Men who have sex with men (MSM)

toolkit material

Eight specific indicators are proposed, some of them similar to the core indicators, but with an adapted formulation.

1) Title & definition: Unprotected anal intercourse (UAI) with a partner of unknown or discordant HIV status in the last 12 months (overall and separately for casual and main partners)

Has a man had unprotected anal intercourse (UAI) in the last 12 months with a sexual partner whose HIV status he did not know, or whose HIV status was discordant (i.e. an HIV-positive man reporting UAI with an HIV negative man or vice-versa) This information should be recorded separately for main and casual partners. Combining the data for main and casual partners will provide an overall figure.

 

Purpose and rationale  UAI with a partner of unknown or discordant HIV status presents a risk for HIV transmission. This indicator measures the extent to which MSM report this risk in a given population
Measurement frequency

Where possible, it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data; there could be recall error, social desirability bias and misreporting of partner’s HIV status

 

2) Title & definition: Unprotected anal intercourse (UAI) with a casual partner of the same HIV status in the last 12 months

Has a man had unprotected anal intercourse (UAI) in the last 12 months with a sexual partner whose HIV status was the same as his own (i.e. an HIV positive man reporting UAI with another HIV positive man or an HIV negative man reporting UAI with another HIV negative man)

 

Purpose and rationale  UAI with a casual partner of the same HIV status does not, in principle, present a risk for HIV transmission. This is the case if both men are definitely HIV positive or both men are definitely HIV negative. This is a risk reduction strategy known as “serosorting”. Serosorting does, however, present a risk for the transmission of other sexually transmitted infections e.g. syphilis or LGV. In addition, if a man believes he and his partner have the same HIV status, whereas in reality they do not, then “serosorting” can also present a risk for HIV transmission. This indicator measures the extent to which MSM report this risk reduction strategy in a given population
Measurement frequency

Where possible it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data; there could be recall error, social desirability bias and misreporting of partner’s HIV status.

 

 

3) Title & definition: Diagnosed with an STI in the last 12 months

Has a man been diagnosed with a sexually transmitted infection (STI) (e.g. syphilis, gonorrhoea, chlamydia) in the last 12 months

 

Purpose and rationale  Among MSM in Europe, the incidence of STI other than HIV has increased steadily over the last ten years. This indicator provides an estimate of the incidence of STI among MSM in a given population
Measurement frequency

Where possible it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data; there could be recall error and under-reporting of STI

 

 

4) Title & definition: Tested for HIV in last 12 months

Has a man had an HIV antibody test in the last 12 months

 

Purpose and rationale  Early diagnosis of HIV infection has benefits for the individual with HIV (access to treatment) as well as for the wider community (potential change in sexual behaviour following diagnosis). In some EU member states MSM are encouraged to have an HIV test once every 12 months, so that undiagnosed HIV infection can be detected at an early stage. This indicator provides an estimate of the recent uptake of HIV testing among MSM in a given population.
Measurement frequency

Where possible it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data. However, there may be less recall error than for the sexual behaviour indicators
Additional sources of information  UNGASS indicator No 8. See this Guidelines on contruction of core indicators from the United Nations General Assembly Special Session on HIV/AIDS

 

 

5) Title & definition: Percentage who are HIV positive

Of the men who are surveyed, how many are living with HIV This estimate could be based on self-reported data or on biological specimens (saliva or blood) collected during the survey and tested in a laboratory.

 

Purpose and rationale  HIV prevalence has increased substantially in many EU member states in the last ten years. This reflects improved survival following the introduction of HAART as well as continuing transmission of HIV. The increased prevalence of HIV requires a corresponding increase in treatment and care services for people with HIV. This indicator provides an estimate of the proportion of MSM with HIV in a given population
Measurement frequency

Where possible it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data – some men whose last HIV test was negative may have seroconverted since that test but are not aware that they are HIV positive. Laboratory based data are therefore more reliable

 

 

6) Title & definition: Number of sexual partners in the last 6 or 12 months (male and female)

How many different sexual partners has a man had in the last 6 or 12 months Male and female partners should be recorded separately.

 

Purpose and rationale  For both individuals and populations, there is a strong correlation between the number of sexual partners reported and the incidence of sexually transmitted infections. In addition MSM who have sex with women are a potential “bridge” for infections between the homosexual and heterosexual populations. This indicator provides an estimate of the number of sexual partners MSM report in a given population
Measurement frequency

Where possible it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data; there could be recall error and social desirability bias.

 

 

7) Title & definition: Used condom at last anal intercourse (ideally for casual, paid and main partners separately)

How many men used a condom the last time they engaged in anal intercourse. The information should be collected for anal intercourse with the most recent casual partner and anal intercourse with the most recent main partner separately

 

Purpose and rationale  Condoms provide maximum protection against HIV and STI transmission. Men in a relationship may have an agreement whereby they use condoms with a casual partner but not with their main partner. By asking individual men about their use of condoms the last time they had anal intercourse, this indicator provides an estimate of protective behaviour at a population level. The estimate can be derived for anal sex with casual and main partners separately.
Measurement frequency

Where possible it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data; there could be recall error and social desirability bias.  The advantage is that information is sought about the last time the man had anal intercourse, which may be easier to recall than some of the other behavioural indicators

 

8) Title & definition: Where men met their sexual partners in the last 12 months (saunas, bars, clubs, Internet, etc.)

There is a wide variety of venues where MSM can meet their sexual partners.  This includes bars and clubs, saunas, cruising grounds, through friends and the Internet.  Men should be asked to report all the different places where they met a sexual partner during the previous 12 months.

 

Purpose and rationale  The use of different venues can vary over time e.g. there has been a steady increase in the number of men meeting sexual partners through the Internet over the last 10 years.  Health promotion campaigns may wish to target different venues at different times and in different ways.   This indicator provides an estimate of the popularity of different venues for meeting sexual partners in a given population
Measurement frequency

Where possible it should be measured annually, but in some countries the information is collected once every two or three years

Strengths and weaknesses Self-reported data; there could be recall error.  However, this question may be easier to answer than some of the other behavioural indicators, especially if men are presented with a list of possible venues and are asked to tick which ones they have used.