men 72 90 91 90 90 with diagnosed HIV

% with undetectable 64 83 84 82 82 viral load, among HIV- diagnosed PREVENTION STRATEGIES LAST 12 MONTHS

REFUGEES LIVE AS OTHER NON- /ASYLUM ALL Descriptions GAY/BI MIGRANTS MIGRANTS SEEKERS

% saw or heard 68 80 76 74 74 information about HIV or STIs for MSM

% with free condoms 39 46 39 31 32 from civil society organisations, clinics, bars or saunas SEXUAL HEALTH KNOWLEDGE NEEDS

REFUGEES NON- DESCRIPTIONS LIVE AS OTHER /ASYLUM MIGRANTS ALL GAY/BI MIGRANTS SEEKERS

Number (mean) of six HIV/STI transmission 1 1 1 11 facts NOT already known

% UNAWARE of PEP 56 31 31 40 39

% UNAWARE of PrEP 53 27 28 38 37

% NOT knowing U=U (THAT A PERSON WITH 51 37 39 43 43 UNDETECTABLE VIRAL LOAD CANNOT PASS ON HIV) SEXUAL HEALTH & WELLBEING OUTCOMES

REFUGEES/ LIVE AS OTHER NON- DESCRIPTIONS ASYLUM GAY/BI MIGRANTSMIGRANTS ALL SEEKERS

% sexually unhappy 31 20 20 23 23 (scoring less than 5 on the 1 to 10 scale) % lacking control 10 10 9 9 9 over unwanted sex % not sure of own 10 4 4 44 HIV status % not knowing where to get 51 43 43 41 42 HIV TEST, among never tested % not knowing where to get HEPATITIS A vaccination, 73 62 57 54 54 among those vulnerable

% not knowing where to get HEPATITIS B vaccination, 75 63 57 54 54 among those vulnerable SEXUAL SAFETY

REFUGEES NON- LIVE AS OTHER Descriptions /ASYLUM MIGRANTS ALL GAY/BI MIGRANTS SEEKERS

% lacking control 11 13 12 11 11 over safer sex

% having had condomless intercourse 37 26 26 26 26 due to lack of condoms,

% without confidence to access PEP, 70 55 56 61 60 excluding men with diagnosed HIV MINORITY STRESS

REFUGEES/ LIVE AS OTHER NON- Descriptions ASYLUM ALL GAY/BI SEEKERS MIGRANTS MIGRANTS

% experiencing VERBAL INSULTS because someone knew/presumed attraction to 33 24 19 21 21 men, last 12 months

% NOT OUT 50 23 27 31 30 or only out to a few people

Lacking Social Support 24 15 12 12 12 (scoring less than 10 in sub scale SPS) MENTAL HEALTH

REFUGEES NON- LIVE AS OTHER Descriptions /ASYLUM MIGRANTS ALL GAY/BI MIGRANTS SEEKERS

% with severe anxiety and depression, 12 10 7 8 8 last two weeks (PHQ-4)

% with self-harm thoughts, last two weeks 27 24 20 21 21 DRUG USE

REFUGEES/ LIVE AS OTHER NON- Description ASYLUM ALL GAY/BI MIGRANTS MIGRANTS SEEKERS

% who injected drugs (excluding steroids), 2 2 2 11 last 12 months

% who used stimulant drugs 7 9 7 55 to make sex more intense or last longer, last four weeks SUBSTANCE USE CONCERNS

REFUGEES NON- LIVE AS OTHER Descriptions /ASYLUM MIGRANT ALL GAY/BI MIGRANTS SEEKERS S

% concerned about own 21 18 15 12 13 drug use

% with potential alcohol dependency 21 21 19 18 18 (CAGE4) DUBLIN PRIDE 2010 Many Thanks for your attention: Appreciation to these migrant men and the 137,000 men who completed EMIS-2017. This and the national reports are available at

WWW.EMIS2017.EU

Mick Quinlan, Gay Health Network and Axel J Schmidt

EMIS-2017 core team: Axel J. Schmidt, Ford Hickson, David Reid, Peter Weatherburn (Sigma Research, London School of Hygiene & Tropical Medicine, UK) in association with Ulrich Marcus and Susanne B. Schink (Robert Koch Institute, Berlin, DE) Acknowledgements Contact: [email protected]

Primary Funding: As part of ESTICOM, EMIS 2017 was carried out under the service contract 2015 71 01 with The Consumers, Health, Agriculture and Food Executive Agency (Chafea), acting under powers delegated by the Commission of the European Union. Other international financial contributions: Swedish Ministry of Health for recruitment in the Nordic Countries; The Arctic University of Norway and University Hospital of North Norway for Russia; Israel Ministry of Health for Israel; Public Health Agency of Canada for Canada; Office of the WHO Representative in the Philippines for the Philippines..

Acknowledgements: We begin by thanking all of the men who took part in EMIS 2017 and our partners who recruited 17% of all respondents through activities on Facebook and other social media and by placing EMIS banners on their websites. We thank all our partners for being part of something huge! Europe: PlanetRomeo, European AIDS Treatment Group (EATG), Eurasian Coalition on Male Health (ECOM), European Centre for Disease Prevention and Control (ECDC), European Monitoring Centre for Drugs & Drug Addiction (EMCDDA), European Commission (DG SANTE).

AL: Arian Boci. AT: Aids Hilfe Wien, Dr Frank M. Amort. BA: lgbti.ba, Masha Durkalić. BE: SENSOA, exaequo, Observatoire du SIDA et des sexualités. BG: HUGE, GLAS Foundation, Dr Emilia Naseva, Petar Tsintsarski. BY: Vstrecha. CA: Health Initiative for Men, Rézo, ’s Sexual Health Alliance of Ontario, CATIE, Université du Quebec & Montréal, University of Toronto, University of Windsor, University of Victoria, Public Health Agency of Canada, Rob Gair. CH: Swiss AIDS Federation, Cantonal Hospital St. Gallen, Centre Hospitalier Universitaire Vaudois, University Hospital Zurich, Swiss Federal Office of Public Health. CY: AIDS Solidarity Movement. CZ: AIDS pomoc, National Institute of Public Health, Tereza Zvolska, Dr Michał Pitonak. DE: Deutsche AIDS-Hilfe, Robert Koch Institute, BZgA, Dr Michael Bochow, Dr Richard Lemke. DK: AIDS-Fondet, Statens Serum Institut, François Pinchon, Jakob Haff. EE: Eesti LGBT, VEK LGBT, Estonia National Institute for Health Development, Dr Kristi Rüütel. ES: Stop Sida, CEEISCAT, Ministerio de Sanidad. FI: Positiiviset, Hivpoint, SeksiPertti, Trasek. FR: AIDES, Coalition PLUS, SexoSafe, Santé Publique France, INSERM. GR: Ath Checkpoint, Thess Checkpoint; Positive Voice. HR: Iskorak, gay.hr, Zoran Dominković, Vjeko Vacek. HU: Háttér, Tamás Bereczky. IE: Gay Health Network, Man2Man, HIV Ireland, Outhouse, GOSHH, Sexual Health Centre Cork, AIDSWEST, Gay Community News, Health Service Executive, Gay Men's Health Service, Sexual Health and Crisis Pregnancy Programme, Health Protection Surveillance Centre. IL: Israel AIDS Task Force, Israel Ministry of Health, Dr Zohar Mor. IS: Samtökin '78. IT: Arcigay, Fondazione LILA Milano ONLUS, University of Verona, Dr Raffaele Lelleri. LB: SIDC, Dr Ismaël Maatouk. LT: demetra, LGL, Gayline. LV: Testpunkts, Baltic HIV Association, Dr Antons Mozalevskis, Indra Linina. MD: GENDERDOC-M. ME: Juventas. MK: Subversive Front, Dr Kristefer Stojanovski. MT: Malta LGBTIQ Rights Movement, Allied Rainbow Communities, Infectious Disease Prevention and Control Unit (Malta), Silvan Agius, Russel Sammut. NL: Results in Health, Maastricht University, Amsterdam Pink Panel, Soa Aids Nederland, Rutgers, Dr Wim Vanden Berghe. NO: Helseutvalget, Norwegian Directorate of Health, Folkehelseinstituttet, Dr Rigmor C. Berg. PH: Bisdak Pride-Cebu, Cebu Plus, HASH, Pinoy Plus, UP Babaylanes, YPEER, TLF, Natasha Montevirgen, Mikael N. Navarro. PL: Spoleczny Komitet ds AIDS, Kampania Przeciw Homofobii, Lambda Warszawa, Dr Łukasz Henszel. PT: GAT Portugal, CheckpointLX, Associação ABRAÇO, rede ex aequo, SexED, dezanove, ILGA Portugal, Trombeta Bath, ISPUP. RO: PSI Romania, ARAS Romania, Tudor Kovacs. RS: Association Duga, Association Red Line, Omladina JAZAS-a Novi Sad, Institute of Public Health of Serbia, Sladjana Baros, Dr Marija Pantelic. RU: LaSky. SE: RFSL, University of Gothenburg, Folkhålsomyndigheten. SI: ŠKUC, Legebitra, LJUDMILA. SK: PRIDE Košice, Light-House Slovakia, Trnavská univerzita, Slovenská zdravotnícka univerzita, Dr Zuzana Klocháňová. TR: Pozitif Yaşam, Sami Sarper Yazıcılaroğlu. UA: Alliance for Public Health, alliance.global, msmua.org, Oleksii Shestakovskyi. UK: Terrence Higgins Trust, NAM, PrEPster, Antidote, Horizon Drugs and Alcohol Support, LGBT Foundation, Yorkshire MESMAC, MESMAC Newcastle, Derbyshire LGBT+, Trade Sexual Health, London Friend, GMFA, Spectra, International HIV Partnerships, International Planned Parenthood Federation, Bristol University, University College London, Sigma Research, Raul Soriano. Other: Dr John Pachankis, Dr Mark Hatzenbühler, Dr Valeria Stuardo Ávila, Dr Michael W. Ross. NOTES: 8.6 MIGRANCY INEQUALITIES (PAGE 125)

• On average, men who migrated to live more openly as gay were younger (mean age 35.4, SD=10.6, median=34) than refugees and asylum seekers (mean age 36.0, SD=12.9, median=33) and those born in their country of residence (mean age 37.0, SD=12.9, median=35) and other migrants (mean age 37.6, SD=12.4, median=36). • All migrants were better educated than men who were resident in their country of birth. • Refugees and asylum seekers were much less likely to be out to ‘almost all’ of friends, family and work colleagues (25%) than those born in their country of residence (41%), those who migrated to be out as gay or bisexual (41%) and other migrants (44%). • They were also more likely to report being a member of an ethnic or racial minority (49%) than those migrating to be more out (39%) than other migrants (30%) and those born in their country of residence (10%). • Refugees and asylum seekers were also less likely to have a steady partner (28%) than other migrants (39%). There was little variation in migrant status for and sex at birth, trans status, injecting drug use or for the selling of sex NOTES: 8.6.1 MIGRANCY & MORBIDITIES (Page 126)

• Refugees and asylum seekers were more likely to have poor mental health and substance dependency. They were also most likely to be recently diagnosed with HIV and overall to have detectable HIV. In contrast, all other infections appear to be more commonly experienced by men who migrate to live as gay or bisexual men.

• Non-migrant MSM are significantly less likely to report all mental health morbidities – anxiety/depression, suicidal thoughts, alcohol dependence, sexual unhappiness – and less likely to report infections – including infection in the last 12 months, or any of the other STIs. NOTES: 8.6.2 MIGRANCY AND BEHAVIOUR (Page 126)

• Sexual risk with non-steady partners, injecting and combining drugs and sex were most common among men who had migrated to live sexually-liberated lives. • They were also above average users of precautions (ART and PrEP). • Refugees and asylum seekers were also more likely than average to be injecting drugs but were less likely to be using ART or PrEP. • The level of ART among MSM with diagnosed HIV who are refugees or asylum seekers is noticeably lower. • Similarly, non-migrant MSM are substantially less likely to report all risk behaviour, including having had less non- steady partners in the last year. • Among the migrants, refugees and asylum seekers are most likely to report the most sexual risk behaviour but there is more variety in the behavioural measures and less consistency in the pattern for the three migrant groups. NOTES: 8.6.3 MIGRANCY AND NEEDS (Page 127)

• For the majority of indicators, refugees and asylum seekers were most likely to be in need, including those associated with specific precautionary behaviour (hepatitis vaccination; access to HIV testing; access to condoms etc.) and for educational/information-based needs. The proportion lacking social support was notably high, as was internalised homonegativity. • The non-migrant MSM were most likely to be unsure of whether they would use PrEP.

NOTES: 8.6.4 MIGRANCY & INTERVENTIONS (Page 128)

As a group, refugees and asylum seekers experienced a high level of homophobic abuse and were less likely than average to encounter information about safer sex or access to hepatitis vaccinations. Those with HIV were less likely to have their infection monitored and managed and were more likely to be detectable.