Understanding the spread of HIV among men who have sex with men in Belgium: results from online and on site special surveys

Transcription

1 Understanding the spread of HIV among men who have sex with men in Belgium: results from online and on site special surveys Wim Vanden Berghe ITM HIV/AIDS center Department of Public Health Institute of Tropical Medicine, Antwerp Breach symposium 2012

2 Overview of the presentation Recent studies among MSM in Belgium: 2008 : An online study on sexual health (FAQ) 2010 : A venue-based Hiv prevalence study (FAQII) 2010 : An online European study on sexual health (EMIS) Conclusion The future

3 2008 : An online study on sexual health Department of sociology, Ghent University (Funding : FWO) In-depth interviews (N:42) Quantitative online research into the sexual lives of MSM (Dutch) (N:2983) Main conclusions : Diversity among MSM has to be acknowledged, there is not 1 group Meeting through the Internet and on specific meeting places holds greater risk for acquiring HIV infection Brussels and Antwerp are attraction poles for those with riskier sexual behaviour Serosorting among Hiv positive MSM is associated with more STI s High depression scores, High drug use

4 Factors associated with UAI and depressive feelings (multivariate): Unprotected anal intercourse Not having a steady relationship More sexual sensation seeking Less social support More lifetime sex partners More sex partners in the last 6m A lower risk perception of the sexual life Less social norms regarding condom use (peers, related to venues) Depressive feelings Not having a steady relationship More sexual sensation seeking Less social support More lifetime sex partners

5 2010 : A venue-based prevalence study Institute of Tropical Medicine, Antwerp (Funding : Flemish government) A venue-based HIV prevalence and behavioural study among MSM in Flanders (N:658) D Cruising venues General venues Young MSM venues *W Vanden Berghe, C Nöstlinger, A Buvé, G Beelaert, K Fransen, M Laga; Eurosurveillance, Volume 16, Issue 28, 14 July 2011, A venue-based HIV prevalence and behavioural study among men who have sex with men in Antwerp and Ghent, Flanders, Belgium, October 2009 to March 2010

6 2010 : A venue-based prevalence study Main conclusions : 14,3% of the men who tested HIV positive are unaware of their serostatus 38,7% of MSM in a steady relationship have casual sex partners Majority had 2 to 5 sex partners during the last year, MSM in cruising venues more than 10 72,1% always uses condoms with casual partners. Condom use with casual partners among the Hiv positive men is 44% 52,2% had an HIV test, 57,4% had an STI test in the last 12 months 1 in 5 MSM in the Antwerp venues have another nationality, mostly Dutch Co-infection with STI s among Hiv positive men High drug use

7 HIV among MSM : More than a local epidemic

8 The European MSM Internet Survey (EMIS) Objective: To harmonise European online sexual health research among MSM 38 countries (EU and neighbouring countries) - 25 different languages More than men participated => Belgium: 4140

9 European comparison : UNGASS (GARP- indicators) For Belgium: Hiv test in the last 12 months: -Second highest percentage of MSM are tested in the year (48.8%) (after France) -However under 25 years old : percentage drops to 38,7% Reach of HIV prevention: Similar percentage (75%) than neighboring and Western European countries Correctly identifying ways of HIV transmission: Belgian MSM score low compared to similar countries (37%) Other indicators: -Condom use during last anal contact (54%) -Positive Hiv diagnosis for those tested (10,4%) => similar percentages but high self reported Hiv prevalence among MSM for Western European countries

10 Belgian sample Total N (Belgium) N Discrepancies Total (Belgium) % Sampled through Gayromeo % Brussels ,9 65 Flanders ,8 57 Wallonia ,6 49 Missing 361 8,7 Age (mean) Education (% High) Unemployed (%) Relationship (%) Total (Belgium) 34,8 66,2 5,7 45,8 Brussels 35,8 78,5 5,7 47,3 Flanders 34,5 61,8 4,1 45,8 Wallonia 33,7 55,2 8,8 43,6

11 UNGASS 23 - % diagnosed positive (among tested) n= ,3 10,4 9, , Belgium Brussels Flanders Wallonia

12 ,2 UNGASS 9 - % reached with prevention programmes n= ,1 75, , Belgium Brussels Flanders Wallonia

13 45 40 UNGASS 14 - % correctly identifying ways of transmission n= ,2 39,1 36, Belgium Brussels Flanders Wallonia

14 60 % sex abroad in the last 12m n= , , , Belgium Brussels Flanders Wallonia

15 60 % UAI with non-steady partner in the last 12m n= , ,2 23, Total Diagnosed positive Untested/Latest test negative

16 % condom use and HIV concordancy last sex n= ,5 42,2 42,2 42, , ,3 24, , ,4 6,7 7,2 6,2 0 No anal intercourse with the last non-steady male partner Protected anal intercourse UAI with presumingly concordant partner Total Diagnosed positive Untested/Latest test negative UAI with partner of discordant/unknown HIV status

17 35 % diagnosis of any STI in the last 12m n= , ,6 8,5 5 0 Total Diagnosed positive Untested/Latest test negative

18 60 % consumed party/sex drugs (xtc, chrystal, GHB ) in the last 12m n= , ,5 14, Total Diagnosed positive Untested/Latest test negative

19 60,0 % on Treatment and viral detectability n=329 50,0 51,1 40,0 34,0 30,0 20,0 10,0 0,0 2,1 Has never received ART Has had ART in the past Currently on ART; detectable VL or unclear 12,8 Currently on ART; VL undetectable

20 Conclusion Online and venue-based studies among MSM research give similar results when looking at indicators We have to go beyond the local epidemic, beyond thinking local. MSM are highly mobile. This holds especially for the men in Brussels. EMIS shows differences for MSM from different Belgian regions. The Wallonian men seem to differ with Brussels and Flanders on different indicators. Further analysis is needed. Depression and drug use are highly prevalent : these syndemics have to be addressed Testing in Belgium among MSM is at a high level but we need to maintain this and apply innovative ways of testing. We need to address lower rates of testing among young MSM. Knowledge gaps on HIV transmission have been identified among Belgian MSM. Condom use is at a high level in general but a subgroup of Hiv positive men does rarely or not use condoms. Other prevention strategies are applied : seropositioning and viral detectability. However, recent hepatitis c co-infections among hiv positive men and high STI rates show the downsides of these strategies

21 The future SIALON II: European project HIV prevalence and behavioural study among MSM in Brussels Venue based Preventive aspects Cooperation with local community-based and prevention organizations

22 Thank you for your attention! Wim Vanden Berghe HIV/aids Center Department of Public Health Institute of Tropical Medicine Nationalestraat 155 B-2000 Antwerp Belgium

23 Acknowledgements EMIS was funded by a grant of the European Commission under the EU Health Programme Further funding was received from CEEISCat (Centre d Estudis Epidemiològics sobre les ITS/HIV/SIDA de Catalunya, Spain); Department of Health for England; Maastricht University (The Netherlands); Regione del Veneto (Italy); and Robert Koch Institute (Germany). Further funding for the participation of men in specific countries was provided by: German Ministry of Health for Ukraine and Moldova; Finnish Ministry of Health for Finland; Norwegian Institute of Public Health for Norway; Swedish Board of Health and Welfare for Sweden; and Bundeszentrale für gesundheitliche Aufklärung (BZgA) for Germany. We thank Axel J. Schmidt (Project co-ordination); Ulrich Marcus (Project initiation and supervision); Peter Weatherburn (Promotion co-ordination); Ford Hickson and David Reid (Technical implementation); Harm J. Hospers (Questionnaire drafting)