Risk and precaution behaviour

• Author: Ford Hickson - Axel J. Schmidt - David S. Reid - Peter Weatherburn - Ulrich Marcus - Susanne B. Schink
• Pages: 50-73

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

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5. Risk and precaution behaviour

This chapter reports on al l activities actually undertaken by the respon dents. EMIS-2017 was mainly interested in

the behaviour that contributes to or detracts from the morbidities described in Chapter 4 – i.e. sexual health risk

and precaution behaviour.

We asked about two types of r isk behaviour (having sex, taking drugs and doing them together) and four t ypes of

precaution behaviour (taking a ntiretroviral drugs, sharing H IV status information, using condoms ,and being

vaccinated).

5.1 Summary

• HIV diagnosis and taking t reatment – 10% indicated t hey had ever been diagn osed with HIV, 94% of whom

were currently taking anti-retroviral therapies (ART). This data suggests that th e average time between

diagnosis and treatment h as declined over time. For participants diagno sed between 2001 and 200 5, the

average time specified b etween diagnosis and AR T was more than 45 months. However, it was 13 m onths for

participants diagnosed betwee n 2011 and 2015, and <5 months for participants diagnosed in 2016 or 2017.

• Post-exposure prophylaxis (PEP) – Among participants not diagnosed w ith HIV, 7% had ever tried to get P EP, 5%

had ever taken PEP and 1% had taken more than one course. A total of 28% of participants without HIV who had

tried to obtain PEP had not been able to. Among participants subsequently diagnosed with HIV, 5% had tried to

obtain PEP before their HIV diagnosis, 3% h ad taken PEP before their di agnosis and less than 1% had taken more

than one course. In all, 35% had tried to obtain PEP before their diagno sis and not been a ble to.

• Pre-exposure prophylaxis (PrE P) – Among participants n ot diagnosed with HIV 3% had ever taken PrEP, and

3% were currently using it, two-thirds of them on a daily basis. PrEP taking varie d substantially between

countries.

• Hepatitis A and B vaccination – 53% were potentially vu lnerable to hepatitis A in fection and 49% were

potentially vulnerable to hepatitis B infection.

• Sex with men – 97% had previ ously had sex with a man . The average (median) a ge of the first sexual

intercourse with a man was 18 years and the average age of first anal interc ourse was 20 years.

• In all, 95% had ever engaged in intercourse with a man, 85% in the previous year and 12% in the previous

24 hours.

• Condomless intercourse – in the last 12 months 61% had had co ndomless intercourse wi th either a steady

partner and/or a non-stea dy partner, including 23 % who had had condomless interco urse with both a steady

partner and a non-steady partner.

• Steady partners – in the last 12 months 35% had had one or m ore condomless steady pa rtners; 10% had

had a penetrative steady p artner/s and always us ed a condom; 4% had had a steady partner and no

intercourse with them; and 51% had had no steady partner.

• Non-steady partners – in the last 12 months 41% had had condomless intercourse with one or more non-

steady partners; 27% ha d had intercourse with one or more non-steady partners and always u sed a condom;

9% had had non-steady partners an d no intercourse with th em; and 23% had had no non-stea dy partners.

• Sero-sorting – participants dia gnosed with HIV were much mor e likely to have had co ndomless intercourse

with a non-steady partner who they kn ew to be positive (61 % vs 12%) or whose status they did not know

(73% versus 59%) than participan ts without diagnosed HI V.

• Undetectable viral load – 68% of participants who had not te sted HIV positive and ha d had condomless

intercourse with non-steady partners whom they knew t o have HIV indicated th at they knew their HIV

positive partner(s) had u ndetectable viral load.

• Sex with women – 47% had e ver had sex with a woman , 19% in the last five year s and 11% in the last ye ar.

Of those reporting sex w ith a woman in the last 12 months: 9% indicated they had not had intercourse; 57%

had had intercourse with one woman only and 34% had had more than one female interco urse partner.

Condom use during interc ourse with women was p olarised, with 43% never using them and 31% al ways

using them in the last 1 2 months.

• Alcohol and tobacco – alcohol was the most commonly use d drug for all time intervals, with almost universal

lifetime use (94%). A total of 37% had used it in the last 24 ho urs and 70% in the previou s week. In all, 34%

had used tobacco in the last 24 hours and 39% in th e previous week.

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

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• Illicit drug use – The most commonly used il licit drug in every t ime period was cannabis, used by 39% ever

and 13% in the last four weeks. Four other drugs ha d ever been used by between 10% and 20% of the

sample: cocaine, ecstasy, amphetamine and GHB/ GBL. Of the other drugs w e asked about (ketamine, LSD,

crystal methamphetamine, m ephedrone, synthetic cannabinoids, other sy nthetic stimulants, hero in and crack

cocaine) none had been u sed by more than 1% in the last week; 2% in th e last four weeks; or 4% in th e last

year.

• Injecting drug use – Slightl y more participants had ever injected anabolic st eroids (3%) than had inj ected

drugs to get high (2%) but both types of behaviour were rare. Half of those who had ever injected had done

so in the last year. A quarter of those who ha d ever injected had don e so with a used needl e or syringe (1%

of all).

• Combined sex and drug use – 15% had ever had chemsex, two thirds of whom (69%) had done so in the last 12

months. Multi-partner ch emsex was common, but the majority of sessions app ear to occur betw een two men.

5.2 Taking HIV treatment among men with HIV

Overall, 10% (N=13 172) indicated they had been diagnosed with HIV (see Section 4.3.1). For people diagnosed

with HIV, taking anti-retroviral treatmen t (ART) can result in undetectable levels of viral load which equ ates to a

non-infectious state. Taking H IV treatment is therefo re a type of precautionary b ehaviour to prevent HIV-

transmission for men with HIV.

5.2.1 Prevalence of HIV antiretroviral treatment taking

Men who had ever been diagnosed w ith HIV were asked ‘Have you ever taken antiretroviral treatm ent (sometimes

known as ART or HAART) for your HIV infection?’ and men who had ever taken ART were asked ‘Are you currently

taking antiretroviral treatment ?’ The percentages givin g each response are set o ut in Table 5.1

.

Table 5.1 Taking ART among men with diagnosed HIV

% ever taken ART among men with diagnosed

HIV (N=13 136, missing n=36)

% Currently taking ART of men with diagnosed

HIV (N=12 623, missing n=549)

No 5.1

No, never taken

5.3

No, not taking now

0.7

Yes

91.2

Yes

94.0

Don’t know

3.7

TOTAL

100.0

100.0

Among men with diagnosed HIV, 91% (N=13 136, missing for n=903) knew they had ever taken ART, or 95%

excluding those who did not know whether they had taken ART.

Of those who had ever ta ken ART, 99% were currently taking it. Overall, 90% (11 863/13 172) of men with

diagnosed HIV indicated th ey were currently taking ART, or 94% (11 863/12 623) excluding those who did not

know or did not answer.

5.2.2 Time between diagnosis and treatment

Men who had ever used ART were asked ‘How mu ch time was there between your HIV diagnosis and you starting

treatment?’ and were offered boxes l abelled ‘years’ and ‘ months’.

Of the men who had ever taken ART (N=11 975), 9% did n ot answer this question and 2% gave a number of

years that were more than wa s possible (i.e. greater than 33 years, which woul d be the answer for someone

diagnosed in 1984 who started treatment in 2017).

Of those for whom there was a valid answer (n=11 241), 23% indicated starting treatment within one month of

diagnosis, and 57% withi n one year of diagnosis.

EMIS-2017 data suggests that the time between diagnosis and treatment initiation has declined over time. For men

diagnosed betw een 2001 and 2005, the average time specified between di agnosis and ART was more than 4 5 months.

However, for men diagnosed between 2011 and 2015 it was 13 months and <5 months fo r men diagnosed in 2016 o r

2017. The data even reflects the interim policy of ‘hitting hard and early’ between 1996 and 2000.