Needs

• Author: Ford Hickson - Axel J. Schmidt - David S. Reid - Peter Weatherburn - Ulrich Marcus - Susanne B. Schink
• Pages: 74-90

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

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6. Needs

We define sexual health needs as the capabilities, op portunities and motivation s to engage in sexual he alth related

behaviour, both precautions and risks. A central r esearch objective of EMIS wa s to identify sexual health needs that

are commonly unmet across the population of gay m en and bisexual men and oth er MSM in order to priori tise

those needs for intervention .

EMIS asked about needs rel ated to several types of precau tionary behaviour and h ealth outcomes. It also asked

about some health needs n ot related to specific behaviour, including social support and inte rnalised

homonegativity.

6.1 Summary

• Social support – using two sub-scales of th e SPS, 7% of the whole sam ple lack reliable allia nce and 9% lack

social integration.

• Internalised homonegativit y – using the short internalised ho monegativity scale (SIHS), 12% of the whole

sample show evidence of i nternalised homonegativi ty

• Unmet need for safer sex

− 28% do not know that most STIs are easier to tr ansmit than HIV.

− 26% had condomless sex in last year solely becau se they lacked access to a condom.

− 22% are not as sexually sa fe as they want to b e.

− 17% do not find it easy t o say no to unwanted s ex.

− 17% do not know that STIs can be asymptomatic.

− 14% do not know that HIV can be transmitted from an anus or vagina through a penis durin g active

intercourse.

− 11% do not know that kis sing and saliva exchang e does not transmit HIV.

− 4% worry about their recre ational drug use.

• Unmet need for viral hepatitis vaccination

− 41% do not know that doc tors recommend vaccination a gainst hepatitis A and .B for MSM.

− 28% do not know where to get hepati tis A vaccine (and are not vaccinated against it ).

− 26% do not know where to get hepatitis B vaccine (and are not vac cinated against it).

− 25% do not know that most hepatitis is caused by viral infections.

− 24% do not know that hepatitis is an inflammation of the liver.

− 17% do not know that vaccines exist for hepatitis A and B.

• Unmet need in relation to Post-Exposure Prophylaxis (PE P)

− 65% do not know that PEP is a one-month course of anti-HIV dr ugs.

− 60% are not confident they could access PEP if they needed it.

− 50% do not know that PEP should be started as soon as possible after ex posure.

− 45% do not know that PEP attempts to stop HIV infection after exposure.

− 39% have not heard of PEP.

• Unmet need for Pre-Exposure Prophylaxis (PrEP) us e

− 80% do not know that PrEP ca n be taken intermittently prior to plan ned risk.

− 70% do not know that PrEP ca n be taken as a daily pill pro tecting against infection a s a consequence of

condomless intercourse.

− 49% do not know that PrE P involves someone witho ut HIV taking a pill pr e and post sex to prev ent HIV

infection.

− 37% have not heard of PrEP.

• Unmet need for HIV testing & treatment

− 43% do not know that peopl e on effective treatmen t cannot transmit HIV ( or undetectable =

uninfectious, U=U).

− 11% do not know that an HIV test may no t pick up HIV infectio n for a few weeks.

− 9% do not know where to get an HIV test (and have n ever had one)

− 9% do not know that there is no cure for HIV infection.

− 4% are ‘unsure’ of their HIV status.

TECHNICAL REPORT EMIS-2017 – The European Men-W ho-Have-Sex-With-Men Internet S urvey

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6.2 Unmet needs related to all health behaviour

Some health needs are no t behaviour-specific but relate to a wide range of beh aviour types and outcomes. Two

important health provision s for MSM are social support and freedom from intern alised homonegativity [27]. In

order to reduce data burden on individual respon dents (both of these scal es required multiple quest ions) men were

randomly given either two sub-scale s from the SPS (four items each for S ocial Integration and Reliable Alliance) or

the SIHS [28].

6.2.1 Lack of social support

Half of the respondents were asked these que stions at random. We used two sub-sc ales of the SPS [29] to g ive a

snapshot of social suppo rt among MSM. Men were as ked ‘Do you disagree or agre e with the following ei ght

statements?’ and were pres ented with the following eight items in a random o rder:

• There is no-one who shares m y interests and concer ns. [R]

• There are people who enjo y the same social activit ies as I do.

• There is no-one who likes to do the things I do. [R]

• I feel part of a group of people who share my at titudes and beliefs.

• There are people I can co unt on in an emergency.

• There is no-one I can depen d on for aid if I real ly need it. [R]

• There are people I can de pend on to help me if I really need it.

• If something went wrong no-one would help me. [R]

Men were instructed to rate each statement using one of four responses: Stron gly disagree; Disagree; A gree;

Strongly agree. Each respon se contributed to an o verall score (Strongly disagre e=1, Disagree=2, Agree=3 a nd

Strongly agree=4). Items a bove marked [R] were reverse scored (i.e. Strongly disa gree=4, Disagree=3, Agree=2 ,

Strongly agree=1).

The first four items measur e social integration an d the second four mea sure reliable alliance

.

Each subscale can

therefore score from 4 to 16.

Social integration is the ex tent to which people feel they belong in a grou p. The mean score on the soci al

integration sub-scale was 12.9 ( median 13) out of 16. Th e figure below shows how the scores for the entir e

sample were distributed. I deally, we would like all men to be on the extreme right.

Figure 6.1 Social integration sub-scale scores for the whole sample (N=62 754, missing n=1 013; not

asked of N=64 025)

Almost one fifth (19%) of all men scored at the top of the sc ale for social integration and 9% h ad a score below

10, an indication of soc ial alienation. The perc entage scoring below 10 in each country is given in section 6.9 and

for each of the target gro ups in Chapter 8.

Reliable alliance is the extent to which people can call on others when they are in need. The mean reliable alliance

score was 13.6 (median 14) out of 16, higher than the sco re for social integration. Figure 6.2 shows the distribution of

reliable alliance scores for the entire sample. Ideally we would like all men to be on the extreme right.

0.3 0.2 0.5 1.2

2.5

3.8

7.5

10.7

18.6

12.1 11.7 11.7

18.9

0

2

4

6

8

10

12

14

16

18

20

4 5 6 7 8 9 10 11 12 13 14 15 16

% of all

Social Integration sub-scale