Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities

U. Marcus, Christiana Nöstlinger, Magda Rosińska, Nigel Sherriff, Lorenzo Gios, Sonia Dias, Ana Gama, I. Toskin, Ivailo Alexiev, Emilia Naseva, Susanne Schink, Massimo Mirandola

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background
Reducing the number of people with undiagnosed HIV infection is a major goal of HIV control and prevention efforts in Europe and elsewhere. We analysed data from a large multi-city European bio-behavioural survey conducted among Men who have Sex with Men (MSM) for previously undiagnosed HIV infections, and aimed to characterise undiagnosed MSM who test less frequently than recommended.
Methods
Data on sexual behaviours and social characteristics of MSM with undiagnosed HIV infection from Sialon II, a bio-behavioural cross-sectional survey conducted in 13 European cities in 2013/2014, were compared with HIV-negative MSM. Based on reported HIV-testing patterns, we distinguished two subgroups: MSM with a negative HIV test result within 12 months prior to the study, i.e. undiagnosed incident infection, and HIV positive MSM with unknown onset of infection. Bivariate and multivariate associations of explanatory variables were analysed. Distinct multivariate multi-level random-intercept models were estimated for the entire group and both subgroups.
Results
Among 497 participants with HIV-reactive specimens, 234 (47.1%) were classified as previously diagnosed, 106 (21.3%) as incident, and 58 (11.7%) as unknown onset based on self-reported status and testing history. MSM with incident HIV infection were twice as likely (odds ratio (OR)= 2.22, 95% confidence interval (95%CI): 1.17-4.21) to have used recreational substances during their last anal sex encounter and four times more likely (OR=3.94, 95%CI: 2.14-7.27) not to discuss their HIV status with the last anal sex partner(s). MSM with unknown onset of HIV infection were 3.6 times more likely (OR=3.61, 95%CI: 1.74-7.50) to report testing for a sexually transmitted infection (STI) during the last 12 months.
Conclusions
Approximately one third of the study participants who are living with HIV were unaware of their infection. Almost two-third (65%) of those with undiagnosed HIV appeared to have acquired the infection recently, emphasizing a need for more frequent testing. Men with the identified behavioural characteristics could be considered as primary target group for HIV Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection. The increased odds of those with unknown onset of HIV infection to have had an STI test in the past year strongly suggests a lost opportunity to offer HIV testing.
Original languageEnglish
Article number368
JournalBMC Infectious Diseases
Volume18
DOIs
Publication statusPublished - 6 Aug 2018

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HIV Infections
Demography
HIV
Sexual Behavior
Odds Ratio
Confidence Intervals
Sexually Transmitted Diseases
Infection
Cross-Sectional Studies
History

Bibliographical note

This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Keywords

  • HIV
  • Men having sex with men
  • Europe
  • biobehavioural survey
  • undiagnosed HIV infection

Cite this

Marcus, U. ; Nöstlinger, Christiana ; Rosińska, Magda ; Sherriff, Nigel ; Gios, Lorenzo ; Dias, Sonia ; Gama, Ana ; Toskin, I. ; Alexiev, Ivailo ; Naseva, Emilia ; Schink, Susanne ; Mirandola, Massimo. / Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities. In: BMC Infectious Diseases. 2018 ; Vol. 18.
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title = "Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities",
abstract = "BackgroundReducing the number of people with undiagnosed HIV infection is a major goal of HIV control and prevention efforts in Europe and elsewhere. We analysed data from a large multi-city European bio-behavioural survey conducted among Men who have Sex with Men (MSM) for previously undiagnosed HIV infections, and aimed to characterise undiagnosed MSM who test less frequently than recommended.MethodsData on sexual behaviours and social characteristics of MSM with undiagnosed HIV infection from Sialon II, a bio-behavioural cross-sectional survey conducted in 13 European cities in 2013/2014, were compared with HIV-negative MSM. Based on reported HIV-testing patterns, we distinguished two subgroups: MSM with a negative HIV test result within 12 months prior to the study, i.e. undiagnosed incident infection, and HIV positive MSM with unknown onset of infection. Bivariate and multivariate associations of explanatory variables were analysed. Distinct multivariate multi-level random-intercept models were estimated for the entire group and both subgroups.ResultsAmong 497 participants with HIV-reactive specimens, 234 (47.1{\%}) were classified as previously diagnosed, 106 (21.3{\%}) as incident, and 58 (11.7{\%}) as unknown onset based on self-reported status and testing history. MSM with incident HIV infection were twice as likely (odds ratio (OR)= 2.22, 95{\%} confidence interval (95{\%}CI): 1.17-4.21) to have used recreational substances during their last anal sex encounter and four times more likely (OR=3.94, 95{\%}CI: 2.14-7.27) not to discuss their HIV status with the last anal sex partner(s). MSM with unknown onset of HIV infection were 3.6 times more likely (OR=3.61, 95{\%}CI: 1.74-7.50) to report testing for a sexually transmitted infection (STI) during the last 12 months.ConclusionsApproximately one third of the study participants who are living with HIV were unaware of their infection. Almost two-third (65{\%}) of those with undiagnosed HIV appeared to have acquired the infection recently, emphasizing a need for more frequent testing. Men with the identified behavioural characteristics could be considered as primary target group for HIV Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection. The increased odds of those with unknown onset of HIV infection to have had an STI test in the past year strongly suggests a lost opportunity to offer HIV testing.",
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author = "U. Marcus and Christiana N{\"o}stlinger and Magda Rosińska and Nigel Sherriff and Lorenzo Gios and Sonia Dias and Ana Gama and I. Toskin and Ivailo Alexiev and Emilia Naseva and Susanne Schink and Massimo Mirandola",
note = "This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.",
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Marcus, U, Nöstlinger, C, Rosińska, M, Sherriff, N, Gios, L, Dias, S, Gama, A, Toskin, I, Alexiev, I, Naseva, E, Schink, S & Mirandola, M 2018, 'Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities', BMC Infectious Diseases, vol. 18, 368. https://doi.org/10.1186/s12879-018-3249-8

Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities. / Marcus, U.; Nöstlinger, Christiana; Rosińska, Magda; Sherriff, Nigel; Gios, Lorenzo; Dias, Sonia; Gama, Ana; Toskin, I.; Alexiev, Ivailo ; Naseva, Emilia; Schink, Susanne; Mirandola, Massimo.

In: BMC Infectious Diseases, Vol. 18, 368, 06.08.2018.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Behavioural and demographic correlates of undiagnosed HIV infection in a MSM sample recruited in 13 European cities

AU - Marcus, U.

AU - Nöstlinger, Christiana

AU - Rosińska, Magda

AU - Sherriff, Nigel

AU - Gios, Lorenzo

AU - Dias, Sonia

AU - Gama, Ana

AU - Toskin, I.

AU - Alexiev, Ivailo

AU - Naseva, Emilia

AU - Schink, Susanne

AU - Mirandola, Massimo

N1 - This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

PY - 2018/8/6

Y1 - 2018/8/6

N2 - BackgroundReducing the number of people with undiagnosed HIV infection is a major goal of HIV control and prevention efforts in Europe and elsewhere. We analysed data from a large multi-city European bio-behavioural survey conducted among Men who have Sex with Men (MSM) for previously undiagnosed HIV infections, and aimed to characterise undiagnosed MSM who test less frequently than recommended.MethodsData on sexual behaviours and social characteristics of MSM with undiagnosed HIV infection from Sialon II, a bio-behavioural cross-sectional survey conducted in 13 European cities in 2013/2014, were compared with HIV-negative MSM. Based on reported HIV-testing patterns, we distinguished two subgroups: MSM with a negative HIV test result within 12 months prior to the study, i.e. undiagnosed incident infection, and HIV positive MSM with unknown onset of infection. Bivariate and multivariate associations of explanatory variables were analysed. Distinct multivariate multi-level random-intercept models were estimated for the entire group and both subgroups.ResultsAmong 497 participants with HIV-reactive specimens, 234 (47.1%) were classified as previously diagnosed, 106 (21.3%) as incident, and 58 (11.7%) as unknown onset based on self-reported status and testing history. MSM with incident HIV infection were twice as likely (odds ratio (OR)= 2.22, 95% confidence interval (95%CI): 1.17-4.21) to have used recreational substances during their last anal sex encounter and four times more likely (OR=3.94, 95%CI: 2.14-7.27) not to discuss their HIV status with the last anal sex partner(s). MSM with unknown onset of HIV infection were 3.6 times more likely (OR=3.61, 95%CI: 1.74-7.50) to report testing for a sexually transmitted infection (STI) during the last 12 months.ConclusionsApproximately one third of the study participants who are living with HIV were unaware of their infection. Almost two-third (65%) of those with undiagnosed HIV appeared to have acquired the infection recently, emphasizing a need for more frequent testing. Men with the identified behavioural characteristics could be considered as primary target group for HIV Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection. The increased odds of those with unknown onset of HIV infection to have had an STI test in the past year strongly suggests a lost opportunity to offer HIV testing.

AB - BackgroundReducing the number of people with undiagnosed HIV infection is a major goal of HIV control and prevention efforts in Europe and elsewhere. We analysed data from a large multi-city European bio-behavioural survey conducted among Men who have Sex with Men (MSM) for previously undiagnosed HIV infections, and aimed to characterise undiagnosed MSM who test less frequently than recommended.MethodsData on sexual behaviours and social characteristics of MSM with undiagnosed HIV infection from Sialon II, a bio-behavioural cross-sectional survey conducted in 13 European cities in 2013/2014, were compared with HIV-negative MSM. Based on reported HIV-testing patterns, we distinguished two subgroups: MSM with a negative HIV test result within 12 months prior to the study, i.e. undiagnosed incident infection, and HIV positive MSM with unknown onset of infection. Bivariate and multivariate associations of explanatory variables were analysed. Distinct multivariate multi-level random-intercept models were estimated for the entire group and both subgroups.ResultsAmong 497 participants with HIV-reactive specimens, 234 (47.1%) were classified as previously diagnosed, 106 (21.3%) as incident, and 58 (11.7%) as unknown onset based on self-reported status and testing history. MSM with incident HIV infection were twice as likely (odds ratio (OR)= 2.22, 95% confidence interval (95%CI): 1.17-4.21) to have used recreational substances during their last anal sex encounter and four times more likely (OR=3.94, 95%CI: 2.14-7.27) not to discuss their HIV status with the last anal sex partner(s). MSM with unknown onset of HIV infection were 3.6 times more likely (OR=3.61, 95%CI: 1.74-7.50) to report testing for a sexually transmitted infection (STI) during the last 12 months.ConclusionsApproximately one third of the study participants who are living with HIV were unaware of their infection. Almost two-third (65%) of those with undiagnosed HIV appeared to have acquired the infection recently, emphasizing a need for more frequent testing. Men with the identified behavioural characteristics could be considered as primary target group for HIV Pre-Exposure Prophylaxis (PrEP) to avoid HIV infection. The increased odds of those with unknown onset of HIV infection to have had an STI test in the past year strongly suggests a lost opportunity to offer HIV testing.

KW - HIV

KW - Men having sex with men

KW - Europe

KW - biobehavioural survey

KW - undiagnosed HIV infection

U2 - 10.1186/s12879-018-3249-8

DO - 10.1186/s12879-018-3249-8

M3 - Article

VL - 18

JO - BMC Infectious Diseases

JF - BMC Infectious Diseases

SN - 1471-2334

M1 - 368

ER -