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In many countries, HIV infections among MSM (MSMHIV) are closely monitored, and updated epidemiological reports are made available annually, yet the true prevalence of MSMHIV can be masked for areas with small population density or lack of data. Therefore, this study aimed to investigate the feasibility of small area estimation with a Bayesian approach to improve HIV surveillance. Data from the European MSM Internet Survey 2017 (EMIS-2017, Dutch subsample, n=3,459) and the Dutch survey ‘Men & Sexuality-2018’ (SMS-2018, n=5,653) were utilized in this study. We first applied a frequentist calculation to compare the observed relative risk of MSMHIV per Public Health Services (GGD) region in the Netherlands. We then applied a Bayesian spatial analysis and ecological regression to account for variance due to space and determinants associated with HIV among MSM to obtain more robust estimates. Results of the prevalence and risk estimations from EMIS-2017 and SMS-2018 converged with minor differences. Both estimations confirmed that the risk of MSMHIV is heterogenous across the Netherlands with some GGD regions, such as GGD Amsterdam [RR=1.21 (95% credible interval 1.05-1.38) by EMIS-2017; RR=1.39 (1.14-1.68) by SMS-2018], having a higher-than-average risk. Results from our ecological regression modelling revealed significant regional determinants which can impact on the risk for MSMHIV. In sum, our Bayesian approach to assess the risk of HIV among MSM was able to close data gaps and provide more robust prevalence and risk estimations. It is feasible and directly applicable for future HIV surveillance as a statistical adjustment tool.

People with mpox are likely to be stigmatized because of analogies to other sexually transmitted infections. Stigma is driven by beliefs about the perceived severity of the condition and perceived responsibility for acquiring the condition, both in broader society and individual responsibility. We explored these beliefs and compared them across mpox, HIV, syphilis, gonorrhoea, and chlamydia in an online survey, conducted in July, 2022, with 394 men-who-have-sex-with-men (MSM) in the Netherlands. We compared mean scores between infections using repeated measures ANOVA and conducted hierarchical regression analyses to identify determinants of both mpox perceived responsibility endpoints. Results showed that participants expected that mpox would be seen as a ‘gay disease’ and will be used to blame gay men. Compared to other infections, mpox was considered less severe than HIV, but more severe than syphilis, gonorrhoea, and chlamydia. Perceived responsibility was comparable across infections, but, for each infection, participants perceived attributed responsibility for infection to be higher in society than individual responsibility. Both perceived responsibility endpoints were highly correlated with each other and with other stigma beliefs. These results provide insight on the underlying determinants of mpox stigma, and demonstrate that mpox stigma is present in the Netherlands.

BackgroundIn the transitioning era towards the COVID-19 endemic, there is still a sizable population that has never been vaccinated against COVID-19 in the Netherlands. To identify regions and populations that have a lower chance of vaccination uptake, this study provides a spatio-temporal estimation of the relative chance of COVID-19 vaccination uptake for the first, second, and the booster doses in the Netherlands on both municipality level and the public health services (regional) level.MethodsData on COVID-19 vaccination uptake were retrieved from the publicly available national COVID-19 surveillance dataset. We used a Bayesian spatio-temporal modelling technique with the integrated nested Laplace approximation to account for the spatial structure and the space-time interaction. Additionally, we used an ecological regression modelling technique which takes into account areal level socio-demographic characteristics to adjust for their potential impact on the chance of the regional vaccination uptake.ResultsOur findings revealed a heterogenous spatio-temporal distribution of the relative chance of COVID-19 vaccination uptake with highly overlapping trends of all three vaccination doses. Internal heterogeneity of COVID-19 vaccination uptake within one public health services region on the municipality level was also identified. The Dutch main urban area and the most religiously conservative regions were identified to have a lower-than-average chance of COVID-19 vaccination uptake compared to the rest of the country. Ecological regression modelling analysis revealed that regions with a higher proportion of non-Western immigrants had a lower chance of COVID-19 vaccination uptake for all vaccination scenarios.ConclusionThe obtained estimates should inform national and local COVID-19 vaccination policies and service strategies in the Netherlands for the ongoing COVID-19 campaign on the second booster. Namely, more regional efforts and services may be needed to close ‘vaccination gaps’ and optimise COVID-19 health-related outcomes, especially with regard to regions with a relatively higher proportion of marginalised populations.

BACKGROUND: The prevalence of chemsex has been reported by multiple systematic reviews among men who have sex with men (MSM) focussing predominantly on the Global North. An Asian perspective with meta-analytical evidence is missing. This meta-analysis summarised the prevalence of substance use associated with chemsex, and chemsex activity among MSM and MSM sub-populations in Asia, as well as the likelihood for chemsex among MSM living with or without HIV. METHODS: We utilized PubMed, Web of Science and medRxiv to search for literature describing chemsex and its associated substance use among MSM and MSM sub-populations in Asia from January 1, 2010 to November 1, 2021 to conduct three meta-analyses with both frequentist and Bayesian approaches. RESULTS: We identified 219 studies and included 23 in the meta-analysis. Based on the frequentist models, methamphetamine was the default substance associated with chemsex among MSM in Asia (prevalence = 0.16, 95 %CI:0.09-0.22), followed by GHB/GBL (prevalence = 0.15, 95 %CI:0.03-0.27) and ketamine (prevalence = 0.08, 95 %CI:0.04-0.12), but hardly any cocaine (prevalence = 0.01, 95 %CI:0.00-0.03). Compared to a general MSM population (prevalence = 0.19, 95 %CI:0.15-0.23), MSM engaging in transactional sex showed a higher prevalence of chemsex (MSM sex work clients [prevalence = 0.28, 95 %CI:0.11-0.45]; MSM sex worker [prevalence = 0.28, 95 %CI:0.17-0.26]). MSM living with HIV also showed higher odds of chemsex activity (OR = 3.35, 95 %CI:1.57-7.10), compared to MSM living without HIV. Both meta-analytic models converged, indicating robust evidence. CONCLUSIONS: Our meta-analyses showed that chemsex is not uncommon among MSM, and MSM engaging in transactional sex in Asia. We confirmed that MSM living with HIV have a higher likelihood of engaging in chemsex, too. Chemsex prevention and management strategies in Asia should be adjusted accordingly.

Long-acting injectable PrEP (LAI-PrEP) is efficacious in preventing HIV among MSM and will be soon available in Europe. This study investigates the intention to use LAI-PrEP among MSM in the Netherlands by employing a diffusion of innovation approach, comparing PrEP naïve, discontinued MSM, oral PrEP early adopters and majority users. 309 MSM were surveyed on their intention and preference of LAI-PrEP. 83% showed high/very-high interest of, and 63% showed high/very-high intention to use LAI-PrEP. Early-adopters of oral PrEP use did not show increased intention to use LAI-PrEP and neither did PrEP naïve nor PrEP discontinued MSM, indicating a missing innovator effect for LAI-PrEP. Among the 218 current oral PrEP users, suboptimal oral PrEP adherence determined LAI-PrEP preference but did not determine LAI-PrEP intention. To reach the full potential of LAI-PrEP, a targeted strategy towards current oral PrEP users with suboptimal adherence seems indicated.

The current monkeypox epidemic is most prevalent among men-who-have-sex-with-men (MSM). PrEP users and MSM with HIV (MSMHIV) are considered having the highest risk for monkeypox infection in the Netherlands and being targeted for monkeypox vaccination. Next to the epidemiological evidence, perceived concern/risk are also important in decision making about health behaviour uptake, e.g., vaccination uptake. It is thus relevant to examine which subpopulations among MSM consider themselves most at risk and most concerned about monkeypox. This study aimed to investigate this to complement and to help determining if the current measures to curb the epidemic are successfully targeted or not in the Netherlands. We conducted an online survey among 394 Dutch MSM. We first calculated the prevalence and standardised prevalence ratio (SPR) of high perceived concern/risk of monkeypox by the PrEP-use and HIV status. We then conducted two multivariable logistic regression analyses to investigate the perceived concern/risk of monkeypox and their potential socio-demographic/behavioural/health/psycho-social determinants. Among the included MSM, 52% showed high perceived concern and 30% showed high perceived risk of monkeypox. PrEP users (SPR=0.83) showed a significantly lower chance of perceived concern; and MSMHIV (SPR=2.09) were found to have a significant higher chance of perceiving high risk of monkeypox. In the multivariable logistic analyses, non-PrEP users (aOR=2.55) were more likely to perceive high concern, while MSM who were retired (aOR=0.23) and who had chemsex recently (aOR=0.63) were less likely to perceive high concern. MSMHIV (aOR=4.29) and MSM who had an unknown/undisclosed HIV status (aOR=6.07), who had attended private sex parties (aOR=2.10), and who knew people who have/had monkeypox (aOR=2.10) were more likely to perceive high risk of monkeypox. We found that a higher perceived risk (aOR=2.97) and a higher concern (aOR=3.13) of monkeypox were correlated with each other, more results see Table 2. In sum, only one-third of Dutch MSM considered themselves at a high risk of a monkeypox infection, and only half of them showed a high concern. We identified a potential discrepancy between the “actual risk” and the perceived risk and concern of monkeypox among MSM in this early stage of the monkeypox epidemic in the Netherlands, especially among PrEP users and MSMHIV. More refined public health communication strategies may be needed to improve the understanding and knowledge of the “actual risk” of monkeypox infections among these MSM sub-populations to encourage and facilitate an improved health behaviour uptake.

The current monkeypox epidemic is most prevalent among men-who-have-sex-with-men (MSM). Vaccination programs are being rolled-out to curb the epidemic. Behavioural measures have been called for as well, e.g., by the WHO to reduce the number of sexual partners and sexual activity. We investigated intentions and determinants among Dutch MSM to follow such measures. Early July 2022, 394 MSM answered an online questionnaire. The overall intentions to reduce number of partners and sexual activity was high, but only a minority had developed definite intentions. Determinant analysis revealed that dating/open relationship status was a positive predictor, vaccination intentions did not predict sexual behaviour change; those not on PrEP were more likely to change their sexual behaviour. Monkeypox infection concern was negatively related to weaker intentions and only predicted definite intentions. Our results show that additional public health measures are necessary to reach and convince MSM to engage in sexual behaviour change.

Monkeypox is a zoonotic disease and leads to a smallpox-like disease in humans. The current epidemic in European countries requires informed responses. We investigated the ability to self-diagnose a potential monkeypox infection, and determinants of vaccination intention and self-isolation intention after exposure among MSM in the Netherlands. We found that about half were able to self-diagnose monkeypox, that 72% had a high intention to get vaccinated and 44% to self-isolate after monkeypox exposure. Determinants went beyond mere risk behaviour criteria.Data availabilityData is available upon request.Ethical statementThe study was assessed and approved by the ERCPN of Maastricht University (ref.188_11_02_2018_S32). Informed consent was provided by all participants.FundingThere was no funding source for this study.Authors’ contributionsAll authors conceptualised this research; KJJ collected the data for this research; HW and KJIDDP analysed the data; all authors drafted the manuscript; all authors critically revised the manuscript for intellectual content; All authors read and approved the final version of the manuscript.

International audience; Combination HIV prevention covers a range of biomedical, behavioral, and socio-structural interventions. Despite the growing availability of pre-exposure prophylaxis (PrEP), it is not always accessible in European Centre for Disease Prevention and Control reporting countries and may not meet the needs of all at-risk populations. Based on the Flash! PrEP in Europe data, multiple correspondence analysis and hierarchical clustering were used to identify patterns in HIV prevention strategies among 9980 men who have sex with men (MSM). PrEP interest was evaluated among four identified clusters: (A) "high condom use, sometimes Treatment as Prevention (TasP)"; (B) "mix of methods, infrequent condom use"; (C) "high condom use, tendency to choose partners based on serological status" and (D) "moderate use of condoms mixed with other prevention strategies". Clusters B and D had higher PrEP interest. These results suggest that MSM use a range of behavioral and biomedical risk reduction strategies that are often combined. On-demand PrEP may meet the needs of MSM who infrequently use condoms and other prevention methods.

The term “Pre-exposure prophylaxis (PrEP) tourists” refers to individuals who obtain PrEP in other countries and use it in their home countries. A prospective observational cohort study was conducted among a group of men who have sex with men (MSM) who obtained PrEP in private clinics in Thailand and used it in Hong Kong. Participants completed two web-based self-administered surveys when obtaining PrEP in Thailand and three months afterwards. Out of 110 participants at baseline, 67 completed the follow-up. The prevalence of sexually transmitted infection (STI) testing was 47.8% during the follow-up period. Eleven participants received an STI diagnosis, and seven of them were incident infections in the past three months. Participants who perceived a higher chance for STI infection (adjusted odds ratios (AOR): 1.90, 95% CI: 1.00, 3.75) and reported higher intention to take up STI testing at baseline (AOR: 1.62, 95% CI: 1.05, 2.50) were more likely to receive STI testing during the follow-up period. Baseline perceptions that service providers would think they were having risky behaviors because of PrEP use was negatively associated with the dependent variable (AOR: 0.51, 95% CI: 0.31, 0.86). Service planning and health promotion related to STI testing is needed for MSM “PrEP tourists”.

Western studies suggest that perceived pressure from family members, peers, and the media to achieve muscularity ideals are associated with higher muscle dissatisfaction and that such associations are mediated through different psychological processes. However, how such findings apply to young Chinese men has not been explored. Using an online survey, this study examined if perceived pressure from family, peers, and the media to achieve muscularity ideals was associated with muscle dissatisfaction among 319 male college students in Hong Kong and investigated the potential mechanisms explaining such associations (social comparison, uncompassionate self-responding, and body surveillance). Structural equation modeling results indicated that pressure from peers was associated with higher muscle dissatisfaction through increased uncompassionate self-responding (β = 0.05, 95% confidence interval [CI] [0.01, 0.09]). Pressure from the media was associated with higher muscle dissatisfaction through increased social comparison (β = 0.12, 95% CI [0.01, 0.22]) and uncompassionate self-responding (β = 0.05, 95% CI [0.01, 0.09]). Contrary to our hypotheses, pressure from family members was not associated with muscle dissatisfaction and the mediating psychological processes. Moreover, the direct effect from perceived peer pressure to muscle dissatisfaction remained significant after considering the mediators (β = 0.18, 95% CI [0.02, 0.33]). The mediation models were supported by satisfactory model fit indices. This study revealed that different sources of muscularity-related pressure were associated with Chinese male college students’ muscle dissatisfaction through varied psychological processes. Practitioners may consider different intervention strategies to reduce the potential impacts of peer and media pressures on muscle dissatisfaction among young Chinese men

Next to its benefits for HIV prevention, PrEP may have psychosocial benefits relating to improved quality of sex life. The aim of the current study was to investigate the onset of changes in the quality of sex life and sexual pleasure of PrEP users in the first months of commencing PrEP use. Moreover, we investigated what factors were related to the quality of sex life of PrEP users. We recruited 145 participants via the Dutch PrEP-advocacy website PrEPnu.nl, and they received follow-up questionnaires after three and six months. We found that PrEP users reported an increase in the quality of their sex life, which was related to reduced fear of HIV since they started using PrEP but not to decreased condom use. PrEP users were more interested in experimenting with sex practices, but they did not always feel more desirable as a sex partner because of PrEP use. Health-care providers and health promotion campaigns could emphasize the positive effects of PrEP on the quality of sex life, in addition to the HIV-preventive effects of PrEP, to decrease PrEP stigma and increase PrEP uptake.

An online assessment among social media-using young men who have sex with men found that 87% were willing to use HIV self-testing with online supervision. Correlates included never tested, having higher numbers of sexual partners, and seeking partners online. HIV self-testing with online supervision may be appropriate for young men who have sex with men who have high risks and may not access venue-based settings.

LGBT-related hate crime is a conscious act of aggression against an LGBT citizen. The present research investigates associations between hate crime, psychological well-being, trust in the police and intentions to report future experiences of hate crime. A survey study was conducted among 391 LGBT respondents in the Netherlands. Sixteen percent experienced hate crime in the 12 months prior. Compared to non-victims, victims had significant lower psychological well-being, lower trust in the police and lower intentions to report future hate crime. Hate crime experience and lower psychological well-being were associated with lower reporting intentions through lower trust in the police. Helping hate crime victims cope with psychological distress in combination with building trust in the police could positively influence future reporting.

Bio-medical HIV pre-exposure prophylaxis (PrEP) is the use of an antiretroviral drug shown to drastically decrease the transmission of HIV between sexual partners. However, there are reports that peer evaluations are an important factor among men who have sex with men (MSM) who are considering or taking PrEP. We used a trait transference paradigm to characterize attitudes towards PrEP users, their sexual behavior, and transference effects on their social network. We recruited 339 men across nine cities in the U.S. from advertisements on a popular smart phone geospatial dating application to complete a survey. They read and judged vignettes about MSM and associated friends on their trustworthiness and responsibility, with the main character being described as having frequently changing partners (FCP) or monogamous, and taking PrEP or not. Our results mainly found PrEP praise within our U.S. sample, especially when evaluating responsibility, while FCP behavior was negatively evaluated. Lastly, we found minimal transference effects on the associated friends suggesting judgments arising from sex-related actions are anchored to the actor only. These insights identify contextual boundaries of associative cognition and can inform interventions hoping to improve PrEP acceptance and uptake.

Introduction The SARS‐CoV‐2 virus can currently pose a serious health threat and can lead to severe COVID‐19 outcomes, especially for populations suffering from comorbidities. Currently, the data available on the risk for severe COVID‐19 outcomes due to an HIV infection with or without comorbidities paint a heterogenous picture. In this meta‐analysis, we summarized the likelihood for severe COVID‐19 outcomes among people living with HIV (PLHIV) with or without comorbidities. Methods Following PRISMA guidelines, we utilized PubMed, Web of Science and medRxiv to search for studies describing COVID‐19 outcomes in PLHIV with or without comorbidities up to 25 June 2021. Consequently, we conducted two meta‐analyses, based on a classic frequentist and Bayesian perspective of higher quality studies. Results and discussion We identified 2580 studies (search period: January 2020–25 June 2021, data extraction period: 1 January 2021–25 June 2021) and included nine in the meta‐analysis. Based on the frequentist meta‐analytical model, PLHIV with diabetes had a seven times higher risk of severe COVID‐19 outcomes (odd ratio, OR = 6.69, 95% CI: 3.03–19.30), PLHIV with hypertension a four times higher risk (OR = 4.14, 95% CI: 2.12–8.17), PLHIV with cardiovascular disease an odds ratio of 4.75 (95% CI: 1.89–11.94), PLHIV with respiratory disease an odds ratio of 3.67 (95% CI: 1.79–7.54) and PLHIV with chronic kidney disease an OR of 9.02 (95% CI: 2.53–32.14) compared to PLHIV without comorbidities. Both meta‐analytic models converged, thereby providing robust summative evidence. The Bayesian meta‐analysis produced similar effects overall, with the exclusion of PLHIV with respiratory diseases who showed a non‐significant higher risk to develop severe COVID‐19 outcomes compared to PLHIV without comorbidities. Conclusions Our meta‐analyses show that people with HIV, PLHIV with coexisting diabetes, hypertension, cardiovascular disease, respiratory disease and chronic kidney disease are at a higher likelihood of developing severe COVID‐19 outcomes. Bayesian analysis helped to estimate small sample biases and provided predictive likelihoods. Clinical practice should take these risks due to comorbidities into account and not only focus on the HIV status alone, vaccination priorities should be adjusted accordingly.

Despite men-who-have-sex-with-men (MSM) from Latin America (LA) are still a vulnerable population for known health-related conditions and social problems, availability of comparable data across LA countries for assessment and monitoring purposes is limited. The objective of this article is to present the study design and the questionnaire of LAMIS-2018 (Latin America MSM Internet Survey), its recruitment strategy, rates and sources by country, and the lessons learned from its implementation. LAMIS-2018 was a cross-sectional, internet-based survey targeting MSM living in 18 LA countries (Argentina, Bolivia, Brazil, Chile, Colombia, Costa Rica, Ecuador, El Salvador, Guatemala, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, Suriname, Uruguay, and Venezuela) that gathered data about sexual behaviors, HIV/STI and viral hepatitis knowledge, prophylactic use of antiretrovirals, psychosocial health, and access to sexual health services. The survey went online for four months and was available in three languages (Spanish, Portuguese, and Dutch). Promotion was carried out using dating apps, websites, social networks, and by community-based and academic organizations of each participating country directly in gay venues and in their own premises. Overall, 64,655 MSM participated in LAMIS-2018. Dating apps and websites were the most important recruitment source in most countries, except for Honduras, Nicaragua, and Suriname, where community-based organizations recruited most of the participants. Beyond the LAMIS-2018 implementation description, we highlight the feasibility of such a study in this context, based on the collaboration between community-based and academic organizations to obtain a large sample of MSM in the region. LAMIS-2018 data will contribute to identify determinants of risk behaviors and prevention needs of vulnerable MSM populations in each country of the region.

Background Pre-exposure prophylaxis (PrEP) uptake has remained low among men who have sex with men (MSM) eligible for PrEP in the Netherlands, which could partly be due to stigma associated with taking PrEP. Perceptions about PrEP users (e.g., PrEP users have an increased rate of (condomless) sexual encounters) may modify mixing behavior and subsequently affect dynamics of HIV and STIs. We investigated whether HIV and STI risk perception, risk behavior, and partner selection depend on PrEP usage. Methods We analyzed sexual behavior and PrEP data from 426 HIV-negative MSM who participated in the Flash! PrEP in Europe survey in the Netherlands in 2016. We distinguished between current PrEP users (n=29), men interested in PrEP (n=267), and men not interested in PrEP (n=130). We tested differences between these 3 groups in risk perception and sexual behavior variables using ANOVA and Chi-squared test. Results Mean age of participants was 42 yrs (range= 18–75); 85% were born in the Netherlands. PrEP users and men not interested in PrEP consider their risk of acquiring HIV low, while men interested in PrEP consider their risk higher (p Conclusion PrEP users engage in sexual behavior with higher risk of STI acquisition than non-PrEP users. Men not interested in PrEP are less open for sexual encounters with PrEP users than men in other groups. Therefore, perceptions of PrEP users and non-PrEP users may change mixing patterns and thus STI dynamics.

Background Since its formal introduction in 2019, PrEP uptake in the Netherlands is growing, but remains at suboptimal levels. Hence, the analysis of determinants is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called ‘Randstad’, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional discrepancies is necessary. We seek to unravel regional differences jointly with known predictors of PrEP use, intention and awareness. Method This cross-sectional study included 3,232 HIV-negative Dutch MSM recruited via the EMIS survey in late 2017. Prevalence and standardized prevalence ratio (SPR) of PrEP use, awareness and intention were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modeling was conducted to identify the association of PrEP use with PrEP awareness and intention, sociodemographic, behavioral, psychological/cognitive determinants, and random effects from regional differences. Results MSM from Randstad used more PrEP (SPR=1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance (adjusted ICC=0.046). Greater influence from intention to use (OR=4.5, 95%CI 2.0–10.1) and knowledge of PrEP (OR=7.0, 95%CI 4.1–12.0), while limited influence from the awareness of PrEP was observed (OR=0.4, 95%CI 0.04–4.4). Lower education (OR=0.4, 95%CI 0.2–0.9) was negatively associated with PrEP use, however, no significant difference was found between middle and high education (OR=1.2, 95%CI 0.7- 2.0). Conclusion We showed that regional differences – MSM in non-urban regions – and with a low educational background account for lower PrEP use and intention. Based on these findings more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

This qualitative study focuses on youth perceptions of cyberbullying (definition, causes, consequences, and management). We also articulate how perceptions of cyberbullying among Thai youth are influenced by Thai culture, including Thai youth culture. Data were collected from 15 to 24 year-olds in Central Thailand through 22 focus group discussions (FGDs) with 4-6 participants each, as well as 26 in-depth interviews (IDIs), totaling 136 participants. These youth defined cyberbullying as harming others through mobile phones and the Internet. To count as cyberbullying, actions had to cause real harm or annoyance and be committed with malicious intent. The relationship between the parties involved also mattered: close friends were unlikely to be considered cyberbullies. Participants thought that the anonymity of cyberspace is a key cause of cyberbullying but also that cyberbullying often results from previous offline incidents of violence. In their view, cyberbullying impacts individuals and their social interactions. Participants tended to manage the problem by themselves and not consult their parents. Alarmingly, participants viewed cyberbullying as 'an ordinary matter'. To raise awareness that cyberbullying is a societal problem with serious consequences, state agencies and educational institutions need to play active roles in preventing it and responding to it constructively when it occurs.

PrEP uptake in the Netherlands is growing but remains at suboptimal levels. Hence, the analysis of hurdles is paramount. Given the initial focus of PrEP provision among men-who-have-sex-with-men (MSM) via a demonstration project that was launched in June 2015, AmPrEP in Amsterdam, and pharmacies in the main urban areas (so called “Randstad”, entailing Amsterdam, Utrecht, Leiden, The Hague and Rotterdam), investigating regional differences is necessary. This study seeks to unravel regional differences jointly with the psycho-social determinants of PrEP uptake. This cross-sectional study included 3232 HIV-negative MSM recruited via the Dutch subsample of the European-MSM-Internet-Survey in late 2017 (EMIS-2017), which aimed to inform interventions for MSM who are highly affected by infections with HIV and other sexually transmitted infections. Prevalence and the standardised prevalence ratio (SPR) of PrEP awareness, intention and uptake were measured on a regional level (Randstad vs. the rest of the country). Multi-level logistic modelling was conducted to identify the association of PrEP uptake with PrEP awareness and intention, socio-demographic, psycho-social determinants and random effects from regional differences. MSM from the Randstad used more PrEP (SPR = 1.4 vs. 0.7) compared to the rest of the country, but there were minor differences for awareness and intention. The regional distinction was estimated to explain 4.6% of the PrEP use variance. We observed a greater influence from PrEP intention (aOR = 4.5, 95% CI 2.0–10.1), while there was limited influence from the awareness of PrEP (aOR = 0.4, 95% CI 0.04–4.4). Lower education (aOR = 0.4, 95% CI 0.2–0.9) was negatively associated with PrEP uptake; however, no significant difference was found between middle (aOR = 1.2, 95% CI 0.7–2.0) and high education. We showed that regional differences—MSM in non-urban regions—and other psycho-social determinants account for lower PrEP uptake. Based on these findings, more fine-tuned PrEP access with a focus on non-urban regions can be implemented, and tailored campaigns increasing intention/use can be conducted among target populations.

Sexual healthcare aims to reduce HIV and sexually transmitted infections (STIs) by promoting testing and prevention. To better reach men who have sex with men (MSM), additional strategies are needed. Here, we describe development of an intervention, which is part of a broader HIV/STI home-care program, targeted to reach MSM and motivate them to use self-sampling tests. Self-sampling includes blood sampling (finger prick) for HIV, hepatitis B, and syphilis, and a urine sample and oral and anorectal swab samples for chlamydia and gonorrhea. Intervention mapping, a systematic six-step approach, was used to guide the development process: (1) needs assessment including interviews with MSM, (2) create a matrix of change, (3) selection of theory-based methods and practical strategies, (4) intervention development, (5) implementation plan, and (6) evaluation (not included in this paper). Stakeholders were involved to increase program support and feasibility. The needs assessment revealed that testing barriers among MSM related to stigma, time, and privacy concerns. Barriers among healthcare providers related to time, competing priorities, lack of expertise, and guideline restrictions. Included intervention components are designed to overcome these barriers, e.g., engaging role models, with a website with a role model story, and providing tailored information. Methods to reach MSM were a variety of information channels (posters, flyers, and audio-visual displays) and delivery modes, such as advertisements on websites and invitational cards (online and paper) distributed by healthcare providers and MSM themselves (social network testing/peer testing). Our intervention aims to encourage MSM to engage in testing, re-testing, and providing a test to peer MSM. Evidence-based methods to overcome barriers were included to reach and motivate an increased number of MSM. Using intervention mapping stimulated systematic evidence-based decision making and adapting the intervention to the target audience and setting. The next step (step 6) is to implement and evaluate the intervention.

The World Health Organization recommends pre-exposure prophylaxis (PrEP) for all populations at substantial risk of HIV infection, including women. However, data regarding PrEP interest among women is lacking, particularly in Europe. Factors associated with interest in using PrEP were assessed among women respondents to the Flash! PrEP in Europe (FPIE) survey. This community-based cross-sectional study, conducted in 12 European countries, aimed to assess PrEP knowledge and interest. “High objective risk” (HOR) was assessed using established risk criteria following EACS and CDC guidelines. Factors associated with interest in using PrEP were assessed in univariable and multivariable logistic regression models. Among 678 women, 12.5% (n = 85) were considered at HOR, 46.8% (n = 317) indicated prior PrEP knowledge and 18.0% (n = 122) reported interest in using PrEP. Among women at HOR, 40.0% (n = 34) were interested in PrEP. Factors significantly associated with PrEP interest in the final multivariable model were: younger age (18–29 years) (aOR 1.91[95CI: 1.07; 3.41]), bad self-perceived financial status (1.84[1.09; 3.11]), migrant status (south to north) (2.87[1.05; 7.89]), single or dating relationship status (1.93[1.23; 3.03]), sexual abuse history (1.86[1.17; 2.97]), “rather high”/ “high” self-perceived HIV risk (3.21[1.32; 7.81]), and HOR (2.49[1.42; 4.35]). These results show that women at HOR and those who perceived themselves to be at high risk are interested in using PrEP. There is a critical need for targeted information and improved access to PrEP to increase uptake of this HIV prevention tool to meet PrEP interest among women, KJJ received a grant from Dutch AIDS Fonds (Grant P-11302)

Background Sexual minority men are at greater risk of depression and suicidality than heterosexuals. Stigma, the most frequently hypothesized risk factor for this disparity, operates across socioecological levels-structural (e.g., laws), interpersonal (e.g., discrimination), and individual (e.g., self-stigma). However, there is limited data on whether changes in structural stigma, such as when a stigmatized person moves to a lower stigma context, affect mental health, and on the mechanisms underlying this association Methods The current study uses data from the 2017/18 European Men-who-have-sex-with-men Internet Survey (n = 123,428), which assessed mental health and psychosocial mediators. We linked these data to an objective indicator of structural stigma related to sexual orientation in respondents’ countries of origin (N = 178) and receiving (N = 48) countries Results Among respondents who moved from higher-to-lower structural stigma countries (n = 11,831), longer exposure to the lower structural stigma environments of their receiving countries was associated with a significantly: 1) lower risk of depression and suicidality; 2) lower odds of concealment, internalized homonegativity, and social isolation; and 3) smaller indirect effect of structural stigma on mental health through these mediators. Conclusions This study provides evidence that structural stigma is associated with the mental health of sexual minority men, both through proximal experiences and as a function of length of exposure to structurally diverse contexts, at least for those who move higher-to-lower structural stigma contexts. Findings suggest the importance of routinely assessing life-course structural influences on mental health and deploying interventions to address those influences.

HIV-related factors and suicide-risk status were assessed among YMSM aged 18-24 years recruited through various MSM-related online social apps in Bangkok (N = 1394). The online survey assessed demographic characteristics, sexual behaviours and suicide-risk status. Measure of suicide risk was taken from the Suicidal Behaviors Questionnaire-Revised (cut-off score of seven or higher). Among participants, 249 (17.9%) reported suicide-risk. In multivariable logistic regression, correlates of suicide-risk status included having sometimes or often ever participated in group sex (AOR=1.58, 95% CI: 1.17-2.14), having received money or opportunities for sex (AOR=1.54, 95% CI: 1.09-2.17), often seeking partners online (AOR=1.59, 95% CI: 1.05-2.39), inconsistent condom use (AOR=1.67, 95% CI: 1.26-2.21), and self-assessed as having "medium" or "high" HIV risk (AOR=2.53, 95% CI: 1.61-3.98 and AOR=3.35, 95% CI: 1.92-5.82, respectively). Findings suggest that HIV risk behaviours shown by YMSM are significantly associated with higher risk of suicide.

Introduction Transgender individuals are at risk for HIV. HIV risks are dynamic and there have been substantial changes in HIV prevention (e.g., pre-exposure prophylaxis [PrEP]). It is thus time to revisit HIV prevalence and burden among transgender individuals. The objective of this systematic review and meta-analysis was thus to examine worldwide prevalence and burden of HIV over the course of the epidemic among trans feminine and trans masculine individuals. Methods We conducted an updated systematic review by searching PsycINFO, PubMed, Web of Science, and Google Scholar, for studies of any research design published in in a peer-reviewed journal in any language that reported HIV prevalence among transgender individuals published between January 2000 and January 2019. Two independent reviewers extracted the data and assessed methodological quality. We then conducted a meta-analysis, using random-effects modelling, to ascertain standardized prevalence and the relative burden of HIV carried by transgender individuals by country and year of data collection, and then by geographic region. We additionally explored the impact of sampling methods and pre-exposure prophylaxis (PrEP). Results Based on 98 studies, overall standardized HIV prevalence over the course of the epidemic, based on weights from each country by year, was 19.9% (95% CI 14.7% - 25.1%) for trans feminine individuals (n = 48,604) and 2.56% (95% CI 0.0% - 5.9%) for trans masculine individuals (n = 6460). Overall OR for HIV infection, compared with individuals over age 15, was 66.0 (95% CI 51.4–84.8) for trans feminine individuals and 6.8 (95% CI 3.6–13.1) for trans masculine individuals. Prevalence varied by geographic region (13.5% - 29.9%) and sampling method (5.4% - 37.8%). Lastly, PrEP effects on prevalence could not be established. Conclusion Trans feminine and trans masculine individuals are disproportionately burdened by HIV. Their unique prevention and care needs should be comprehensively addressed. Future research should further investigate the impact of sampling methods on HIV prevalence, and monitor the potential impact of PrEP.

Contains fulltext : 214941.pdf (Publisher’s version ) (Open Access) We present a consensus-based checklist to improve and document the transparency of research reports in social and behavioural research. An accompanying online application allows users to complete the form and generate a report that they can submit with their manuscript or post to a public repository. 3 p.

Author(s): Aczel, Balazs; Szaszi, Barnabas; Sarafoglou, Alexandra; Kekecs, Zoltan; Kucharský, Simon; Benjamin, Daniel; Chambers, Christopher D; Fisher, Agneta; Gelman, Andrew; Gernsbacher, Morton A; Ioannidis, John P; Johnson, Eric; Jonas, Kai; Kousta, Stavroula; Lilienfeld, Scott O; Lindsay, D Stephen; Morey, Candice C; Munafo, Marcus; Newell, Benjamin R; Pashler, Harold; Shanks, David R; Simons, Daniel J; Wicherts, Jelte M; Albarracin, Dolores; Anderson, Nicole D; Antonakis, John; Arkes, Hal R; Back, Mitja D; Banks, George C; Beevers, Christopher; Bennett, Andrew A; Bleidorn, Wiebke; Boyer, Ty W; Cacciari, Cristina; Carter, Alice S; Cesario, Joseph; Clifton, Charles; Conroy, Ronan M; Cortese, Mike; Cosci, Fiammetta; Cowan, Nelson; Crawford, Jarret; Crone, Eveline A; Curtin, John; Engle, Randall; Farrell, Simon; Fearon, Pasco; Fichman, Mark; Frankenhuis, Willem; Freund, Alexandra M; Gaskell, M Gareth; Giner-Sorolla, Roger; Green, Don P; Greene, Robert L; Harlow, Lisa L; de la Guardia, Fernando Hoces; Isaacowitz, Derek; Kolodner, Janet; Lieberman, Debra; Logan, Gordon D; Mendes, Wendy B; Moersdorf, Lea; Nyhan, Brendan; Pollack, Jeffrey; Sullivan, Christopher; Vazire, Simine; Wagenmakers, Eric-Jan | Abstract: An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Background Indonesia has the fourth-largest number of new HIV diagnoses per year worldwide, is the only country in the Asia-Pacific region where HIV prevalence is increasing, and the WHO aims of 90–90–90 has not yet been reached. It is therefore important to investigate barriers and facilitators to antiretroviral (ARV) therapy initiation and adherence. This study set out to delineate these barriers and facilitators from the perspective of health care providers. Methods Between March and May 2020, 20 semi-structured interviews were conducted with health care providers in Indonesia. Thematic analyses were subsequently conducted to ascertain categories of barriers and facilitators to initiation and adherence. Results Main facilitators to ARV initiation and adherence were social support; good client-provider communication; less bureaucracy or easy access to ARV; and sufficient HIV and ARV knowledge among people with HIV. Additionally, the use of euphemistic terminology for ARV was a facilitator for adherence, but not for initiation; whereas having sufficient self-care motivation, a desire to live or having health goals, and HIV status acceptance were facilitators to initiation but not adherence. Barriers to initiation and adherence included stigma; complicated bureaucracy; insufficient health care facilities, health care coverage or ARV supply; and distance to clinics. Side effects and experiencing regimens as tedious were additional barriers to adherence; and being in denial, being asymptomatic, fatalism, and the influence of anti-ARV social media were additional barriers to initiation. Conclusion Barriers and facilitators to initiation and adherence occur on various socio-ecological levels and should therefore be targeted on structural, interpersonal, and individual levels. Health care providers can play a key role in promoting facilitators and reducing barriers, but must be supported by national and organizational level efforts that increase access to HIV clinics and health care coverage, and decrease bureaucracy and community-level initiatives that correct myths and misinformation.

Embarrassment displays show others that one is aware of one's own misbehavior and willing to make up for it. The facial actions of embarrassment, however, are partly similar to those of disinterest, which has an opposite function, signaling that one is not concerned about one's self in relation to others. In the context of negative intergroup relations, embarrassment displays of outgroup members may therefore be misinterpreted as disinterest. In the present research, the authors predicted that Whites would perceive Arab expressions of embarrassment more as disinterest, but embarrassment displays of Whites more as embarrassment. Aggregated Study 1 (N = 1,154) confirms this hypothesis showing that White participants perceived more intense embarrassment in Whites than in Arabs and more intense disinterest in Arabs than in Whites. Studies 2 (n = 193) and 3 (n = 260) include methodological improvements and either largely or fully replicated our findings. Based on this evidence in an Arab-White context, the authors conclude that the affiliative function of embarrassment perception is dependent on the nature of the group context. Finally, they discuss the generalizability of this intergroup emotion bias in which emotional expressions may be perceived as the opposite of what they are intended to display. (PsycINFO Database Record

The possibility that holding an expansive nonverbal display for two minutes could affect a person’s behavioral, psychological, and physiological states was a provocative idea when first proposed (C...

Background Despite public-health efforts, men who have sex with men (MSM) are still not sufficiently reached with current HIV/STI care. We developed a regional MSM home-care program, used by public-health STI care, hospital HIV care, and general practitioners. The program combines home-based self-sampling testing for HIV, syphilis, chlamydia and gonorrhoea (anorectal, genital and oropharyngeal) with counselling, treatment and sexual health care after positive diagnosis. We developed this program using the systematic intervention mapping (IM) protocol (six steps). Here, we describe the development process. Methods Step1 (needs assessment): we conducted a literature review and interviews with 18 MSM and 19 healthcare professionals from public-health and hospital care. Step 2–5: specific objectives were formulated to achieve the program goal and methods were selected to address determinants that needed to be changed. Program production was done with evidence-based methods to overcome barriers identified in the needs assessment. A plan was made for implementation. Results Step 1 (needs assessment): Healthcare professionals and MSM expressed a positive attitude towards home-based self-sampling. Care providers raised concerns to missing face-to-face counselling and expected that MSM may experience difficulties with blood drawing (finger prick). Steps 2–4: Identified target change behaviors were 1) testing in MSM and 2) adoption of the program in care-providers. Solutions to decrease testing barriers in MSM in the program include: 1) home-based self-sampling 2) reminders (text messaging) 3) social network peer-dissemination of tests and 4) re-testing opportunities. To improve adoption and implementation, a sustainable collaborative infrastructure is set up between public-health service, hospital care providers and general practitioners. Conclusion The regional homecare program to motivate MSM to HIV/STI testing and to motivate care providers to use it was systematically developed for effective behavioral change. In the program, evidence-based methods to overcome barriers are included to reach an increased number of MSM and motivate care providers. The next step is to pilot implementation of the program. Disclosure No significant relationships.