HIV infection among ethnic minority and migrant men who have sex with men in Britain

Transitions in sexual behaviour among gay, bisexual, and other men who have sex with men in England: Data from a prospective study

The effectiveness of population-level intervention for HIV elimination is influenced by individual-level variation in sexual behaviour. We assess within-person changes in the frequency of condomless anal sex with two or more partners (CLS2+), estimate the transition probabilities and examine the predictors of transitions among a prospective cohort of HIV-negative gay, bisexual, and other men who have sex with men (GBMSM). Participants were recruited through one of three sexual health clinics in London and Brighton (July 2013 to April 2016) and self-completed a baseline paper questionnaire in the clinic. During follow-up, they were invited to complete four-monthly questionnaires twice a year and subsequent annual online questionnaires once a year (March 2015 to March 2018). We used Markov chain models to estimate transition probabilities from 'higher-risk' (CLS2+) to 'lower-risk' (no CLS2+) and vice versa, and to assess factors associated with transitions between different sexual risk levels. Among 1,162 men enrolled in the study, 622 (53.5%) completed at least one online questionnaire. Higher-risk behaviour was reported in 376/622 (60.4%) men during online follow-up. Overall, 1,665/3,277 (37.5%) baseline and follow-up questionnaires reported higher-risk behaviour. More than 60% of men (376/622) reported higher-risk behaviour at least one period during the follow-up, while 39.5% of men (246/622) never reported CLS2+ during the follow-up. In the next four months, the estimated probability of continuing higher-risk behaviour among men who reported higher-risk behaviour was 78%. Calendar time, recent HIV tests, PrEP and PEP use were the predictors of staying in higher-risk behaviour, while less stable housing status was associated with switching to lower-risk behaviour. Among men who reported lower-risk behaviour, the probability of engaging in the same behaviour was 88%. Recent HIV tests, PrEP and PEP use, recreational drugs, chemsex-associated drug and injection drugs, and bacterial STIs diagnosis were the predictors of switching to higher-risk behaviour. Our results indicate that at any one point in time, the majority of GBMSM are at low risk for HIV acquisition, although many experience short periods in which they are at higher risk. Markers of transitions can be utilized to identify which GBMSM are likely to increase or decrease their risk, thus helping the timing of HIV prevention interventions.

Determinants of HIV Testing Among Migrant Men Who Have Sex With Men from Sub-Saharan Africa and Other Regions Residing in 10 European Countries

Migrant men who have sex with men (mMSM) from sub-Saharan Africa (SSA) and other regions outside Europe are highly vulnerable to HIV. However, research on the determinants of HIV testing among mMSM from SSA, and how these differ across the categories of mMSM living in Europe, is limited. Using data from the European MSM Internet Survey (EMIS-2017), we assessed HIV testing prevalence and recency in mMSM from SSA and other mMSM residing in ten European countries, as well as the determinants of HIV testing across different mMSM categories with logistic regression analyses. Ever-testing for HIV was slightly higher in mMSM from SSA (83%) compared to other mMSM categories (75-80%), except for mMSM from Latin America and Caribbean region (84%). Overall, 20% of mMSM had never tested. In multivariable analysis, higher age (adjusted odds ratio [AOR] 1.05, 95% confidence interval [CI] 1.01-1.10), higher HIV knowledge (AOR 1.45, 95%-CI 1.11-1.90), and residence in smaller settlements (AOR 0.45, 95%-CI 0.21-0.96) were significantly associated with ever testing for HIV in mMSM from SSA. Comparing mMSM from SSA to mMSM from other regions, we found varying significant similarities (higher age, residence in smaller settlements and HIV knowledge) and differences (lower educational attainment, not identifying as gay, being a student, and limited disclosure of homosexual attraction) in the determinants of ever-testing for HIV. Community-specific interventions addressing identified sociodemographic and behavioral determinants to increase HIV testing uptake in the different mMSM categories and better data for further research are warranted.

HIV prevalence ratio of international migrants compared to their native-born counterparts: A systematic review and meta-analysis

BACKGROUND

People on the move, including international migrants, may face health inequities that expose them to a higher risk for HIV than native-born populations. We conducted a systematic review to calculate the HIV prevalence ratio of international migrants compared with native-born populations.

METHODS

We searched five databases between January 2010 and March 2022. Using random-effects meta-analysis, we calculated the pooled HIV prevalence ratios (PR) by comparing the HIV prevalence of migrants with native-born populations. Our research protocol is registered in the International prospective register of systematic reviews (PROSPERO, CRD42021250867).

FINDINGS

In total, 5,121 studies were screened, and 38 were included in the final analysis: 7,121,699 migrants and more than 270 million natives were included in the analysis. The pooled PR for any foreign-born migrants was 1·70 (95% CI 1·11 - 2·61, I² =99·67%, n = 33 studies), refugees was 2·37 (95% CI 0·33-16·99, I² =99·5%, n = 5), undocumented people was 3·98 (95% CI 0·11-143·01, I² =94·6%, n = 3), whilst asylum seekers was 54·79 (95% CI 17·23-174·23, I² =90·2%, n = 2). Meta-regression revealed that population type (adjusted R-squared 11.5%), region of origin (11.3%) and migrant type (10.8%) accounted for heterogeneity more than country-income (2.4%) and study setting (2.3%).

INTERPRETATION

Although it was not possible to assess if HIV infection occurred in the country of origin or destination, the HIV prevalence ratio was higher among migrants than in native-born populations. Inclusive health policies and strategies for delivering HIV testing, prevention and treatment services for migrant populations tailored to their needs are urgently needed.

FUNDING

J.J.O. and E.P.F.C. are supported by the Australian National Health and Medical Research Council (NHMRC) Emerging Leader Fellowship (GNT1193955 and GNT1172873, respectively).

National trends in sexual health indicators among gay and bisexual men disaggregated by ethnicity: repeated cross-sectional behavioural surveillance in New Zealand

OBJECTIVES

To assess trends in sexual health outcomes among men who have sex with men (MSM) disaggregated by ethnicity.

DESIGN

Repeated cross-sectional.

SETTING

Behavioural surveillance data from 2006, 2008, 2011 and 2014 were collected in-person and online across Aotearoa New Zealand.

PARTICIPANTS

Eligible participants were self-identified men aged 16 years or older who reported sex with another man in the past 5 years. We classified 10 525 participants' ethnicities: Asian (n=1003, 9.8%), Māori (Indigenous people of Aotearoa New Zealand, n=1058, 10.3%), Pacific (n=424, 4.1%) and European (n=7867, 76.8%).

OUTCOME MEASURES

The sexual health outcomes examined were >20 recent (past 6 months) male sexual partners, past-year sexually transmitted infection (STI) testing, past-year STI diagnosis, lifetime and past-year HIV testing, lifetime HIV-positive diagnosis and any recent (past 6 months) condomless anal intercourse with casual or regular partners.

RESULTS

When disaggregated, Indigenous and ethnic minority groups reported sexual health trends that diverged from the European MSM and each other. For example, Asian MSM increased lifetime HIV testing (adjusted OR, AOR=1.31 per survey cycle, 95% CI 1.17 to 1.47) and recent HIV testing (AOR=1.14, 95% CI 1.02 to 1.28) with no changes among Māori MSM or Pacific MSM. Condomless anal intercourse with casual partners increased among Māori MSM (AOR=1.13, 95% CI 1.01 to 1.28) with no changes for Asian or Pacific MSM. Condomless anal intercourse with regular partners decreased among Pacific MSM (AOR=0.83, 95% CI 0.69 to 0.99) with no changes for Asian or Māori MSM.

CONCLUSIONS

Population-level trends were driven by European MSM, masking important differences for Indigenous and ethnic minority sub-groups. Surveillance data disaggregated by ethnicity highlight inequities in sexual health service access and prevention uptake. Future research should collect, analyse and report disaggregated data by ethnicity to advance health equity.

Ethnicity classification systems for public health surveys: experiences from HIV behavioural surveillance among men who have sex with men

Background

Race and ethnicity classification systems have considerable implications for public health, including the potential to reveal or mask inequities. Given increasing “super-diversity” and multiple racial/ethnic identities in many global settings, especially among younger generations, different ethnicity classification systems can underrepresent population heterogeneity and can misallocate and render invisible Indigenous people and ethnic minorities. We investigated three ethnicity classification methods and their relationship to sample size, socio-demographics and sexual health indicators.

Methods

We examined data from New Zealand’s HIV behavioural surveillance programme for men who have sex with men (MSM) in 2006, 2008, 2011, and 2014. Participation was voluntary, anonymous and self-completed; recruitment was via community venues and online. Ethnicity allowed for multiple responses; we investigated three methods of dealing with these: Prioritisation, Single/Combination, and Total Response. Major ethnic groups included Asian, European, indigenous Māori, and Pacific. For each classification method, statistically significant associations with ethnicity for demographic and eight sexual health indicators were assessed using multivariable logistic regression.

Results

Overall, 10,525 MSM provided ethnicity data. Classification methods produced different sample sizes, and there were ethnic disparities for every sexual health indicator. In multivariable analysis, when compared with European MSM, ethnic differences were inconsistent across classification systems for two of the eight sexual health outcomes: Māori MSM were less likely to report regular partner condomless anal intercourse using Prioritisation or Total Response but not Single/Combination, and Pacific MSM were more likely to report an STI diagnosis when using Total Response but not Prioritisation or Single/Combination.

Conclusions

Different classification approaches alter sample sizes and identification of health inequities. Future research should strive for equal explanatory power of Indigenous and ethnic minority groups and examine additional measures such as socially-assigned ethnicity and experiences of discrimination and racism. These findings have broad implications for surveillance and research that is used to inform public health responses.

Modes of administering sexual health and blood-borne virus surveys in migrant populations: A scoping review

There has been a growing number of sexual health and blood-borne virus (SHBBV) surveys specifically administered to migrant populations. The purpose of this scoping review is to collate available information about how SHBBV surveys have been administered in migrant populations and the effect that mode of administration has on data quality, reliability and other practical considerations, e.g. response rates (RR) and social desirability bias. A methodological framework for scoping reviews was applied. SHBBV survey studies administered to international migrants published since 2000 were included if they contained some description of mode of administration. Ninety one studies were identified for inclusion from Embase, Medline, Web of Science, Google Scholar and supplementary grey literature. 'Interview only' was the most common mode of administration (n = 48), predominately comprising face-to-face interviews. Thirty six studies reported data from 'self-completed' surveys only, with pen-and-paper being most common (n = 17). Few studies (n = 7) combined interview and self-completed methods of survey administration. Sixty one studies did not report (or only partially reported) RR or the data necessary to calculate RR. Of the studies that reported RR, most were missing other key information including method of recruitment, consent procedures and whether incentives were offered. Strengths and limitations of all administration modes are summarised. Guidelines to inform future SHBBV survey research in migrant populations are presented.

Surveying testing preferences in Black, Latin American, and other minorities for the co-design of digital vending machines for HIV self-testing

The use of digital vending machines (VMs) to delivery HIV self-testing (HIVST) could expand HIV testing in priority populations. We surveyed primarily Black African (BA) participants and other minority ethnicities, to identify acceptability, preferences, and concerns of using VMs for HIVST dispensing. A structured survey was developed with Black African and Caribbean, Latin American and other Minorities (BLAM) communities, and distributed between September 2018 and January 2019. Participants were recruited using mobile tablet surveys distributed by outreach volunteers, and online through BLAM communities’ websites, workshops, and language-specific messages on social media. Descriptive analyses were undertaken stratified by ethnic groups. One hundred and twenty-eight (67.0%) participants identified as BAs, 31 (16.2%) Black Caribbeans (BCs), 22 (11.5%) Latin Americans (LAs), and 10 (5.2%) other non-white ethnicities (ONWEs). Rates of willingness to use the HIVST were high in all groups except BCs (BAs 77.9%, BCs 53.6%, LAs 81.8%, ONWEs 80.0%). Most participants favoured healthcare-associated venues for VM placement, but there were differences in community venues favoured by different ethnic groups and concerns reported. HIVST is acceptable in many BLAM communities and increases understanding of the concerns and how to address them in the design of VMs for HIVST, to expand HIV testing in these priority communities.

2016 United Kingdom national guideline on the sexual health care of men who have sex with men

This guideline is intended for use in UK Genitourinary medicine clinics and sexual health services but is likely to be of relevance in all sexual health settings, including general practice and Contraception and Sexual Health (CASH) services, where men who have sex with men (MSM) seek sexual health care or where addressing the sexual health needs of MSM may have public health benefits. For the purposes of this document, MSM includes all gay, bisexual and all other males who have sex with other males and both cis and trans men. This document does not provide guidance on the treatment of particular conditions where this is covered in other British Association for Sexual Health and HIV (BASHH) Guidelines but outlines best practice in multiple aspects of the sexual health care of MSM. Where prevention of sexually transmitted infections including HIV can be addressed as an integral part of clinical care, this is consistent with the concept of combination prevention and is included. The document is designed primarily to provide guidance on the direct clinical care of MSM but also makes reference to the design and delivery of services with the aim of supporting clinicians and commissioners in providing effective services. Methodology This document was produced in accordance with the guidance set out in the BASHH CEG's document 'Framework for guideline development and assessment' published in 2010 at http://www.bashh.org/guidelines and with reference to the Agree II instrument. Following the production of the updated framework in April 2015, the GRADE system for assessing evidence was adopted and the draft recommendations were regraded. Search strategy (see also Appendix 1) Ovid Medline 1946 to December 2014, Medline daily update, Embase 1974 to December 2014, Pubmed NeLH Guidelines Database, Cochrane library from 2000 to December 2014. Search language English only. The search for Section 3 was conducted on PubMed to December 2014. Priority was given to peer-reviewed papers published in scientific journals, although for many issues evidence includes conference abstracts listed on the Embase database. In addition, for 'Identification of problematic recreational drug and alcohol use' section and 'Sexual problems and dysfunctions in MSM' section, searches included PsycINFO. Methods Article titles and abstracts were reviewed and if relevant the full text article was obtained. Priority was given to randomised controlled trial and systematic review evidence, and recommendations made and graded on the basis of best available evidence. Piloting and feedback The first draft of the guideline was circulated to the writing group and to a small group of relevant experts, third sector partners and patient representatives who were invited to comment on the whole document and specifically on particular sections. The revised draft was reviewed by the CEG and then reviewed by the BASHH patient/public panel and posted on the BASHH website for public consultation. The final draft was piloted before publication. Guideline update The guidelines will be reviewed and revised in five years' time, 2022.

High levels of postmigration HIV acquisition within nine European countries

OBJECTIVE

We aimed to estimate the proportion of postmigration HIV acquisition among HIV-positive migrants in Europe.

DESIGN

To reach HIV-positive migrants, we designed a cross-sectional study performed in HIV clinics.

METHODS

The study was conducted from July 2013 to July 2015 in 57 clinics (nine European countries), targeting individuals over 18 years diagnosed in the preceding 5 years and born abroad. Electronic questionnaires supplemented with clinical data were completed in any of 15 languages. Postmigration HIV acquisition was estimated through Bayesian approaches combining extensive information on migration and patients' characteristics. CD4 cell counts and HIV-RNA trajectories from seroconversion were estimated by bivariate linear mixed models fitted to natural history data. Postmigration acquisition risk factors were investigated with weighted logistic regression.

RESULTS

Of 2009 participants, 46% were MSM and a third originated from sub-Saharan Africa and Latin America & Caribbean, respectively. Median time in host countries was 8 years. Postmigration HIV acquisition was 63% (95% confidence interval: 57-67%); 72% among MSM, 58 and 51% in heterosexual men and women, respectively. Postmigration HIV acquisition was 71% for Latin America and Caribbean migrants and 45% for people from sub-Saharan Africa. Factors associated with postmigration HIV acquisition among heterosexual women and MSM were age at migration, length of stay in host country and HIV diagnosis year and among heterosexual men, length of stay in host country and HIV diagnosis year.

CONCLUSION

A substantial proportion of HIV-positive migrants living in Europe acquired HIV postmigration. This has important implications for European public health policies.

HIV, sexual risk and ethnicity among gay and bisexual men in England: survey evidence for persisting health inequalities

OBJECTIVES

To examine ethnic group differences in HIV testing and sexual behaviours among a large sample of gay and bisexual men (GBM), 13 years after similar observations were made, assess national HIV prevention responses and inform planning priorities.

METHODS

Cross-sectional convenience self-completion online survey in summer 2014, designed and recruited in collaboration with community-based health promoters and gay internet services; comparison with earlier findings reporting on similarly designed survey in 2001.

RESULTS

We recruited 15 388 GBM living in England who self-reported as follows: 18.5% from ethnic minorities; 9.0% tested HIV positive (cf. 17.0% and 5.4% in 2001). Compared with the white British, Asian men were no longer less likely to report diagnosed HIV but had an equal probability of doing so (2001 OR=0.32, 95% CI 0.13 to 0.79; 2014 OR=1.04, 95% CI 0.71 to 1.54); black men remained significantly more likely to report diagnosed HIV (2001 OR=2.06, 95% CI 1.56 to 3.29; 2014 OR=1.62, 95% CI 1.10 to 2.36) as did men in the other white group (2001 OR=1.54, 95% CI 1.23 to 1.93; 2014 OR=1.31, 95% CI 1.10 to 1.55). Overall annual incidence of reported HIV diagnoses in 2014 was 1.1%. Black men were significantly more likely to report diagnosis with HIV in the last 12 months than the white British (adjusted odds ratios (AOR) 2.57, 95% CI 1.22 to 5.39). No minority ethnic group was more or less likely to report condom unprotected anal intercourse (CUAI) in the last year but men in the Asian, black and all others groups were more likely than the white British to report CUAI with more than one non-steady partners.

CONCLUSIONS

Among GBM in England, HIV prevalence continues to be higher among black men and other white men compared with the white British. The protective effect of being from an Asian background appears no longer to pertain. Sexual risk behaviours may account for some of these differences.

HIV risk behaviours among immigrant and ethnic minority gay and bisexual men in North America and Europe: A systematic review

HIV surveillance systems show that gay, bisexual, and other men who have sex with men (MSM) bear a disproportionate burden of HIV in North American and European countries. Within the MSM category, HIV prevalence is often elevated among ethnic minority (i.e., Latino, Asian, and Black) MSM, many of whom are also foreign-born immigrants. Little research has focused specifically on foreign-born populations, though studies that provide data on the nativity of their samples offer an opportunity to investigate the potential role of transnational migration in informing HIV risk among ethnic minority MSM. This systematic review of ethnic minority MSM studies where the nativity of the sample is known provides a robust alternative to single studies measuring individual-level predictors of HIV risk behaviour. In this review, HIV prevalence, unprotected sex, drug use, and HIV testing are analysed in relation to the ethnicity, nativity, and location of the samples included. The results, which include high rates of HIV, unprotected sex, and stimulant use in foreign-born Latino samples and high rates of alcohol and club drug use in majority foreign-born Asian Pacific Islander (API) samples, provide baseline evidence for the theory of migration and HIV risk as syndemics within ethnic minority populations in North American and European countries. The findings also suggest that further research on the contextual factors influencing HIV risk among ethnic minority MSM groups and especially immigrants within these groups is needed. These factors include ethnic networks, individual post-migration transitions, and the gay communities and substance use cultures in specific destination cities. Further comparative work may also reveal how risk pathways differ across ethnic groups.

HIV testing and prevention among foreign-born Men Who have Sex with Men: an online survey from Sweden

BACKGROUND

There is an increasing trend toward international migration worldwide. With it comes a challenge for public health and public funded health care systems to meet the migrating population's health needs. Men who have sex with men are a key population for HIV, contributing an estimated 42% of new HIV cases in Europe in 2013. HIV monitoring data suggest that foreign-born MSM are not only exposed to a high risk of HIV before migration but also while living in Sweden. The aim of this study is to examine HIV testing prevalence and uptake of HIV prevention interventions among foreign-born MSM living in Sweden.

METHODS

A web survey available in English and Swedish was conducted from October 1 to October 30, 2013 via a Scandinavian Web community for Lesbian, Gay, Bisexual, Transgender and Intergender people. The web survey included modules on sociodemographics, condom use, sexual risk behaviour and HIV/STI testing experience. 244 eligible MSM participants born abroad and living in Sweden participated in the study. Descriptive and inferential analysis was performed.

RESULTS

Half of the foreign-born MSM participants in this study had been tested for HIV during the last 12 months. Participants who had lived in Sweden less than or equal to 5 years were more likely to have been tested for HIV during the last 12 months. Having talked about HIV/STI with a prevention worker during the past year was associated with having been tested for HIV. Requested services among the majority of participants were HIV rapid test, anonymous HIV testing, HIV/STI testing outside of the health care setting and MSM-friendly clinics.

CONCLUSION

Efforts are needed to promote HIV testing among foreign-born MSM. Peer outreach, individual and group counselling may be preferred interventions to do so. In addition, it is critically important to increase HIV testing among foreign-born MSM who have lived in Sweden for more than five years. Further research should explore if scale up of implementation of requested services may increase frequency of HIV testing and detection of new cases linked to treatment among foreign-born MSM living in Sweden.

Views about HIV/STI and health promotion among gay and bisexual Chinese and South Asian men living in Auckland, New Zealand

Ethnic minority gay, bisexual, and other men who have sex with men (MSM) are considered to have a high risk for HIV infection. The aim of this study was to identify some of the ways Chinese and South Asian MSM talk about and understand issues related to HIV/STI and health promotion, as well as highlighting some of this group's health promoting behaviours. A qualitative study using face-to-face interviews with 44 Chinese and South Asian MSM living in Auckland, New Zealand, was undertaken. Following data analysis, four major themes were identified: the importance of condoms, condom use, HIV/STI practices, and HIV health promotion. The results showed that the men interviewed had a good understanding of the benefits of using condoms for anal sex. They also reported strong recall of the local HIV health promotion campaigns which seek to influence men's behaviours through promotion of a single, unequivocal message to always use a condom for anal sex. The men however did not always report consistent condom use, and a range of reasons why this happened were identified. Among the men who discussed testing practices, regular testing was much more likely to have occurred in men who have lived in New Zealand for more than 5 years. These results suggest that future health promotion initiatives should be tailored to ensure the needs of Chinese and South Asian MSM are appropriately addressed when promoting condom use for anal sex.

An analysis of socio-demographic and behavioural factors among immigrant MSM in Montreal from an HIV-testing site sample

Little Canadian research exists on immigrant men who have sex with men (MSM), who are internationally reported to use rapid HIV-testing sites. Our objective was to describe immigrant MSM in a sample of clients at an HIV testing site. From July 2012 to November 2013, clients at Actuel sur Rue (AsR), a Montreal-based HIV rapid-testing site, provided data for a staff- and a self-administered questionnaire. We compared immigrant and non-immigrant MSM's socio-demographics and risk practices. Among immigrants, we analyzed these variables by country of origin. We conducted regression analyses examining how immigrant status and socio-demographics were associated with risk practices. During the study, 1353 MSM visited AsR and 407 (30%) were immigrants, mostly from Europe, Latin America/Caribbean, and Africa/Middle-East. The same proportion (2%) of immigrant and non-immigrant MSM received a positive rapid HIV test result. Relative to non-immigrant MSM, significantly more immigrant MSM reported a post-secondary degree, a lower income, and being unemployed. Fewer reported receiving an HIV-positive/unknown-status partner's sperm/blood in their mouth, ever having unprotected sex with an HIV-positive partner, and ever selling sex. In comparisons between MSM immigrants by origin, fewer Asian and African/Middle-Eastern MSM reported ever testing for HIV. In the regression analyses, immigrant status was not independently associated with sexual risk. MSM who earned less, were unemployed, or had a high school degree or less were more likely to have sold sex. Socio-demographics like employment, education and income were associated with reported sexual risk in MSM clients, but not immigrant status alone.

HIV Infection in Migrant Populations in the European Union and European Economic Area in 2007-2012: An Epidemic on the Move

BACKGROUND

Migrants are considered a key group at risk for HIV infection. This study describes the epidemiology of HIV and the distribution of late HIV presentation among migrants within the European Union/European Economic Area during 2007-2012.

METHODS

HIV cases reported to European Surveillance System (TESSy) were analyzed. Migrants were defined as people whose geographical origin was different than the reporting country. Multiple logistic regression was used to model late HIV presentation.

RESULTS

Overall, 156,817 HIV cases were reported, of which 60,446 (38%) were migrants. Of these, 53% were from Sub-Saharan Africa, 12% from Latin America, 9% from Western Europe, 7% from Central Europe, 5% from South and Southeast Asia, 4% from East Europe, 4% from Caribbean, and 3% from North Africa and Middle East. Male and female migrants from Sub-Saharan Africa and Latin America had higher odds of late HIV presentation than native men and women. Migrants accounted for 40% of all HIV notifications in 2007 versus 35% in 2012. HIV cases in women from Sub-Saharan Africa decreased from 3725 in 2007 to 2354 in 2012. The number of HIV cases from Latin America peaked in 2010 to decrease thereafter. HIV diagnoses in migrant men who have sex with men increased from 1927 in 2007 to 2459 in 2012.

CONCLUSIONS

Migrants represent two-fifths of the HIV cases reported and had higher late HIV presentation. HIV epidemic in migrant populations in European Union/European Economic Area member states is changing, probably reflecting the global changes in the HIV pandemic, the impact of large-scale ART implementation, and migration fluctuations secondary to the economic crisis in Europe.

Hispano-Americans in Europe: what do we know about their health status and determinants? A scoping review

BACKGROUND

Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry.

METHODS

We identified systematically papers that addressed the concepts "health" and "Hispano Americans" indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process.

RESULTS

Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of cross-sectional descriptions that considered "Hispano-Americans" as a homogeneous category, limiting our analysis. Our results are also constrained by the availability and varying quality of studies reviewed.

CONCLUSIONS

Burgeoning research has produced some consistent findings but there are huge gaps in knowledge. To prevent unhelpful generalisations we need a more holistic and nuanced understanding of how mobility, ethnicity, income, gender, legislative status, employment status, working conditions, neighbourhood characteristics and social status intersect with demographic variables and policy contexts to influence the health of the diverse Hispano-American populations present in Europe.

Sexual behaviour and HIV prevention needs of men attending a suburban Sex on Premises Venue

Background Sexual behaviour and HIV prevention needs of men who have sex with men (MSM) attending suburban Sex on Premises Venues (SOPVs) are understudied. Methods: A cross-sectional survey examining sexual activity, health services utilisation, sexual health services needs and STI knowledge was conducted among MSM over 18 years old attending a SOPV in Western Sydney between June and July 2013. Results: A total of 213 MSM were sampled; approximately half of the respondents (51%) reported that they only had sex with other men, and 46% had sex with both men and women. Condom use varied considerably, with ~50% of responders not using condoms consistently during anal sex. Consistent condom usage was not associated with having regular, casual or a mix of regular and casual partners during anal sex (P = 0.09). The majority (59.5%) obtained sexual health screening services from general practitioners; only 15.0% sought services from a local sexual health clinic. Over half of respondents (57.7%) believed that SOPVs should offer on-site and free testing services. Those with the highest level of previous STI diagnoses were gay men (41%), those who only had casual partners (38%) and those who did not complete high school (65%). Conclusions: Sexual health services and non-government organisations should consider targeting bisexual men with rapid HIV testing and condom usage campaigns. Low cost or free on-site HIV and STI testing at SOPVs and stronger partnerships between general practitioners and sexual health services are needed.

Internet-based cohort study of HIV testing over 1 year among men who have sex with men living in England and exposed to a social marketing intervention promoting testing

OBJECTIVES

Increasing HIV testing among men who have sex with men (MSM) is a major policy goal in the UK. Social marketing is a common intervention to increase testing uptake. We used an online panel of MSM to examine rates of HIV testing behaviour and the impact of a social marketing intervention on them.

METHOD

MSM in England were recruited to a longitudinal internet panel through community websites and a previous survey. Following an enrolment survey, respondents were invited to self-complete 13 surveys at monthly intervals throughout 2011. A unique alphanumeric code linked surveys for individuals. Rates of HIV testing were compared relative to prompted recognition of a multi-part media campaign aiming to normalise HIV testing.

RESULTS

Of 3386 unique enrolments, 2047 respondents were included in the analysis, between them submitting 15,353 monthly surveys (equivalent to 1279 years of follow-up), and recording 1517 HIV tests taken, giving an annual rate of tests per participant of 1.19 (95% CI 1.13 to 1.25). Tests were highly clustered in individuals (61% reported no test during the study). Testing rates were higher in London, single men and those aged 25-34 years. Only 7.6% recognised the intervention when prompted. After controlling for sociodemographic characteristics and exposure to other health promotion campaigns, intervention recognition was not associated with increased likelihood of testing. Higher rates of testing were strongly associated with higher number of casual sexual partners and how recently men had HIV tested before study enrolment.

CONCLUSIONS

This social marketing intervention was not associated with increased rates of HIV testing. More effective promotion of HIV testing is needed among MSM in England to reduce the average duration of undiagnosed infection.

Clinical and epidemiological features of HIV/AIDS infection among migrants at first access to healthcare services as compared to Italian patients in Italy: a retrospective multicentre study, 2000-2010

PURPOSE

Migrants account for approximately 8.7% of the resident population in Italy. The immigration status deeply influences access to prevention and care, thus contributing to increase the burden of HIV/AIDS among such a fragile category. The aim of this study was to investigate socio-demographic and baseline clinical and immunological features of HIV-infected migrants, as compared to Italians.

METHODS

We retrospectively analysed data for all the 1,611 HIV-infected migrant patients and a random sample of 4,230 HIV-infected Italian patients aged 18 or older who first accessed nine Italian clinical centres in 2000-2010 and were followed up at least 1 year. Differences in baseline characteristics between migrants and Italians were evaluated in univariate analysis, while factors associated with late presentation were evaluated in multivariate analysis using logistic regression models.

RESULTS

The baseline profile differs between the HIV-infected migrant and Italian patients, substantially reflecting what reported by current statistics in terms of gender, age, risk category as well as clinical features. Late presenters were more frequent among migrants as compared to Italians (53.0 vs 45.8%; adjusted odds ratio [(AOR) = 1.55, 95% confidence interval (CI) 1.34-1.78]. Other factors associated with late presentation included increasing age, as well as undocumented legal status among foreign-born subjects (AOR = 1.41, 95% CI 0.97-2.04), though of borderline significance.

CONCLUSIONS

Late presentation still represents a relevant problem despite the advances in the management of HIV infection. More efforts are needed to allow early diagnosis and access to care among the most vulnerable, such as undocumented foreign-born subjects in a country where migration flows are on the rise.

Factors associated with recent HIV testing among younger gay and bisexual men in New Zealand, 2006-2011

Background

Understanding HIV testing behaviour is vital to developing evidence-based policy and programming that supports optimal HIV care, support, and prevention. This has not been investigated among younger gay, bisexual, and other men who have sex with men (YMSM, aged 16-29) in New Zealand.

Methods

National HIV sociobehavioural surveillance data from 2006, 2008, and 2011 was pooled to determine the prevalence of recent HIV testing (in the last 12 months) among YMSM. Factors associated with recent testing were determined using manual backward stepwise multivariate logistic regression.

Results

Of 3,352 eligible YMSM, 1,338 (39.9%) reported a recent HIV test. In the final adjusted model, the odds of having a recent HIV test were higher for YMSM who were older, spent more time with other gay men, reported multiple sex partners, had a regular partner for 6-12 months, reported high condom use with casual partners, and disagreed that HIV is a less serious threat nowadays and that an HIV-positive man would disclose before sex. The odds of having a recent HIV test were lower for YMSM who were bisexual, recruited online, reported Pacific Islander or Asian ethnicities, reported no regular partner or one for >3 years, were insertive-only during anal intercourse with a regular partner, and who had less HIV-related knowledge.

Conclusion

A priority for HIV management should be connecting YMSM at risk of infection, but unlikely to test with appropriate testing services. New generations of YMSM require targeted, culturally relevant health promotion that provides accurate understandings about HIV transmission and prevention.

What constitutes the best sex life for gay and bisexual men? Implications for HIV prevention

Background

While a large body of research has sought to understand HIV transmission risk behaviours among gay men, bisexual men and other men who have sex with men (MSM), less attention has been paid to the wider sexual health and well-being of this population. While some community-based organisations aim to support a more holistic sense of sexual well-being there is little evidence to draw on to inform their interventions. The current study sought to explore gay and bisexual men’s conceptions of what constitutes the ‘best sex’.

Method

The EMIS survey of 2010 recruited more than 180,000 respondents from 38 European countries to complete an online questionnaire about sexual health and behaviour. The 12,942 English language, UK-based responses to the open ended question, “What’s your idea of the best sex life?” were subjected to a detailed content analysis. A framework was devised to reflect and describe the key themes emerging from the data, which was then used to code all responses to one (or more) of these themes. Further statistical analysis sought to establish if and how responses differed according to key demographic variables.

Results

Eight themes emerged that capture the diversity of gay and bisexual men’s sexual desires. Most common among responses was a desire for sex within committed relationships, followed by a desire for sex which is emotionally or psychologically connected. Men also expressed a desire for volume and variety in their sexual lives, and for sex that is free from physical, social or psychological harm. Comparative analysis identified that older men were less likely to idealise a relationship or emotional connection, but were more likely to specify the sexual acts or behaviours they wished to engage in.

Conclusions

Attending to what men value or aspire to can help ensure interventions are engaging and meaningful to the target population. HIV prevention interventions need to attend to the broad range of sexual desires held by gay and bisexual men in delivery of holistic sexual health promotion that can help them to have the best sex with the least harm.

Circumcision and HIV infection among men who have sex with men in Britain: the insertive sexual role

The objective was to examine the association between circumcision status and self-reported HIV infection among men who have sex with men (MSM) in Britain who predominantly or exclusively engaged in insertive anal intercourse. In 2007-2008, a convenience sample of MSM living in Britain was recruited through websites, in sexual health clinics, bars, clubs, and other venues. Men completed an online survey which included questions on circumcision status, HIV testing, HIV status, sexual risk behavior, and sexual role for anal sex. The analysis was restricted to 1,521 white British MSM who reported unprotected anal intercourse in the previous 3 months and who said they only or mostly took the insertive role during anal sex. Of these men, 254 (16.7 %) were circumcised. Among men who had had a previous HIV test (n = 1,097), self-reported HIV seropositivity was 8.6 % for circumcised men (17/197) and 8.9 % for uncircumcised men (80/900) (unadjusted odds ratio [OR], 0.97; 95 % confidence interval [95 % CI], 0.56, 1.67). In a multivariable logistic model adjusted for known risk factors for HIV infection, there was no evidence of an association between HIV seropositivity and circumcision status (adjusted OR, 0.79; 95 % CI, 0.43, 1.44), even among the 400 MSM who engaged exclusively in insertive anal sex (adjusted OR, 0.84; 95 % CI, 0.25, 2.81). Our study provides further evidence that circumcision is unlikely to be an effective strategy for HIV prevention among MSM in Britain.

Sexual mixing and HIV risk among ethnic minority MSM in Britain

We conducted a cross-sectional online survey of men who have sex with men (MSM) living in Britain in 2007-2008 to examine sexual mixing among ethnic minority MSM. The sample comprised 115 black, 112 South Asian, 47 Chinese and 4,434 white MSM who reported unprotected anal intercourse (UAI) in the previous 3 months. In each ethnic minority group, MSM were three times more likely to report UAI with a partner of the same ethnicity than would be expected by chance alone (χ(2) > 8.43, p < 0.05). Nonetheless, most (>80 %) ethnic minority MSM reported UAI with men from an ethnic group other than their own. In multivariable analysis there was statistical evidence that, compared with white British MSM, self-reported HIV seropositivity remained low for South Asian and Chinese MSM after adjusting for UAI with partners of the same ethnicity (e.g. South Asian MSM, adjusted odds ratio 0.35, 95 % CI 0.19-0.66). This analysis suggests that differences in self-reported HIV seropositivity between ethnic minority and white MSM in Britain cannot be explained by sexual mixing with partners from the same ethnic group.