Sialon : bio-behavioural study among MSM in Brussels and other European cities Wim Vanden Berghe Christiana Nöstlinger ITM, Antwerp Breach symposium, ITM, Antwerp November 27 th, 2015 Massimo Mirandola, Lorenzo Gios, Igor Toskin, Ulrich Marcus, Susanne Schink, Nigel Sherriff, Cinta Folch, Laia Ferrer, Alexandra Montoliu, Christiana Nöstlinger, Wim Vanden Berghe, Sharon Kühlmann-Berenzon, Inga Velicko, Achilleas Tsoumanis, Sónia Dias, Barbara Suligoi, Vincenza Regine, Danica Stanekova, Magdalena Rosińska, Saulius Caplinskas, Rima Krupenkaite, Irena Klavs, Alexandru Rafila, Carolina Marin, Ivailo Alexiev, Emilia Naseva This presentation is based on data from the Sialon II project, funded under the European Commission s (EC) Public Health Programme 2008-2013 (Work Plan 2010). The sole responsibility lies with the authors and the Commission is not responsible for any use that may be made of the information contained therein
Background: Epidemiology HIV still is a pressing public health issue in Europe MSM are a key population affected by HIV (next to migrants) Figure 1: Mode of transmission of newly-diagnosed HIV cases reported in the EU/EEA 2013 Figure 2: Number of new HIV diagnoses among MSM EU/EEA 2004-2013 Source: Mode of transmission of newly-diagnosed HIV cases reported in the EU/EEA 2013 (European Centre for Disease Prevention and Control /WHO 2014)
The Sialon II project 13 EU countries Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovak Republic, Slovenia, Spain, Sweden, United Kingdom Technical support and Collaborating partners ECDC WHO, UNAIDS, LSHTM 2 non-eu countries Armenia, Moldova
Tools RDS Informed consent form Questionnaires Behavioural questionnaire (GARPRs) Network size form Coupons and result card Tests Tests for HIV, Syphilis, HBV-HCV according to the protocol (4 generation HIV assay, etc.) TLS Informed consent form Questionnaires Behavioural questionnaire (GARPRs) Venue attendance items Tests BIORAD Genscreen HIV1/2 V.2 Vironostika HIV-1 Plus O Microelisa System - Biomerieux Total IgG test for sample validation
Objectives To pilot the implementation of a bio-behavioural survey using different sampling methods, namely Time-Location Sampling (TLS) and Respondent-Driven Sampling (RDS); To estimate HIV prevalence among MSM in data collection using the TLS method; To estimate HIV, Syphilis, and HBV-HVC prevalence among MSM in data collection sites using the RDS method; To describe sexual risk behavior patterns, prevention needs and sexual health in the MSM population, triangulating the biological and behavioural data, and contextual factors.
Results Bio-behavioral data were collected in the following cities in 13 EU countries: Brussels, Sofia, Hamburg, Warsaw, Lisbon, Ljubljana, Barcelona, Stockholm, Brighton (TLS); n=3.596 Verona, Vilnius, Bratislava, Bucharest (RDS), n=1.305 Total sample: N=4.901 6
Study participants by venue type and age-groups 7
Residence of participants by city 8
HIV weighted prevalence among MSM by city Point 95% 95% Estimated City Lower Upper Design Denominator Estimate Bound Bound Effect BARCELONA 14.2 10.1 19.5 1.2 400 BRATISLAVA 4.3 2.2 6.2 1.4 400 BRIGHTON 17.6 13.8 22.3 0.9 402 BRUSSELS 12.3 7.6 19.4 4.9 379 BUCHAREST 18.0 9.1 27.0 2.6 183 HAMBURG 7.5 3.9 13.8 3.6 390 LISBON 17.1 12.4 23.0 2.6 371 LJUBLJANA 4.4 2.1 8.9 1.8 347 SOFIA 3.0 0.9 9.1 0.8 361 STOCKHOLM 2.4 1.1 5.2 2.2 356 VERONA 9.6 4.5 14.9 3.5 400 VILNIUS 3.4 0.0 6.9 3.6 322 WARSAW 7.2 4.3 11.9 2.0 405 9
Distribution (weighted percentage) of HIVpositive MSM by HIV status knowledge and city Known HIV positive City (%) Newly diagnosed HIV positive (%) Indeterminate Denominator knowledge HIV (N. of HIV positive Positive (%) individuals) BARCELONA 50.9 28.9 20.2 62 BRATISLAVA 34.1 51.8 14.0 20 BRIGHTON 64.6 23.7 11.7 68 BRUSSELS 69.9 12.3 17.8 47 BUCHAREST 27.1 28.6 44.2 36 HAMBURG 74.5 18.3 7.3 50 LISBON 17.9 47.7 34.4 69 LJUBLJANA 31.6 35.9 32.5 16 SOFIA 4.0 88.4 7.6 17 STOCKHOLM 28.8 44.2 26.9 18 VERONA 57.8 33.1 9.1 32 VILNIUS 16.7 59.2 24.1 8 WARSAW 21.8 37.9 40.3 54 10
Partner numbers in the last six months by city (weighted) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Barcelona Bratislava Brighton Brussels Bucharest Hamburg Lisbon Ljubljana Sofia Stockholm Verona Vilnius Warsaw > 10 partners 21,7 9,5 17,5 24,1 4,3 21,8 13,8 5,8 29,1 14,2 14,4 5,8 12,0 6-10 partners 21,3 19,2 13,1 17,8 16,4 12,0 13,5 7,1 30,4 14,8 18,1 12,3 18,0 4-5 partners 11,2 17,1 11,0 16,9 17,8 11,8 14,2 12,1 12,7 14,4 13,9 20,7 12,4 2-3 partners 13,4 32,7 17,3 20,8 29,1 19,6 28,6 40,7 14,1 21,3 27,2 33,2 22,8 1 partner 24,5 16,1 30,2 16,8 23,0 23,8 22,9 26,1 13,0 22,7 20,4 22,5 28,4 no partner 7,9 5,4 10,9 3,6 9,5 11,1 7,0 8,2 0,7 12,5 6,2 5,5 11 6,4
r e p o r ti n g c o n d o m proportionaiwithout Unprotected anal intercourse with steady and nonsteady partners (weighted) 100% 80% 60% 40% 20% 0% Barcelona Bratislava Brighton Brussels Bucharest Hamburg Lisbon Ljubljana Sofia Stockholm Verona Vilnius Warsaw UAI with SP 91,5% 82,4% 71,9% 76,9% 79,9% 70,0% 87,5% 71,3% 95,3% 82,8% 77,2% 80,4% 85,0% UAI with NSP 51,7% 66,3% 51,3% 38,9% 59,1% 48,1% 39,4% 21,4% 61,1% 58,3% 52,1% 65,5% 57,7% 12
Percentage (95% CI) of MSM using poppers or party drugs, by city Party drugs Poppers 13
Discussion and conclusions Harmonizing surveillance methodologies across the EU is a complex process (heterogeneous settings) Results contribute to tailoring prevention activities to local prevention needs, involving communities Brussels : High HIV testing rates, most + MSM on treatment Maintain campaigns on STIs other than HIV (Syphilis and HBV-HCV) More prevention efforts targeting young MSM International mobility and drug misuse! 14
Acknowledgements Thank you! EU disclaimer: This presentation is based on data from the Sialon II project, funded under the European Commission s (EC) Public Health Programme 2008-2013 (Work Plan 2010). The sole responsibility lies with the authors of this report and the Commission is not responsible for any use that may be made of the information contained therein! Community partners: All local community-based organizations giving input through the whole course of the project and participated in data collection and prevention activities! For Belgium : Sensoa, Rainbowhouse Brussels We would also like to thank all study participants! More information : www.sialon.eu Sialon II is a WHO collaborating study 15