Report on a Bio-Behavioural Survey Among MSM in 13 European Cities
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Capacity building in combining targeted prevention with meaningful HIV surveillance among MSM REPORT ON A BIO-BEHAVIOURAL SURVEY AMONG MSM IN 13 EUROPEAN CITIES CIERRE GRAFICA Massimo Mirandola Infectious Diseases Section, Department of Pathology-Verona Univer- sity Hospital - Veneto Region & Coordinamento Regionale per il Mana- gement e la Progettazione Europea, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Lorenzo Gios Coordinamento Regionale per il Management e la Progettazione Euro- pea, Azienda Ospedaliera Universitaria Integrata, Verona, Italy Nigel Sherriff Centre for Health Research CHR, University of Brighton, Brighton, UK Igor Toskin Department of Reproductive Health & Research World Health Organiza- tion, Geneva, Switzerland Marcus Ulrich Robert Koch Institute, Berlin, Germany Susanne Schink Robert Koch Institute, Berlin, Germany Barbara Suligoi Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy Cinta Folch Centre for Epidemiological Studies on HIV/STI in Catalonia CEEISCAT, Agència de Salut Pública de Catalunya, Barcelona, Spain Magdalena Rosińska NIZP-PZH, Warsaw, Poland Expert external reviewer ditors Lisa Johnston School of Public Health and Tropical Medicine, Tulane University, New E Orleans, LA, USA Capacity building in combining targeted prevention with meaningful HIV surveillance among MSM Report on a Bio-behavioural Survey among MSM in 13 European cities Co-funded by the Health Programme of the European Union This document is based on data from the Sialon II project, co-funded under the European Commission’s (EC) Public Health Programme 2008-2013 (Work Plan 2010). The sole responsibility lies with the authors of this report and the Commission is not responsible for any use that may be made of the information contained therein Suggested citation for this report: The Sialon II Project. Report on a Bio-behavioural Survey among MSM in 13 European cities. ISBN 978-88-98768-55-4 Cierre Grafica, 2016. Editors: Massimo Mirandola, Lorenzo Gios, Nigel Sherriff, Igor Toskin, Ulrich Marcus, Susanne Schink, Barbara Suligoi, Cinta Folch, Magdalena Rosińska Project Design: Ruggero Ughetti Print: Cierre Grafica | www.cierrenet.it © Cover picture by Juri Pozzi Index 1. Introduction ................................................................................................................................................. 7 2. Background ................................................................................................................................................. 21 3. Methods ....................................................................................................................................................... 29 4. Ethical considerations ............................................................................................................................... 43 5. Survey results ............................................................................................................................................. 49 5.1 Sample description .............................................................................................................................. 53 5.2 Prevention programmes ..................................................................................................................... 73 5.3/5.4 Partner numbers, anal intercourse, and condom use with steady and non-steady partners in the last six months .......................................................................................................................... 87 5.5 Sexual behaviour in the last six months with a female partner .......................................................................................................................... 101 5.6 Sexual behaviour during last episode ................................................................................................. 109 5.7 Commercial sex ................................................................................................................................... 121 5.8 High risk sex behaviour (fisting) ......................................................................................................... 127 5.9 HIV and other STIs ............................................................................................................................... 133 5.10 Treatment and viral load ..................................................................................................................... 147 5.11 Sexual health ....................................................................................................................................... 159 5.12 Substance use ..................................................................................................................................... 167 6. Discussion ................................................................................................................................................... 181 7. Conclusions and recommendations .......................................................................................................... 186 The Sialon II Project. Report on a Bio-behavioural Survey among MSM in 13 European cities 3 LIST OF ABBREVIATIONS AI Anal intercourse AIDS Acquired immune deficiency syndrome ARV Antiretroviral CI Confidence interval DE Design Effect EC European Commission ECDC European Centre for Disease Prevention and Control EEA European Economic Area EU European Union GARPR Global AIDS Response Progress Reporting GUM Genito-urinary medicine HBV Hepatitis B Virus HCV Hepatitis C Virus HIV Human Immunodeficiency Virus LGV Lymphogranuloma venereum MS Member State MSM Men who have Sex with Men NGO Non-Governmental Organization NSP Non-Steady Partner OF Oral Fluids PEP Post-Exposure Prophylaxis PIS Participant Information Sheet RDS Respondent-Driven Sampling SGSS Second Generation Surveillance System SD Standard Deviation SE Standard Error SP Steady Partner STI Sexually Transmitted Infection TLS Time-Location Sampling UAI Unprotected Anal Intercourse UN United Nations UNAIDS The Joint United Nations Programme on HIV/AIDS UNGASS United Nations General Assembly Special Session VCT Voluntary Counselling and Testing VDT Venue-Day-Time WHO World Health Organization 4 The Sialon II Project. Report on a Bio-behavioural Survey among MSM in 13 European cities Executive Summary This report presents the findings from a large-scale bio-behavioural survey implemented across 13 Euro- pean countries. The survey was implemented in the context of the European Commission co-funded Sialon II project (see www.sialon.eu). The overall objective of the Sialon II project (2011-2014) was to carry out and pro- mote combined and targeted prevention, complemented by meaningful surveillance, among MSM. The Sialon II project follows on from its predecessor Sialon (2008-2010); both projects were set within a context of rising HIV infections among MSM in many countries across Europe as indicated by both the ECDC and the other scientific literature. The Sialon II survey employed two different probability sampling procedures, namely Time-Location Sam- pling (TLS) and Respondent-Driven Sampling (RDS). These two methods allowed researchers to enrol hetero- geneous populations and to collect reliable information on behaviour patterns, prevention needs and sexual health in the MSM population. The survey is without precedence in Europe in terms of its size and from the point of view of the practical implementation of the WHO – Joint United Nations Programme on HIV/AIDS (UNAIDS) Second Generation Surveillance System (SGSS) approach and behavioural surveillance recommendations from the ECDC. The TLS method was adopted in Belgium, Bulgaria, Germany, Poland, Portugal, Slovenia, Spain, Sweden, and the UK whereas the RDS method was employed in Italy, Lithuania, Romania, and the Slovak Republic. The choice of sampling procedure was dependent both on the cultural and social characteristics of the participating cities and taking into consideration the activities of the previous Sialon project where only the TLS method was employed. Data from the Sialon II survey have provided a wealth and diversity of insights regarding: access to preven- tion programs and testing in each partner country; results on sexual behaviour in the last six months (with steady and non-steady partners) including condom use; as well as findings relating to commercial sex, ‘fisting’, treatment and viral load, substance (mis)use, and sexual health (sexual satisfaction, sexual safety, and sexual autonomy). In terms of HIV prevalence, data suggested a range between 2% and 20%, with higher prevalence among individuals older than 25 years of age. A relevant proportion (ranging between 12% and 88%) of partici- pants were unaware of being HIV-positive. On the one hand, the findings confirm the already identified trend of rising infection among MSM in Europe. The Sialon II Project. Report on a Bio-behavioural Survey among MSM in 13 European cities 5 One the other hand, the data reveal some alarming findings with regard to prevention, treatment and support to MSM and underline the disparities within Europe. The high number of MSM who were tested for the first time in the context of this survey, in particular in the Eastern European survey cities and the high estimates of HIV positive participants unaware of their real se- rum-status, seem to suggest critical conditions in terms of future increase of the HIV epidemic. The situation seems to be particularly