Interventions

• Author: Ford Hickson - Axel J. Schmidt - David S. Reid - Peter Weatherburn - Ulrich Marcus - Susanne B. Schink
• Pages: 91-109

TECHNICAL REPORT EMIS-2017 – The European Men-W ho-Have-Sex-With-Men Internet Surv ey

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7. Interventions

To intervene is to participate in an activ ity so as to alter a cou rse of events, usually to make something less or

more likely to occur. Within EMIS, relevant interventio ns are the actions of oth ers that meet or undermin e the

health promotion needs de scribed in Chapter 6.

Interventions can be posit ive (meeting needs) or ne gative (undermining needs and generating unmet need).

Positive interventions include education, health and so cial services, as well as th e myriad ways in which com munity

members help each other. Negative interventions include homophobic legisl ation, exclusion and abu se.

7.1 Summary

• Homophobic abuse: intimida tion, insults, and viol ence – in the last 12 months, 3% of participants had been

physically assaulted; 21% had been verbally insu lted and 27% had been i ntimidated because someo ne had

known or presumed they w ere attracted to men.

• Access to free condoms – one thi rd (32%) of participants reported having received f ree condoms from civil

society organisations, clin ics, bars, or saunas i n the last 12 month s.

• HIV/STI education services – the majority (88%) who answered the question h ad seen MSM-specific

information about HIV or STIs in the last year and more than half (57%) had done so in the last four weeks.

• Substance use services – less than 5% had ev er consulted a health pr ofessional in relation to their dr ug use

or alcohol use concerns.

• PrEP (Pre-Exposure Prophylaxi s) services – among partici pants without diagnos ed HIV, less than 10% sa id

that someone at a health servi ce in their country of residence had t alked to them about Pr EP. However, 79%

of PrEP users received m edical counselling befor e starting PrEP, and ju st over half of PrEP users had received

a medical prescription fo r it. All others had acquired PrEP informally, most ly by purchasing it online an d

importing it into Europe.

• HIV testing – 56% had received an HIV test result in the last 12 months, most commonly in clinical s ettings

(almost two thirds). Community-based testing accounted for just over one fifth of tests in the last year. Only

3% had used a HIV self-testing kit.

• HIV cascade of care – EMIS data contributes towards the design of the last four stages of t he HIV care

cascade: linked to care, retained in care, on ART, undetectable viral loa d. Among HIV-diagnosed partici pants,

the second and third of UNAIDS’ three 90-90-90 go als were reached acro ss the European Union , in EFTA

countries and in Israel, but not in other ENP countries, the EU enlargement area, or Russia.

• STI testing services – almo st half (46%) had test ed for STIs other than HIV in the last 12 mont hs. In total,

92% of STI-testing featured a bloo d test (for syphilis or H CV), but only 37% inclu ded anal swabbing. A

physical examination of genitalia or the perian al region was uncommon. A full STI screen, defin ed as an HIV-

test, a blood test for S TIs, a urine sample or u rethral swabbing, and anal swabbing during the la st year was

reported by 13% of non-HIV-d iagnosed participants.

• Partner notification for syphilis and gonorrhoea diagnoses – th e majority of participant s diagnosed with eith er

syphilis or gonorrhoea in formed at least some of their sexual partners th at they needed to seek a test or

treatment.

• Viral hepatitis vaccination – despi te existing recommendati ons regarding hepatiti s A and B vaccination in most

of the countries included, only just over half said they had ever been offered a hepatitis vaccination in a

healthcare setting; 43% re ported a full course of vaccination against hep atitis A; and 49% reported a full

course of hepatitis B.

7.2 Homophobic abuse: intimidation, insults and violence

We asked about one negative inter vention – homophobic abuse. Homophobic abuse under mines all health-related

needs. It causes isolatio n and anxiety as well as physical harm.

All men were asked ‘When wa s the last time you…’ followed by three stat ements:

• ‘…were stared at or intimid ated because someone kn ew or presumed you are attracted to men? ‘

• ‘…had verbal insults directe d at you, because someone knew or presumed you ar e attracted to men?’

• ‘…were punched, hit, kick ed, or beaten because som eone knew or presumed yo u are attracted to men? ’

For each statement, men were o ffered a scale to indicate ho w recently this had occ urred. The cumulative

percentages for having exp erienced each event within each time period are shown in Figure 7.1.

EMIS-2017 – The European Men-Who -Have-Sex-With-Men Internet Surv ey TECHNICAL REPORT

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Figure 7.1 Cumulative recency of homophobic abuse

In the last 12 months, 3% had been physically ass aulted (N=127 296, missing n=49 6), 21% had been verbally

insulted (N=127 255, missi ng n=537) and 27% ha d been intimidated because someone had known or pr esumed

they were attracted to men (N =127 285, missing n=507).

7.3 Access to condoms

Condom distribution is a key intervention for increasin g access to condoms, an d condom packs often ca rry health

promotion information on or inside their packaging.

All men were asked ‘Where h ave you got condoms from in th e last 12 months?’ and were asked to tick as many a s

responses as were appropriat e from the range of sources in the table below. Men who indicated they obtained

condoms from any source were al so asked ‘Where have you most commonly got condoms from in th e last 12

months?’ and asked to ind icate one of these sou rces.

Table 7.1 Sources of condoms in the last 12 months and most common source

Where have you got condoms from…?

Tick as many as apply

% in last 12 months

(N=127 206,

missing n=586)

% most commonly

(N=107 487,

missing n=375)

Bought at a physical shop (not online)

52.8

53.3

Free from gay bars or clu bs

17.2

8.7

From friends or sex partn ers

15.2

6.1

Bought online

12.7

11.2

Free from gay or HIV community organisations

11.5

5.9

Free from saunas

10.8

4.6

Free from clinics

9.9

4.8

Bought from a vending machine

5.3

3.0

Other answer

2.6

2.3

I have not got condoms in the last 12 months

15.2

–

The most common source of condoms was buying them fro m a physical shop, which was the most commonly used

source for over half the men. The other half relied o n a range of sources, with no single source being the most

commonly used by more than 10%, except for the purcha se of condoms online (11%).

The Dublin Declaration Monitoring indicator #3.1a aims to monitor MSM condom promotion and distribution

coverage. We constructed this indic ator by combining free con doms from civil society organisations, clinics, bars, or

saunas. Overall, 32% reporte d receiving condoms from an y of these sources in th e last year.

24 hrs 7

days 4 wks 6

mths

12

mths 5 yrs Ever

stared at/intimidated 2.1 6.3 11.3 19.6 27.4 40.6 56.3

verbal insults 1.1 3.3 6.5 13.5 20.8 36.8 57.6

punched, hit, kicked, beaten 0.2 0.4 0.7 1.5 2.5 6.4 16.6

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

100.0

Cumulative % of all respondent s