HIV risk behaviour knowledge, substance use and unprotected sex in men who have sex with men in Tallinn, Estonia

Substance Use and Misuse among Sexual and Gender Minority Communities Living in Former Soviet Union Countries: A Scoping Review

Objectives

We reviewed literature examining substance use among sexual and gender minorities (SGM) living in the former Soviet Union (USSR) nations.

Methods

Searches were conducted across five databases (PubMed, SocINDEX, CINAHL, PscyInfo, LGBTQ + Source) to identify peer-reviewed literature.

Results

Across 19 studies, high hazardous substance use prevalence was documented. Substance use was correlated with (a) sexual health and behaviors and (b) mental wellbeing and the use of other substances.

Conclusion

We discuss minority stress implications and challenges presented by the paucity of evidence in the literature examining substance use among SGM women and SGM living in countries unrepresented in reviewed studies.

Knowledge of HIV infection and other sexually transmitted diseases among men who have sex with men in Finland

Background

The purpose of this study was to describe what is known about HIV infection and other sexually transmitted diseases, infection transmission routes, care, and sources of information, from the viewpoint of men having sex with men.

Methods

National data (n = 2,072) was collected from June to August 2010 in Finland as part of a joint internet-based survey conducted in 38 countries (EMIS, European MSM Internet Sex Survey).

Results

The respondents’ age, place of residence, highest education and employment status were statistically significantly related to how often the respondent sought information on HIV, testing and treatments, and what they knew about infection transmission routes. The respondents’ information seeking behavior was not seen as active regarding HIV infection and other sexually transmitted diseases.

Conclusions

We should also consider the possibility of using internet-based interventions, especially in smaller and northern catchment areas, in order to improve the knowledge level of men having sex with men.

HIV and STI Testing and Related Factors Among Men Who Have Sex with Men in Estonia

HIV and sexually transmitted infections (STI) testing rates among men who have sex with men (MSM) in Estonia are low. We collected data from 265 MSM in a national, online survey. Lifetime HIV testing was related to risky sexual behaviors and contacts with health care services, while lifetime STI testing was related only to contacts with health care services. In addition, some personal values were significant predictors of testing. For example, high achievement (personal success through demonstrating competence according to social standards) had a negative impact on lifetime HIV testing, and high interpersonal conformity (avoiding upsetting others) had a negative impact on lifetime STI testing. The results demonstrate the need to develop gay-friendly health services and to recognize the role of personal values and individual differences in values when designing attractive interventions to increase HIV/STI testing rates among MSM.

Outcomes associated with anxiety and depression among men who have sex with men in Estonia

BACKGROUND

Evidence supports that gay, lesbian, and transgender populations are at increased risk for mental health problems. The current study was conducted to estimate the prevalence of anxiety and depressive symptoms and related factors among men who have sex with men (MSM) in Estonia. This is the only known study of its type in the Eastern European region.

METHODS

In 2013, an Internet-based survey was conducted among men who have sex with men, collecting data on socio-demographics, sexuality, drug and alcohol use, mental health, suicidality, and internalized homonegativity.

RESULTS

265 MSM completed the questionnaire (median age 31 years, 90% Estonian, 71% from the capital; 73% employed full-time, 42% with at least college education; 44% in a steady relationship; 72% gay, 23% bisexual; 23% reported illegal drug use in the last 12 months). One third met criteria for problem drinking and depressive symptoms with one quarter for anxiety symptoms. Suicidality was 44% reported lifetime suicidal thoughts and 11% with at least one suicide attempt.

LIMITATIONS

The study instruments, EST-Q and CAGE, only measure symptoms and are not diagnostic tests. A non-random sample which could possibly include persons with easier internet access. Self-reported data and cross-sectional study design are prone to issues with recall bias and temporality.

CONCLUSIONS

With demonstrated high rates of anxiety, depression, drinking, and drug use among MSM which is consistent with similar studies in Western countries, further research could help determine effective MSM focused interventions to address the broad spectrum of issues among MSM.

Internet-based recruitment system for HIV and STI screening for men who have sex with men in Estonia, 2013: analysis of preliminary outcomes

The aim of the current project was to develop an Internet-based recruitment system for HIV and sexually transmitted infection (STI) screening for men who have sex with men (MSM) in Estonia in order to collect biological samples during behavioural studies. In 2013, an Internet-based HIV risk-behaviour survey was conducted among MSM living in Estonia. After completing the questionnaire, all participants were offered anonymous and free-of-charge STI testing. They could either order a urine sample kit by post to screen for chlamydia infections (including lymphogranuloma venereum (LGV)), trichomoniasis, gonorrhoea and Mycoplasma genitalium infections, or visit a laboratory for HIV, hepatitis A virus, hepatitis B virus, hepatitis C virus and syphilis screening. Of 301 participants who completed the questionnaire, 265 (88%), reported that they were MSM. Of these 265 MSM, 68 (26%) underwent various types of testing. In the multiple regression analysis, Russian as the first language, previous HIV testing and living in a city or town increased the odds of testing during the study. Linking Internet-based behavioural data collection with biological sample collection is a promising approach. As there are no specific STI services for MSM in Estonia, this system could also be used as an additional option for anonymous and free-of-charge STI screening.

HIV prevalence, sexual and HIV testing behaviors among men who have sex with men in the Republic of Cyprus: 2011-2012 data from a cross-sectional study

Background

The Republic of Cyprus is recognized as a low level HIV epidemic country with strong evidence of an increase in the transmission through the male to male sexual contact. Little is known about the factors that influence the sexual and HIV testing behavior in the Republic of Cyprus.

Methods

This is the first bio-behavioral study among men who have sex with men (MSM) in three major cities in the Republic of Cyprus, conducted between 2011 and 2012. Eligible participants were sampled in gay venues by using time-location sampling.

Results

Estimated HIV prevalence was 2.5%. The mean age of the sample was 29 ± 6.6 years old. One out of three MSM has not been tested for HIV in the last year. Multivariate logistic regression analysis revealed that the educational level (AOR 0.23, 95% CI 0.09-0.55), the cocaine use (AOR 3.78, 95% CI 1.21-11.83) as well as the type of sexual partner i.e. steady vs casual (AOR 0.18, 95% 0.08-0.45) were significantly associated with condom use in the last anal intercourse.

Conclusions

HIV prevalence among MSM in the Republic of Cyprus remains low; however more efforts are needed in order to increase HIV awareness and prevent the expansion of HIV epidemic in broader community.

Conversation about Serostatus decreases risk of acquiring HIV: results from a case control study comparing MSM with recent HIV infection and HIV negative controls

Background

Data on knowledge, attitudes, behaviour and practices (KABP) of persons with recent HIV infection compared to controls with negative HIV test result provide information on current risk patterns and can help to re-focus HIV prevention strategies.

Methods

From March 2008 through May 2010, persons newly diagnosed with HIV (cases) and HIV-negative controls were recruited by physicians in Germany. To distinguish recent (< 5 months) from longstanding (> 5 months) infection, dried blood spots from people newly diagnosed with HIV were tested with the BED IgG-capture ELISA. Cases and controls completed a KABP-questionnaire. We compared cases with recent infection and controls among men having sex with men (MSM) regarding reported risk behaviour in the previous 6 months. To detect differences, unadjusted Odds Ratios (OR) were calculated and multivariate analysis was performed.

Results

Cases and controls did not differ in terms of knowledge on transmission risks, HIV testing frequency, partnership status, or regarding the frequency of any unprotected sex with partners known to be HIV-positive or assumed to be HIV-negative. Cases more often reported a shorter duration of partnership (< 6 months) with a primary partner than controls (OR = 3.9; p = 0.003) and indicated lower rates of condom use outside of primary relationships, with acquaintances (OR = 2.5; p = 0.01), and with persons met online (OR = 4.5; p = 0.04). Unprotected sex with persons of unknown HIV-serostatus was more often indicated by cases than controls (OR = 3.0; p = 0.003). Having a conversation about HIV serostatus before having sex was associated with a lower risk of infection (OR = 0.2; p = 0.01). In multivariate analysis “being always safe” (always using a condom when having sex in different situations outside of a relationship) and talking about serostatus before sex (OR = 0.23; p = 0.004; OR = 0.14; p = 0.014) were negatively associated with HIV- infection.

Conclusions

There were no significant differences regarding knowledge about HIV-transmission risks among cases and controls. Differences in risk behaviour were observed regarding unprotected sex with partners of unknown HIV-serostatus and duration of primary partnership at the time of diagnosis, suggesting some HIV-transmissions occurring in newly formed partnerships. The practice of discussing serostatus with prospective sex partners before engaging in sex seems to be protective for HIV-transmission.

Piloting HIV rapid testing in community-based settings in Estonia

BACKGROUND

In the European Union it is estimated that up to 30% of HIV-infected people are not aware of their status. Community-based testing (CBT) models are implemented to increase the uptake of HIV testing.

AIMS

The aim of this project was to assess the feasibility and acceptance of HIV rapid testing in CBT settings in Estonia to identify non-clinical recruitment venues for people more likely to engage in high-risk behaviours.

METHODS

Participants for this anonymous, cross-sectional study were recruited from a syringe exchange programme and gay-oriented locations using convenience sampling. Socio-demographic and HIV testing preferences data were collected using a semi-structured questionnaire. HIV rapid testing was performed using Determine HIV-1/2 (Abbott) rapid test system.

RESULTS

With a participation rate of 88.3%, this project enrolled 308 persons and identified 58 preliminary positive cases. Out of them, 52 reported injecting drug use in last 12 months and 30 reported no previous HIV test. Approximately 45% of all participants preferred rapid testing while 25% reported a preference for a full blood test.

CONCLUSIONS

This project demonstrates that HIV rapid testing in community-based settings in Eastern Europe can be an effective approach for reaching people who engage in high-risk behaviours and increasing the number of HIV-infected people who are aware of their status.

Review of HIV vulnerability and condom use in central and eastern Europe

The epidemiological trend of increasing HIV incidence rates due to sexual transmission in central and eastern Europe has been documented. The current review analysed research articles that report on a wide spectrum of vulnerable populations from this world region. Studies of injection drug users, commercial sex workers, men who have sex with men, adolescents and young adults all reported inconsistent condom use. However, these patterns varied across populations and geographic areas. Populations in former Soviet countries - the most affected by HIV - also often appeared to have lower condom use rates. Intensified, comprehensive and locally tailored measures to curb sexual HIV transmission are urgently needed. Social development programs need to incorporate HIV prevention.

Estonia at the threshold of the fourth decade of the AIDS era in Europe

This article describes the trends of HIV/AIDS and related conditions in Estonia during the past decade (2000-2009), with special focus on the potential for epidemic transition. Key transmission determinants and major risk groups are examined and problems and barriers to fighting HIV/AIDS with possible applications in prevention and control are described. Estonian routine data sources and published literature were reviewed, supplemented with information from personal communication with physicians and public health specialists. For comparative European data, international HIV/AIDS and drug addiction surveillance documents, administrative data, and published literature were reviewed. In Eastern Europe (including Estonia) the predominant HIV transmission mode is injection drug use (IDU), closely followed by heterosexual transmission, an increasing risk factor for new cases. Although the contribution of cases acquired by sexual contact with high-risk partners such as IDUs is not known, characteristics of the sexual networks of IDUs may be important in determining the evolution of the HIV/AIDS epidemics in the region. In Estonia, despite major gaps in available data, the HIV/AIDS epidemic is still presumably confined to IDUs (and probably, to their sexual partners). In Eastern Europe, young women in IDU-non-IDU partnerships engaging in unprotected sex potentially serve as a bridge to the general population, yet knowledge of and research into the population characteristics and potential magnitude of bridging are limited. In Estonia, as in other Eastern European countries, HIV prevention and harm reduction initiatives should be tailored not only to the predominantly male HIV-positive IDU population, but also to their noninfected non-IDU female sexual partners.