National Report Malta EMIS-2017 European MSM Internet Survey Infectious Disease Control Unit (IDCU), Malta - December 2018 European MSM Internet Survey 2017, Malta EMIS is the largest international and multi-language study on gay, bisexual and other men who have sex with men (MSM). This report aggregates data generated in the 2017 European MSM Internet Survey (EMIS) and the sub-sample of MSM living in Malta represents the largest ever research sample of MSM in Malta. This report has been prepared with the support of: Health Promotion and Disease Prevention Directorate, Infectious Disease Control Unit From the Department for Health Regulation of the Ministry for Health in Malta. EMINISTRY FOR HEALTH 5B, THE EMPORIUM, TRIQ C. DE BROCKDORFF, MSIDA, MALTA For further information on EMIS and other Country Reports, visit: emis2017.eu 2 European MSM Internet Survey 2017, Malta Table of Contents 1 The EMIS-2017 - Introduction ........................................................................................................ 5 1.1 LGBTI rights and situation in Malta ...................................................................................... 5 1.2 EMIS-2017 Research aims and objectives ............................................................................ 5 2 Methods ......................................................................................................................................... 6 2.1 Countries participating in EMIS-2017 ................................................................................... 6 2.2 Designing the questionnaire ................................................................................................. 6 2.3 Inclusion criteria ................................................................................................................... 7 2.4 Recruitment procedures ....................................................................................................... 7 2.5 Participation ......................................................................................................................... 7 2.6 Ethics approval ..................................................................................................................... 8 2.7 Statistical Analysis ................................................................................................................ 8 3 Demographics ................................................................................................................................ 8 3.1 Age ........................................................................................................................................ 8 3.2 Area of residence .................................................................................................................. 9 3.3 Country of Birth .................................................................................................................. 10 3.4 Migration to Malta: length of residency and reasons of migration .................................... 10 3.5 Education, Employment and Financial Coping ................................................................... 12 3.6 Sexual attraction, Sexual identity and Outness .................................................................. 13 3.7 Partnership Status .............................................................................................................. 13 3.8 Sexual contacts in exchange for money. ............................................................................ 14 4 Morbidities ................................................................................................................................... 14 4.1 Mental Health ..................................................................................................................... 14 4.2 Diagnoses of infectious diseases ........................................................................................ 16 5 Risk and Precaution Behaviours ................................................................................................... 17 5.1 First and most recent sex with men ................................................................................... 17 5.2 Steady and non-steady sex with men in the last year ........................................................ 18 5.3 Condom use in non-steady sex with men ........................................................................... 20 5.4 Sex with Women ................................................................................................................ 21 5.5 Substance use ..................................................................................................................... 21 5.6 Combining sex and drugs .................................................................................................... 23 5.7 Seeking and using PrEP ....................................................................................................... 24 5.8 Taking HIV treatment ......................................................................................................... 25 5.9 Being vaccinated against hepatitis A and B ........................................................................ 25 3 European MSM Internet Survey 2017, Malta 6 Needs: The capabilities, opportunities and motivations for risk and precaution behaviours ..... 26 6.2 Unmet needs for safer drug use: drug use concern ........................................................... 26 6.3 Unmet needs for PEP use (Post-Exposure Prophylaxis) ..................................................... 26 6.4 Unmet needs for PrEP use (Pre-Exposure Prophylaxis) ...................................................... 29 6.5 Unmet needs for HIV testing and treatment ...................................................................... 31 6.6 Unmet needs for viral hepatitis vaccination ....................................................................... 32 7 Interventions: the actions of others that meet or undermine needs .......................................... 33 7.1 Homophobic abuse: how common are intimidation, name-calling, violence? .................. 33 7.2 Who is distributing condoms? ............................................................................................ 35 7.3 PrEP services ....................................................................................................................... 35 7.4 HIV/STI education services: penetration of information .................................................... 35 7.5 HIV testing services ............................................................................................................ 36 7.6 Viral hepatitis vaccination: how far is the hepatitis vaccination offer penetrating? .......... 36 7.7 STI testing services ............................................................................................................. 36 8 A Snapshot of non-steady sex between men: Characteristics of the last session ....................... 38 9 Recommendations ....................................................................................................................... 39 10 Acknowledgements ................................................................................................................ 40 10.1 Funding ............................................................................................................................... 40 10.2 Acknowledgements ............................................................................................................ 40 10.3 Authors ............................................................................................................................... 40 Further Information: http://health.gov.mt ......................................................................................... 40 For any further information on EMIS-2017 and other National Reports: www.emis2017.eu ............ 40 11 References .............................................................................................................................. 41 4 European MSM Internet Survey 2017, Malta 1 The EMIS-2017 - Introduction This report contains information relevant to those working with improving the sexual health and well- being of MSM and presents evidence relevant to policy and programme design for gay and bisexual men in Malta. This survey took place between October 2017 and the end of January 2018. A total of 50 countries took part of EMIS-2017. The study was conducted not only in the European Union, but also in Norway, Iceland, Switzerland, all Balkan countries, Turkey, Lebanon, Israel, Moldova, Belarus, Ukraine, Russia, Canada, and the Philippines – 50 countries in total. High rates of participation across Europe: 128,000 men living in Europe took part. We estimate that more than 2% of all men who have sex with men in Europe took part in EMIS-2017. We are proud to say that Malta was one of the countries with the highest participation rates, followed by Norway, Sweden, Ireland, and Switzerland. The participation rate in Malta was 20.1 per 10,000 men aged 15– 64; translating to more than 6% or Malta’s estimated MSM population) This success was only possible thanks to the great support of you all and we want to acknowledge all of you who completed the questionnaire. All together you contributed to this success. A big THANK YOU! 1.1 LGBTI rights and situation in Malta According to the United Nations, LGBTI rights in Malta are highly protected even