EMIS2017 Priorities ConsultationDecember 2016
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Introduction
You are invited to contribute to determining what questions will be asked of thousands of men-who-have-sex-with-men (MSM) in the European MSM Internet Survey 2017, which is one of the three main elements of ESTICOM.
About ESTICOM
ESTICOM (European Surveys and Trainings to Improve MSM Community Health) is a 3-year project delivering evidence about the sexual health of gay men, bisexual men and other MSM across Europe, funded as part of the European Commission Health Programme 2014-2020. The goal is to strengthen the community response and raise awareness about the persisting legal, structural, political and social barriers to a more effective response to the syndemic of HIV, hepatitis viruses B and C, and other STIs among gay men and other MSM.
The ESTICOM partnership will deliver on three inter-linked projects over the next three years:
- The European MSM Internet Survey (EMIS) 2017, a pan-European online survey of MSM.
- The European Community Health Worker Online Survey (ECHOES), a pan-European online survey of community health workers who provide services and support to MSM in EU countries.
- The development and piloting of a training programme for MSM-focused community health workers intended to be adaptable for all EU countries.
About EMIS 2017
Sigma Research (London) andthe Robert Koch Institute (Berlin) are leading on the first objective, an online survey similar to the European MSM Internet Survey (EMIS) which occurred in 2010. The overall aim of the MSM survey is to generate data useful for the planning of HIV and STI prevention and care programmes and the monitoring of national progress in this area, by describing the level and distribution of HIV transmission risk and precautionary behaviours, related HIV prevention needs, and by assessing the coverage of interventions.
We would like to stress that:
EMIS 2017 is focussed on sexually transmitted infections (including HIV) among MSM – it is not a generic health and well-being survey.
EMIS 2017 is intended to describe the level and distributions of alreadyknown health outcomes, risk and precaution behaviours, prevention needs and prevention interventions among MSM. It is not attempting to test theories about the validity of or relationship between these variables.
At a country level, EMIS 2017 will generate data for understanding the needs of populations and directing prevention programmes. At the international level, patterns of policy, service and cultural responses can be examined for their impact on epidemic spread and containment, providing knowledge beyond the grasp of any one country.
This document
The starting point for the 2017 survey is the EMIS 2010 survey. This document is a summary of all the questions asked in EMIS 2010. The questions are not in the survey order but in conceptual order. They are arranged in five groups: health end-points; behaviours; needs; interventions; and descriptives. Some NEW topics that did not appear in 2010 but which we know are required for 2017 have been added (in red). A few questions we already know will not be asked again have been removed. The numbering is for reference and will not appear in the final survey where the questions will appear in a wholly different order.
What you should do with this document
We think EMIS 2010 was too long. Of the men who started it, 28% dropped out before the end and we lost all of their data. We want EMIS 2017 to be shorter but it also needs to include some new questions. We want you to help us decide what to cut and what to add.
We need you to:
1. Strikethrough (using the Font menu) those questions which you can live without – we are hoping to cut about 30% of the questions. Where possible cut sections rather than single questions.
2. Add (using Track changes) topics which you really want to be included – you do not need to design the exact question, just give an indication of the topic or measure you would like to see.
Then email this document back to before 19th December 2016.
Please make only one submission per agency or organisation.
We will inform all agencies collaborating in this process of the outcome in early 2017.
Many thanks
The EMIS 2017 Development Team
1.0HEALTH ENDPOINTS (the purpose of our programmes)
1.1SATISFACTORY SEX LIFE
• Are you happy with your sex life?
1.2DIAGNOSES OF SEXUALLY TRANSMITTED INFECTIONS
• When were you last diagnosed with syphilis?
• When were you last diagnosed with gonorrhoea?
• When were you last diagnosed with chlamydia?
• When were you FIRST diagnosed with anal or genital warts?
• When were you FIRST diagnosed with anal or genital herpes?
• When were you FIRST diagnosed with hepatitis C?
• What is your current hepatitis C status?
[see section 2.3.2 for Hep B]
1.3DIAGNOSIS OF HIV
• In which year were you first diagnosed HIV positive?
• Were you first diagnosed with HIV within the last 12 months?
1.4SWIFT HIV DIAGNOSIS
• When you were first diagnosed with HIV, what was your CD4 count?
1.5HIV VIRAL SUPPRESSION
• What was the result of your viral load test the last time you had your HIV infection monitored?
2.1BEHAVIOURS: SEX
2.1.1FIRST AND LAST SEX WITH MEN
• How old were you the very first time you had any kind of sex with a man/boy, or a man/boy had any kind of sex with you?
• How old were you the very first time you had anal intercourse with a man/boy?
• When did you last have anal intercourse with a man (either with or without a condom)?
• On that most recent occasion of anal intercourse, did you have unprotected anal intercourse (that is without a condom)?
• When did you last have unprotected anal intercourse with a man (that is without a condom)?
2.1.2SEX WITH STEADY MALE PARTNERS IN LAST 12 MONTHS
• In the last 12 months have you had any kind of sex with a steady male partner?
• How many different steady male partners have you had sex with in the last 12 months?
• How many steady male partners have you had anal intercourse with in the last 12 months?
• How many steady male partners have you had anal intercourse without a condom with in the last 12 months?
• In the last 12 months, how often have you had anal intercourse with your steady male partner?
• In the last 12 months, how often were condoms used for anal intercourse with your steady male partner?
• The last time you had anal intercourse with your steady male partner, did you use a condom?
• Do you and this steady male partner have the same HIV status?
2.1.3SEX WITH NON-STEADY MALE PARTNERS IN LAST 12 MONTHS
• In the last 12 months have you had any kind of sex with a non-steady male partner?
• How many different non-steady male partners have you had sex with in the last 12 months?
• How many non-steady partners did you have anal intercourse with in the last 12 months?
• How many non-steady male partners have you had anal intercourse without a condom with in the last 12 months?
[The following appear in another section of the survey]
• Just to check, have you had anal intercourse with a non-steady male sex partner in the last 12 months?
• In the last 12 months, what proportion of your non-steady male sex partners have you had anal intercourse with?
• In the last 12 months, how often were condoms used when you had anal intercourse with non-steady male partners?
• Have you had unprotected anal intercourse with a non-steady partner who you knew at the time was HIV positive?
• Have you had unprotected anal intercourse with a non-steady partner who you knew at the time was HIV negative?
• Have you had unprotected anal intercourse with a non-steady partner whose HIV status you did not know or think about at the time?
2.1.4FEATURES OF MOST RECENT SEX SESSION WITH A NON-STEADY MALE PARTNER
• Where did you first meet him?
• Have you had sex with him before (on a different occasion)?
• What did you tell him about your HIV status before or during sex?
• What did you know or think about his HIV status before having sex?
• Why did you think this? Please read the list below and tick the answer that best applies.
• Did you have anal intercourse (fuck) on that occasion?
• Did he use a condom when he was active in anal intercourse (when he fucked you)?
• Did he ejaculate (cum) into your rectum (arse)?
• Did you use a condom when you were "active" in anal intercourse?
• Did you ejaculate (cum) into his rectum (arse)?
• Did he ejaculate (cum) into your mouth on that occasion?
• Did you ejaculate (cum) into his mouth on that occasion?
• Were you using poppers (nitirite inhalants) during this sexual session?
• Was he using poppers (nitrite inhalants) during this sexual session?
• On a scale of 1 (worst) to 10 (best), how would you rate this sexual session?
2.1.5MOST RECENT SEX WITH FOREIGN MEN IN OTHER COUNTRIES
• When did you last have sex in a country outside the one you live in, with a man who does not also live in <COUNTRY OF RESIDENCE>?
• In which country was that?
• Where did you first meet him?
• On that occasion did you and that partner have anal intercourse (fucking), either with or without condoms
• On that occasion did you and that partner have anal intercourse (fucking) without a condom?
2.1.6SEX WITH WOMEN IN THE LAST 12 MONTHS
• When did you last have any kind of sex with a woman?
• How many different women, have you had vaginal or anal intercourse with in the last 12 months?
• In the last 12 months, how often have you used condoms when you had vaginal or anal intercourse with women?
2.1.7CONDOM FAILURE BEHAVIOURS
• Just to check, have you worn a condom when having active anal intercourse in the last 12 months?
<IF WORE CONDOM IN LAST 12 MONTHS, WHICH OF THESE DID YOU DO>
• Not using any lubricant
• Using saliva as a lubricant
• Putting lubricant inside the condom before putting it on
• Not using lots of lubricant on the outside of the condom
• Using a condom that is too large or small for my penis
• Having intercourse for over half an hour without changing the condom
• Using an oil based lubricant (such as petroleum jelly, baby oil, moisturiser) with latex (rubber) condoms
• In the last 12 months has a condom you were wearing torn or slipped off during intercourse?
2.1.8COMMERCIAL SEX ENGAGEMENT
NEW • Selling sex [question to be drafted]
NEW • Buying sex [question to be drafted]
2.2BEHAVIOURS: DRUG USE
2.2.1RECENCY OF DRUG USE
• Have you ever injected anabolic steroids (testosterone)?
• Have you ever injected any drug other than anabolic steroids or medicines?
• When was the last time you consumed alcohol?
• When was the last time you consumed tobacco products?
• When was the last time you consumed poppers (nitrite inhalants)?
• When was the last time you consumed Viagra®, Cialis®, Levitra® or other substances that help to keep an erection?
• When was the last time you consumed sedatives or tranquilizers (Valium®, Rivotril®, Rohypnol ®)?
• Have you EVER taken any other recreational or illicit drugs?
• When was the last time you consumed cannabis (hashish, marijuana)?
• When was the last time you consumed ecstasy (E, XTC, MDMA)?
• When was the last time you consumed amphetamine (speed)?
• When was the last time you consumed crystal methamphetamine (crystal, meth, Tina)?
• When was the last time you consumed heroin or related drugs (poppy straw, kompot, fentanyl)?
• When was the last time you consumed mephedrone (4-MMC, meow, methylone, bubbles)?
• When was the last time you consumed GHB/GBL (liquid ecstasy)?
• When was the last time you consumed ketamine (special K)?
• When was the last time you consumed LSD (acid)?
• When was the last time you consumed cocaine?
• When was the last time you consumed crack cocaine?
NEWCOMBINING SEX AND DRUG BEHAVIOURS (‘CHEMSEX’)
•[questions to be drafted]
2.3BEHAVIOURS: USE OF STI PREVENTION RELATED CLINICAL SERVICES (what people do)
2.3.1CIRCUMCISION
• Are you circumcised?
2.3.2HEP B VACCINE
• Have you been vaccinated against hepatitis B?
2.3.3HIV TESTING
• When did you last have an HIV test?
2.3.4ASSYMPTOMATIC STI TESTING
• Have you ever had a test for sexually transmitted infections (STIs) other than HIV?
• When did you last have a test for STIs other than HIV?
• Did you have any symptoms on that occasion? [of last STI test]
2.3.5TAKINGPOST EXPOSURE PROPHYLAXIS
• Have you ever been treated with PEP?
• Before you were diagnosed with HIV, had you ever been treated with PEP?
NEWTAKING PRE-EXPOSURE PROPHYLAXSIS
•[questions to be drafted]
3.0NEEDS (opportunities, capabilities & motivations for sexual health - the foundations for doing)
3.1REASONS FOR SEXUAL UHAPPINESS
• [I’m unhappy because] I am not having any sex.
• [I’m unhappy because] I would like more sexual partners.
• [I’m unhappy because] I worry about having too many sexual partners.
• [I’m unhappy because] I would like more sex with the man / men I have sex with.
• [I’m unhappy because] I want a steady relationship with someone.
• [I’m unhappy because] I have problems in my steady relationship.
• [I’m unhappy because] I am not as sexually confident as I want to be.
• [I’m unhappy because] I worry about passing on HIV or other STIs.
• [I’m unhappy because] I worry about picking up HIV or other STIs.
• [I’m unhappy because] I have problems getting or keeping a hard-on (erection).
• [I’m unhappy because] My sex drive is too low.
• [I’m unhappy because] My health problems interfere with sex.
• [I’m unhappy because] My partner's health problems interfere with sex.
• [I’m unhappy because] Other reason
3.2CONFIDENCE IN HIV STATUS
• What do you think your current HIV status is (whether or not you've ever tested for HIV)?
3.3SEXUAL SELF EFFICACY
• The sex I have is always as safe as I want it to be. [agree-disagree]
• I find it easy to say ‘no’ to sex I don’t want. [agree-disagree]
3.4KNOWLEDGE OF HIV, TESTING AND TREATMENT
• I’m satisfied with what I know about HIV and sexually transmitted infections. [agree-disagree]
• AIDS is caused by a virus called HIV. [did you know this already]
• You cannot be confident about whether someone has HIV or not from their appearance. [did you know this already]
• There is a medical test that can show whether or not you have HIV. [did you know this already]
• There is a medical test that can show whether or not you have HIV. [did you know this already]
• If someone becomes infected with HIV it may take several weeks before it can be detected in a test. [did you know this already]
• There is currently no cure for HIV infection. [did you know this already]
• HIV infection can be controlled with medicines so that its impact on health is much less. [did you know this already]
• Effective treatment of HIV infection reduces the risk of HIV being transmitted.[did you know this already]
3.5KNOWLEDGE OF HIV/STI TRANSMISSION
• HIV cannot be passed during kissing, including deep kissing, because saliva does not transmit HIV. [did you know this already]
• You can pick up HIV through your penis while being 'active' in unprotected anal or vaginal sex (fucking) with an infected partner, even if you don’t ejaculate. [did you know this already]
• You can pick up HIV through your rectum while being 'passive' in unprotected anal sex (being fucked) with an infected partner. [did you know this already]
• Even without ejaculation, oral sex (sucking and being sucked) carries a risk of infection with syphilis or gonorrhoea. [did you know this already]
• When HIV infected and uninfected men have sex together, the chances of HIV being passed on are greater if either partner has another sexually transmitted infection. [did you know this already]
• Most sexually transmitted infections can be passed on more easily than HIV. [did you know this already]
3.6KNOWLEDGE OF PEP
• Post-exposure prophylaxis (PEP) attempts to stop HIV infection taking place after a person is exposed to the virus. [did you know this already]
• PEP is a one month course of anti-HIV drugs. [did you know this already]
• PEP should be started as soon as possible after exposure, preferably within hours. [did you know this already]