The SIALON Project ( ): HIV prevalence, undiagnosed HIV infections and testing seeking behaviour among MSM attending gay venues in six European cities Lisbon, Portugal, March 2011 Massimo Mirandola 1,2, Jean Pierre Foschia 2, Michele Breveglieri 2, Ruth Joana Davis 1, Martina Furegato 2, Enrica Castellani 2, Lorenzo Gios 1, Dunia Ramarli 4, Paola Coato 4 & The SIALON network 1 Dept. of Health - Office for International Health and Social Affairs - Veneto Region - Italy 2 Regional Centre for Health Promotion (CRRPS) – ULSS 20 Verona – Veneto Region – Italy 3 Verona University Hospital – Clinical Immunology - Verona – Italy 4 Verona University Hospital – Microbiology - Verona – Italy Project co-funded by the European Commission under the Public Health Programme

Objectives To estimate HIV among MSM based on oral fluid test To study sexual behaviour risk patterns and the determinants of VCT (Voluntary Counselling and Testing) access in the MSM population To model the relationship between risk behaviour, socio-ecological factors, real and self reported sero-status

–QUESTIONNAIRE –GENSCREEN HIV 1 / 2 version 2, BIO-RAD EIA Test – Validation on 504 pos. and neg. samples Project Methodology

Questionnaire flow-chart 12 months period Last time 6 months period

MSM per At least 10 VDT? FILL IN THE EXCEL FILE Gay venues mapping review Advertisements Internet searchGay guidesKey informants Gay venues identification Venues opening time Attendance patterns identification Owners - patrons cross validation Special events identification Need of furhter info ? NO PotentialVDTs list YES Safety for data collectors? NO YES EligibleVDTs list YES Observation at venues SIALON TLS SAMPLING NO excluded Venues mapping Opening Time mapping Further info Safety check and final VDTs list

Some results

Prague Athens Verona Bucharest Bratislava Ljubliana Barcelona Number of Subjects Mean (Age) Mdn (Age) SD (Age) Subjects enrolled in the study by city

HIV TESTING PRACTICE, HIV PREVALENCE AND PERCENTAGE OF HIV UNDIAGNOSED MSM BY CITY HIV prevalence (OF TEST) (UNGASS 23 – ECDC suggested indicator) 2.6 ± ± ± ± ± ± * Provided only for reference % of undiagnosed cases among OF HIV positive MSM PragueBratislavaBarcelonaBucharestLjubljanaVeronaTotal * MSM who received an HIV test over the last 12 months and who know their test results (UNGASS 8 – ECDC suggested indicator) 40.2 ± ± ± ± ± ± Confidence Intervals 95%

Multilevel logistic model on HIV testing seeking behaviour Random Intercept Model Random Coef. M. Sex orientation Random Coef. M. Sex Orient. & age PredictorORSEORSEORSE Fixed part Age1.04** ** **0.01 Education: university degree 1.31* * *0.16 Living alone or with a male partner 1.64** ** **0.19 Living in a metropolitan area1.90** ** **0.24 Sexual orientation: gay/homosexual1.73** * *0.45 Reached with HIV prevention programme (condom) 1.59** ** **0.20 Perceived Positive Interpersonal Attitudes Towards Homo-bisex Men 1.07* * *0.02 Random part σ1 2 city level σ2 2 sex orient. at city level σ3 2 age at city level Loglikelihood

Testing seeking behaviour predicted probability by age, city and sexual orientation

Testing seeking behaviour predicted probability by age and sexual orientation

Conclusions HIV prevalence was higher in Southern European cities than elsewhere. Data seems to indicate that quite a number of infections was recently acquired over the last 12 months. Outreach prevention programmes promoting HIV testing are needed in order to promote HIV testing and detect undiagnosed infections. Testing seeking behaviour is influenced by age, education, living conditions, perceived homonegativity at micro-meso level and sexual orientation/identity. In relation to the study cities Sexual orientation/identity plays an important role in predicting testing seeking behaviour TLS increases the possibility of involving a variety of participants who probably do not attend health services and of obtaining more valid results. TLS is easily applicable in cities with a considerable number of eligible gay venues. It is more difficult to implement in cities where the gay community is poorly organised and where there are few easily accessible venues. TLS does not take into account other ways of recruiting, such as the internet, gay magazines, chat room, therefore the estimate of HIV and risk behaviour prevalence may be biased.