MSM-enkäten. Riskhandlingar, hivtest och preventiva behov bland män som har sex med män

In this report the result from the MSM-Survey 2008 is presented. The first survey, the MSM-Survey 2006, was conducted in 2006 and the next is planned in 2012. The same questions (with a few exceptions) are used in both surveys. The 2008 questionnaire was administered through the Swedish web site QX.se (http://www.qx.se), which is a web site primarily for lesbian, gay, bisexual, transgender and queer (LGBTQ) persons. One part of the web site is the Qruiser community (http://www.qruiser.com), which is the largest LGBTQ web community in the Nordic countries with over 100 000 members. At the time for the study, the Qruiser community had 51 814 members (member accounts) who met the criteria for being included in the current study, i.e. being men, 15 years or older, and using Swedish as the preset language in the community. The data collection took place between the 28th of March and the 9th of April 2008. During this period of time, members who met the criteria for being included in the current study were exposed to random banner and pop-up advertisements asking them to participate in a study with a possibility to participate in a competition for travel vouchers if completing the whole questionnaire. Furthermore, the advertisements included the Malmo University logotype. In this 13-day period, approximately 50 percent of the members who met the criteria logged in at least once. By clicking on the banner or pop-up advertisement, members were linked to a web site with a more detailed explanation of the study, its purpose, the questionnaire, the researchers and the ethical principles guiding the study. The ethical committee at Malmo University has ethically approved of the study. Participation was voluntary, anonymous, and restricted to those 15 years or older. A total of 7 591 members visited this information site; 2 289 (30 percent) were linked from the banners and 5 302 (70 percent) from the pop-ups, making pop-ups the most efficient way of recruitment regarding the number of respondents. Of the 7 591 who visited the information web page, 4 715 (62 percent), 876 respondents from the link and 3 839 from the pop-up, agreed to participate under the conditions mentioned above, and by clicking a button they were linked to the questionnaire which was physically located on a server owned and administered by the company Easyresearch, who were responsible for overseeing the data collection procedure and managing the technical aspects of running the questionnaire, including safety back-ups and data delivery to the researchers. Of the 4 715 respondents who started to fill out the questionnaire, 163 questionnaires were removed due to the fact that the reported never to have had sex with a man and defining themselves as heterosexual. Another 204 respondents were removed because they had dropped out in the demographic section in the beginning of the questionnaire. 10 respondents were removed because they did not meet the age criteria. 65 respondents were judged as not being sincere due to inconsistencies in the way they had filled in the questionnaire. In total 442 respondents (9 percent) were removed by the researchers before the data analysis. In the dataset we have 4 273 respondents who started to fill in the questionnaire and by question 79 (of 80) 562 respondents (13 percent) had dropped out. Compared to similar studies, this retention rate has to be considered as remarkably high. The high retention rate in the current study can possibly be explained by the fact that incentives were used (the possibility to win travel vouchers) as well as the subject of the study might have motivated the men to participate and complete the questionnaire. The questionnaire, administered in Swedish, comprised 80 questions in total, which was divided into four subsections. The first section included socio-demographic questions such as age, sexual orientation, education, occupation, residence, and nationality. It also included questions on the respondents’ present relationship status and sexual behaviour within and/or outside the relation. The first subsection ended with a question whether the respondent had ever had sex with a man. The second subsection focused on sexual behaviours, emphasizing that the respondents should refer to the latest sexual encounter with a man. Questions were asked about when the respondents had this encounter, where this encounter took place, who and how many were involved in this latest encounter, how they met, and sex partners’ age. Furthermore, questions were asked about their sex partners’ HIV-status, if they told them about their own HIV-status. Also questions were asked about what kind of sexual activities they engaged in on the latest encounter, about condom and lubrication use, and if they were under the influence of alcohol and/or drugs. The third subsection focused on respondents’ sexual behaviour and HIV/STI experience during the last 12 months, including questions about the number of male and female sex partners and if they have had intentional unprotected anal intercourse with a casual partner during the past 12 months. Furthermore, questions were asked about their HIV-status and if they had had any STIs, their HIV/STI testing habits, and about the actual testing situation (where they were tested and how the results were being followed up). Also, questions were asked about how many persons living with HIV they knew of, how many they have known who have died of AIDS, and if they knew of Post Exposure Prophylaxis. Section three ended with a set of attitude questions regarding HIV. In section four two sets of questions were asked about the respondents’ need for information and services with regard to HIV, STI, and safer sex. The final section comprised questions about the respondents’ contact with HIV prevention interventions during the past 12 months, as well as involvement in the LGBTQcommunity, online as well as offline, during the same time period. The questionnaire ended with a possibility for the respondents to comment on the study and to supply any additional information they thought might be of importance. The age of the respondents ranged from 15 to 77 years and the mean age was 34.6 years (SD = 12.6). Compared with the general Internet population in Sweden, the age distribution was similar in the current study for respondents over 25 years, while respondents between 15 and 24 were underrepresented. Among the respondents, 71 percent identified themselves as homosexual, 19 percent identified themselves as bisexual, and 1.1 percent identified themselves as heterosexuals. Approximately two thirds of the respondents lived in one of the three largest cities in Sweden (Stockholm, Goteborg, Malmo). The majority, eight out of ten, perceives their HIV-status as HIVnegative. One out of ten is unsure of his current status and three percent are HIV-positive. The HIV-prevalence rises to ten percent when looking at middle aged self-identified homosexual men residing in a metropolitan area. Nine out of ten men know where to go if they want to get tested for HIV. There are fewer men under 25 who know where to get tested. The majority of men over 25 have been tested for HIV. Among the youngest men only 50 percent have this experience. It is most common among the men to have taken the latest HIV and/or STI test at a clinic that is specialized on MSM. Most of these men have been offered additional services, such as counseling, in connection with their latest test. The offering of such additional services is less common at a non-specialized clinic. More than half of the respondents in the MSM-Survey 2008 want access to rapid HIV-testing. About half of the men have never been tested for a STI. Nine percent have had a STI during the past 12 months. The most common STI among the men is Chlamydia. STI is more common among self-identified homosexual men residing in a metropolitan area who have had many male sex partners during the past 12 months. The incidence of STI is much higher among HIV-positive men. Anal intercourse is practiced in approximately half of the sexual encounters that take place between the men. Condoms are consistently used during half of these anal intercourses. About 50 percent of the men in the study have had unprotected anal intercourse during the past 12 months. Ten percent of the men have had so with four different men or more. This is more common among those who have a large number of sex partners, who are HIV-positive or unsure of their HIV-status and among those who have had a STI during the past 12 months. Ten percent of the men had an unprotected anal intercourse during the latest sexual encounter where the HIV status of the sex partner (or the respondent) was unknown. These men are more likely to be younger, single, to have less experience of HIV-testing, and to have had a large number of sex partners during the past 12 months. Half of the men in study live in a committed relationship. Approximately two out of ten use condoms consistently when having anal intercourse with their partner. Two out of ten have had unprotected anal intercourse outside the relationship during the past 12 months. Most of the men in the study have had contact with HIVprevention during the past 12 months. There are, however, still some preventive needs that has to be met with accurate interventions. For example, the men who have experience of sexual risk taking want access to interventions that improve their skills in communication about HIV-status.