Men who have sex with men

toolkit material

In Europe, behavioural surveillance in MSM is mainly based on convenience samples of this population. Selected features of available methods for collecting behavioural data for surveillance among MSM are presented in the Table 1 below.

The second table presents the best three methods proposed by the experts according to two different contexts.

Table 1. Selected features of available methods for collecting behavioural data among MSM

 

Design Advantages Disadvantages Comments

"Convenience samples", non-representative designs

Venue-based surveys (a)
  • Practical
  • Can reach a lot of men
  • Can be linked to an intervention
  • Can collect biological samples
  • Can use time-location sampling to reduce bias
Not representative of the whole target population, although there is information on the bias.
  • Suitable for behavioural surveil-lance in resource-constrained settings or where there is a large number of widely used venues. 
  • Will exclude marginalised or stigmatised populations having no defined venues or meeting places
Internet surveys (b)
  • Practical
  • Low cost
  • Possibility of reaching many individuals
  • Increasing number of MSM are using the Internet to meet sexual partners
  • Not representative of the whole population although there is information on the bias
  • Cannot collect biological samples 
  • Suitable for behavioural surveil-lance in resource-constrained settings or where large numbers of MSM use the Internet
  • Marginalised MSM who do not go to venues are more likely to use the Internet
  • Will exclude those without Internet access or basic IT skills
Service-based surveys (c)    
  • Practical
  • Can be linked with an intervention, 
  • Sampling frame exists
  • Can collect biological samples
Not representative of the whole target population
  • Suitable for behavioural surveil-lance in resource-constrained settings, or where there is provision of well used easy access services. 
  • Marginalised or stigmatised  populations may not use the services
Community-based/outreach surveys (e.g. snowball sampling)
  • Can access marginalised groups 
  • Can sample purposively to target specific sub-groups 
  • Not representative of the whole sub-group
  • Biases difficult to spot
  • Can access marginalised populations difficult to reach by other methods
  • Extremely marginalised populations  may not be in contact with community or outreach services

 

 

The second table presents the best three methods proposed by the experts according to two different contexts:

  • the population is reachable in known settings and is not severely stigmatised
  • the population is not very well known, not easy to reach, and/or stigmatised

Table 2. Best three methods to access MSM according to context 

 

   Best Methods  Main indication for preference
     A. The population is reachable in known settings and is not severily stigmatised
 1  Internet (1)
  • Easy access to the population
  • In most European countries, the majority of MSM have access to the Internet, and an increasing number use the Internet to look for sexual partners
 2  Venue-based (2)
  •  In large European cities there are many commercial and non-commercial venues used by MSM
 3  Service-based (3)
  • Where there is extensive provision of well-used, easy to access sexual or other health services
     B. The population is not very well-known, not easy to reach, and/or stigmatised
 1  Internet a)
  • Marginalised groups use the Internet - although they may not be willing to take part in a survey
 2 Respondent driven sampling (RDS) d)
  • Could reach marginalised men where the population is well networked
 3 Community outreach sampling e)
  • Could reach marginalised men who do not go to venues or used the Internet

 

 

 

 

Notes(1) InternetSince 1998, the Internet has been used for behavioural surveillance in 14 European countries.  These are Belgium, Denmark, Estonia, France, Germany, Greece, Ireland, Lithuania, Netherlands, Norway, Spain, Sweden, Switzerland, United Kingdom. The surveys include Net Gay Barometre Gay (France), Gay Men’s Sex Survey (UK), Sex Life survey (Denmark), Gaysurvey (Switzerland) and Gay men and AIDS (Germany). The Internet has also been used extensively in the USA and Australia.

(2) Venue-basedBehavioural surveys have been conducted in gay venues (bars, clubs, gyms, saunas, Gay Pride) in the UK (London, Glasgow, Edinburgh), France (Paris), Australia (Sydney, Melbourne) and the USA (Baltimore, Los Angeles, Miami, New York, and San Francisco) and Switzerland (Geneva, Zurich), Netherlands (Amsterdam), Slovenia, Spain.

(3) Service-basedService-based surveys have been conducted in the UK (London), Netherlands (Amsterdam, Rotterdam), France (national sample), Germany (Berlin and Frankfurt) and the Netherlands (Amsterdam).

Examples (a) Venue-based surveysAmirkhanian YA, Kelly JA, Kukharsky AA, Borodkina OI, Granskaya JV, Dyatlov RV, McAuliffe TL, Kozlov AP. Predictors of HIV risk behavior among Russian men who have sex with men: an emerging epidemic. AIDS. 2001 Feb 16;15(3):407-12.

Balthasar H, Jeannin A, Dubois-Arber F. First anal intercourse among men who have sex with men in Switzerland. Arch Sex Behav 2009; 38(6) 1000-8

Centers for Disease Control and Prevention. HIV prevalence, unrecognised infection and HIV testing among men who have sex with men (MSM) – five US cities, June 2004-April 2005. MMWR Morb Mortal Wkly Rep 2005;54:597-601.

Csepe P, Amirkhanian YA, Kelly JA, McAuliffe TL, Mocsonoki L. HIV risk behaviour among gay and bisexual men in Budapest, Hungary. Int J STD AIDS. 2002 Mar;13(3):192-200.

Dodds JP, Johnson AM, Parry JV, Mercey DE. A tale of three cities: persisting high HIV prevalence, risk behaviour and undiagnosed infection in community samples of men who have sex with men. Sex Transm Infect 2007;83(5):392-6.

Elford J, Bolding G, Sherr L, Hart G. No evidence of an increase in serosorting with casual partners among HIV-negative gay men in London, 1998-2005. AIDS 2007;21(2):243-5.

Hickson FC, Reid DS, Davies PM, Weatherburn P, Beardsell S, Keogh PG. No aggregate change in homosexual HIV risk behaviour among gay men attending the Gay Pride festivals, United Kingdom, 1993-1995. AIDS 1996;10(7):771-4.

Lattimore S, Thornton A, Delpech V, Elford J.  Changing patterns of sexual risk behaviour among London gay men: 1998-2008.  Sexually Transmitted Diseases  2011;38:221-229

MacKellar DA, Gallagher KM, Finlayson T, Sanchez T, Lansky A, Sullivan PS. Surveillance of HIV risk and prevention behaviors of men who have sex with men--a national application of venue-based, time-space sampling.  Public Health Rep. 2007;122 Suppl 1:39-47.

Snowden J, Raymond HF, McFarland W. Prevalence of seroadaptive behaviors of men who have sex with men, San Francisco, 2004. 1: Sex Transm Infect. 2009; 85(6) 469-76

Williamson LM, Dodds JP, Mercey DE, Hart GJ, Johnson AM. Sexual risk behaviour and knowledge of HIV status among community samples of gay men in the UK. AIDS 2008;22(9):1063-70.

Zablotska IB, Crawford J, Imrie J, Prestage G, Jin F, Grulich A, Kippax S. Increases in Unprotected Anal Intercourse with Serodiscordant Casual Partners Among HIV-Negative Gay Men in Sydney. AIDS Behav. 2009; 13(4) 638-44

(b) Internet surveysAnonymous. The European MSM Internet Survey (EMIS) Community Report 1

Balthasar H, Jeannin A, Dubois-Arber F. First anal intercourse among men who have sex with men in Switzerland. Arch Sex Behav 2009;38:1000-8.

Bolding G, Davis M, Hart G, Sherr L, Elford J. Where young MSM meet their first sexual partner: the role of the Internet. AIDS and Behavior 2007;4:522-526.

Chiasson MA, Hirshfield S, Remien RH, Humberstone M, Wong T, Wolitski RJ. A comparison of on-line and off-line sexual risk in men who have sex with men. J of AIDS 2007;44:235-243.

Cowan SA, Haff J. HIV and risk behaviour among men who have sex with men in Denmark – the 2006 Sex Life survey. Eurosurveillance 2008;13:1-6.

Hickson F, Reid D, Weatherburn P, Stephens M, Nutland W, Boakye P.  HIV, sexual risk and ethnicity among men in England who have sex with men.   Sex Transm Infect 2004;80:443-450

Horvath KJ, Rosser BR, Remafedi G. Sexual risk taking among young Internet-using men who have sex with men. Am J Public Health 2008;98:1059-67.

Hospers HJ, Kok G, Harterink P, de Zwart O. A new meeting place: chatting on the Internet, e-dating and sexual risk behaviour among Dutch men who have sex with men. AIDS 2005;19:1097-1101.

Johnston LG, Trummal A, Lohmus L, Ravalepik A.  Efficacy of convenience sampling through the internet versus respondent driven sampling among males who have sex with males in Tallinn and Harju County, Estonia: challenges reaching a hidden population.  AIDS Care. 2009; 21:1195-202.

Leobon A, Frigault LR. Frequent and systematic unprotected anal intercourse among men using the Internet to meet other men for sexual purposes in France: results from the "Gay Net Barometer 2006" Survey. AIDS Care 2008;20(4):478-84.

(c) Service-based surveysBouhnik AD, Préau M, Schiltz MA, Lert F, Obadia Y, Spire B; the VESPA Study Group. Unprotected sex in regular partnerships among homosexual men living with HIV: a comparison between sero-nonconcordant and seroconcordant couples (ANRS-EN12-VESPA Study). AIDS. 2007 Jan;21 Suppl 1:S1-3.

Elford J, Bolding G, Davis M, Sherr L, Hart G. Barebacking among HIV positive gay men in London. Sexually Transmitted Diseases 2007;34:93-98.

Elford J, Ibrahim F, Bukutu C, Anderson J. Sexual behaviour of people living with HIV in London: implications for HIV transmission. AIDS 2007;21 Suppl 1:S63-70.

Rietmeijer CA, Bull SS, McFarlane M, Patnaik JL, Douglas JM Jr. Risks and benefits of the internet for populations at-risk for sexually transmitted infections (STI): results of an STI clinic survey. Sex Transm Dis. 2003 Jan;30(1):15-9.

Stolte IG, de Wit JB, van Eeden A, Coutinho RA, Dukers NH. Perceived viral load, but not actual HIV-1-RNA load, is associated with sexual risk behaviour among HIV-infected homosexual men. 1: AIDS. 2004 Sep 24;18(14):1943-9.

van der Snoek EM, de Wit JB, Mulder PG, van der Meijden WI. Incidence of sexually transmitted diseases and HIV infection related to perceived HIV/AIDS threat since highly active antiretroviral therapy availability in men who have sex with men. Sex Transm Dis. 2005 Mar;32(3):170-5.

(d) Respondent driven samplingIn Europe, RDS has only been used in Estonia and Greece. RDS has been used extensively in Africa, Asia and South America for recruiting MSM.

(e) Community outreach samplingThis has been used in the UK, Belgium, France, Switzerland and Germany.