implementationplanetromeo

RESEARCHARTICLEOpenAccessKnowledgeofHIVinfectionandothersexuallytransmitteddiseasesamongmenwhohavesexwithmeninFinlandTarjaSuominen1*,TeppoHeikkinen2,MarjaPakarinen1,Anne-MariSepponen1andJariKylm1AbstractBackground:ThepurposeofthisstudywastodescribewhatisknownaboutHIVinfectionandothersexuallytransmitteddiseases,infectiontransmissionroutes,care,andsourcesofinformation,fromtheviewpointofmenhavingsexwithmen.
Methods:Nationaldata(n=2,072)wascollectedfromJunetoAugust2010inFinlandaspartofajointinternet-basedsurveyconductedin38countries(EMIS,EuropeanMSMInternetSexSurvey).
Results:Therespondents'age,placeofresidence,highesteducationandemploymentstatuswerestatisticallysignificantlyrelatedtohowoftentherespondentsoughtinformationonHIV,testingandtreatments,andwhattheyknewaboutinfectiontransmissionroutes.
Therespondents'informationseekingbehaviorwasnotseenasactiveregardingHIVinfectionandothersexuallytransmitteddiseases.
Conclusions:Weshouldalsoconsiderthepossibilityofusinginternet-basedinterventions,especiallyinsmallerandnortherncatchmentareas,inordertoimprovetheknowledgelevelofmenhavingsexwithmen.
Keywords:Knowledge,HIV,Transmission,PEP,MSM,SexuallytransmitteddiseasesBackgroundFinlandisacountrywithabout5.
5millioninhabitants,andtodate(20.
3.
2016),3,559peoplehavereceivedanHIVdiagnosis.
Ofallofthecaseswhichnotedthetransmissionroute(84%),72%weresexuallytransmitted.
Ofthese,32%werearesultofsexbetweenmen[1].
TheincidenceofHIVinfectioninmenengaginginsexwithmenisseveraltimeshigherthanseeninthepopulationonaverage[1],andac-cordingtoresearchconductedin2006,theincidenceofHIVinthisgroupwas4.
6%[2].
TherehashoweverbeenanincreaseinthenumberofHIVinfectionstransmittedviasexbetweenmeninseveralEuropeancountries[3],andvariousmethodshavebeendevelopedtoascertaintherealnumbersofHIVinfectionsintheEuropeanarea[4].
Theincreaseininfectionsconnectedtosexbetweenmenaccel-eratedinFinlandatthebeginningofthe2000s,reachingapeakin2007when72newinfectionswerediagnosed.
Sincethistime,approximately40infectionshavebeendiagnosedeachyear[5].
Asignificantincreaseinthenumberofsexuallytrans-mitteddiseaseshasbeenobservedinthecountriesofWesternEurope[6].
Therehavealsobeenreportsofahighprevalenceofsexuallytransmitteddiseases,espe-ciallyamongmenengaginginsexwithmen(e.
g.
[7]).
InFinland,themostcommonsexuallytransmitteddis-easesarechlamydia,genitalwartsandgenitalherpes.
Inrecentyearstheincidenceofchlamydiahasremainedhigh[5].
About244/100000newcasesperyearhavebeenfound2012to2014[1].
In2014,thenewcasesofgonorrheaamountedto286,ofwhich73%occurredinmen.
In2014inFinland,203casesofsyphiliswerediag-nosed,ofwhich64%occurredinmen[1].
Thisrepre-sentedanincreaseofmorethan50casescomparedtothepreviousyear.
Thenumberofmalesyphilisinfec-tionshasbeenincreasingsince2006andaconsiderableproportionofthesecaseshavebeenduetosexualcon-tactbetweenmen[5].
*Correspondence:tarja.
suominen@uta.
fi1UniversityofTampere,SchoolofHealthSciences,Tampere,FinlandFulllistofauthorinformationisavailableattheendofthearticleTheAuthor(s).
2017OpenAccessThisarticleisdistributedunderthetermsoftheCreativeCommonsAttribution4.
0InternationalLicense(http://creativecommons.
org/licenses/by/4.
0/),whichpermitsunrestricteduse,distribution,andreproductioninanymedium,providedyougiveappropriatecredittotheoriginalauthor(s)andthesource,providealinktotheCreativeCommonslicense,andindicateifchangesweremade.
TheCreativeCommonsPublicDomainDedicationwaiver(http://creativecommons.
org/publicdomain/zero/1.
0/)appliestothedatamadeavailableinthisarticle,unlessotherwisestated.
Suominenetal.
BMCInfectiousDiseases(2017)17:121DOI10.
1186/s12879-017-2203-5Factorsconducivetoriskybehaviorcanbeattributedtoseekingsexualpartnersovertheinternet,anoptimismasregardstotheavailabilityofeffectivemedicationforHIV,theburdenoftakingprecautionsagainstHIV,andtheuseofintoxicants[7].
Thereisalsoaconnectionbe-tweentheavailabilityofeffectivemedicationforHIV,theyoungageofmenengaginginriskysexualbehavior,andtheincreaseinsexuallytransmitteddiseasesamongmenengaginginsexwithmen[8].
Accordingtoresearch,thereisvariationinwhatmenengaginginsexwithmenknowaboutHIVinfection,HIVtransmissionandAIDS.
Thisvariationisalsoseenbe-tweenstudies,andwhilstsomestudieshavedemonstratedalowlevelofknowledge[9],othersreportagoodlevelofknowledge[10].
EventhoughpeoplemaybewellinformedaboutHIVinfections,lessmaybeknownaboutitsassoci-ateddiseases.
Forexample,Phillipsetal.
[11]notedthat75%ofrespondentsintheirstudyidentifyingthemselvesashomosexualorbisexualhadheardofKaposi'sSarcoma,butonly6%knewwhatcausedit.
AlthoughmanymenwhohavesexwithmenknowaboutHIVinfectionanditssymptoms,theyarenotgen-erallysowellinformedaboutothersexuallytransmitteddiseases[7,12].
Forexample,ithasbeenobservedthatmenhavingsexwithmenknowrelativelylittleaboutsyphilis[13].
EveniftheirknowledgelevelofHIVisgood,asmanyas44%ofthisgroupmaybeunawareoftheirownHIV-positivestatus.
Thisisespeciallynotedinyoungmenaged18–29[14].
However,thereisnotal-waysaconnectionbetweenthelevelofknowledgeandtheincidenceofsexuallytransmitteddiseasesorHIV.
AmongthoseconsideringHIVinfectiontobeaseriousillness,ithasbeenshownthattheincidenceofsexuallytransmitteddiseaseswaslesscommon[7].
Insexbetweenmen,thegreatestriskforHIVinfec-tionandothersexuallytransmitteddiseasesisconnectedtounprotectedanalintercourse.
Inanalintercourse,thebestprotectionagainstHIVinfectionandothersexuallytransmitteddiseasesistheuseofacondomandthecor-recttypeoflubricantcream.
However,sincenotevery-oneusesacondom[15,16]orwhenrisksituationsemergeforotherreasons,thenvariouspost-exposureprophylactics(PEP)havebeendevelopedtopreventin-fection[17]andalsopre-exposureprophylactics(PrEP).
AccordingtoastudybySidatetal.
[18],therewasnoconnectionbetweenanawarenessofPEPmedicationandengaginginunprotectedanalsex.
EarlierstudieshavereportedaconnectionbetweenahigherlevelofawarenessregardingHIV,andvariablessuchashavingahighincomelevel,seekingsexualpart-nersontheinternet,orhavingtakenanHIVtestmorethanoneyearearlier[19];beingHIVpositive[11];age(withyoungestandoldestagegroupshavingtheleastlevelofawareness)[19];andhavingahighlevelofeducation[11,20,21].
Ontheotherhand,insomestudiesincomelevel,sexualorientationandagehavenotbeenobservedasrelatingtothelevelofawareness.
However,erroneousconceptionshavebeenfoundabouthowHIVinfectionspreads,andincludesuchvectorsasinsects,food,crock-eryandcutlery[21].
SourcesofinformationonHIVinfectionmostoftenincludetelevision,asexualpartner,informationbulle-tins,andtheinternet[19].
Theinternetwasparticularlyseentobefavoredbythosewiththehighestlevelofedu-cationandthosewholivedinametropolis[22].
Wilker-sonetal.
[23]identifiedfourtypesofinformationseekers:thosewhosoughtlittleinformation,thosewhosoughtonlyontheinternet,thosewhoprimarilysoughtinformationfromhealthcarepersonnel,andthosewhousedmultiplesources.
AccordingtoastudybyLiuetal.
[19],thehighestlevelofknowledgerelatedtoHIVwasamongthosewhosoughtinformationthroughbooks,healthcareprofessionals,informationbulletinsandsex-ualpartners.
Amongthosewhosoughtinformationfrommagazinesandbooks,condomusewasmorecommonthaninothergroups,whereasamongthosewhosoughttheirinformationfromhealthcareprofessionalsandpublicmaterials,condomusewasfoundtobemediocre.
Inaquestionnaireandinterviewstudy(datacollection1997–1998)onFinnishhomosexualandbisexualmen,overhalfoftherespondentsreportedthatthemediahadthegreatesteffectonthemengaginginsafesex[24].
Thenextmostpopularsourceofinfluencewastheex-ampleoffriends,followedbythehomosexualcommu-nityandtheAIDSsupportcentre[24].
ThepurposeofthestudypresentedinthispaperistodescribewhatisknownamongmenhavingsexwithmeninFinlandaboutHIVinfectionsandothersexuallytransmitteddiseases,whatisknownabouthowsuchin-fectionsspreadandabouttreatments,andtoidentifythesourcesfromwhichsuchinformationisobtained.
MethodsThedataforthestudywasgatheredinJune–August2010,aspartoftheEuropeanMSMInternetSexSurvey(EMIS:[25]).
Thesurveywasajointeffortof38coun-trieswithaEurope-wideinternetquestionnairein25differentlanguages.
PermissiontoconductthestudyineachcountrywasobtainedfromtheResearchEthicsCommitteeoftheUniversityofPortsmouth,UnitedKingdom(RECapplicationnumber08/09:21)[26,27].
ForthenationalrecruitmentinFinlandnationalweb-sites(n=6),PlanetRomeo,Manhut,Baydar,7000cardsand750posterswereused.
Thequestionnairewasanonymousandrelativelyshort.
Participantswerevolun-teers,responsewasbytherespondent'scomputerandindividualrespondentscouldnotbeidentified.
EachandeveryparticipantactivelyclickedafieldtogiveinformedSuominenetal.
BMCInfectiousDiseases(2017)17:121Page2of6consent.
Respondentswereadequatelyinformedaboutboththepracticalimplementationofthestudyandthepublicizingoftheresults[26,28].
SpecifictothedatacollectedintheFinnishcomponentofthesurvey,thebackgroundvariableselicitedweretherespondent'sage,placeofresidence,provinceofresidence,durationofstayinFinland,highesteducationalqualifica-tion,employmentstatus,HIVpositivity,HIVstatusofper-manentpartner,occurrenceofsexuallytransmitteddiseases(yes/no),andwhethertheyhadeverbeentreatedwithaPEPmedication.
TheinformationregardingHIVinfections,testsandtreatmentswaselicitedwithsevenstatements.
Thedegreeoftherespondent'sknowledgeaboutthespreadofHIVinfectionswasevaluatedwithsixstatements,andwhattheyknewaboutPEPmedicationwasevaluatedwiththreestatements.
Thestatementswereinfive-stepLikertform.
Foranalysis,thestatementswerereclassifiedintothreeclasses('withinthelastmonth','lessoften',and'never'),orintotwoclasses('Iknewthisalready'/'Iamnotsure',and'Idon'tunderstand'/'Idon'tbelievethis'.
Theapproachestofindinginformationwereassessedwithfourstatementswhichofferedfiveresponseoptions.
Forpurposeofanalysis,theseresponseswerelaterclassifiedintothreeclasses('inthelastmonth','lessoften','never').
ThedatawasanalyzedusingSPSSsoftwareversion16.
0.
Connectionsbetweenvariableswereexam-inedwithcross-tabulationsandPearson'sx2testofinde-pendence.
Afivepercentrisklimitwassetasthelevelofsignificance[28].
ResultsParticipantsThesurveyrespondentsinFinlandnumbered2,072,andtheiraverageagewas34.
3years(SD=11.
5).
32%wereresidentinanareawithpopulationoflessthan100,000,30%inmid-sizedareas,and38%inanareawithapopu-lationgreaterthan500,000.
Halfoftherespondents(50.
4%)livedinotherprovincesthanthelargestprov-inceofUusimaa,situatedinsouthernFinland.
Therewere196responsestothequestionregardingthelengthofstayinFinland(intendedforthosenotborninFinland),andhalfofthese(50.
5%)hadlivedinFinlandfor≤15years.
Abouthalf(48.
9%)ofalltherespondentshadeitheracollege-levelqualificationorhigher,andjustoverhalf(53.
8%)wereworkingfull-time.
MostoftherespondentswereHIV-negative,and3.
2%wereHIV-positive.
Oftherespondentsinapermanentrelationshipwithaman,87%(n=867)hadthesameHIVstatusastheirpartner.
Ofthoseinapermanentre-lationshipwithawoman,90%(n=156)hadthesameHIVstatusastheirpartner.
Thisstatusmighteitherbepositiveornegative.
Overall,73.
5%ofrespondentshadneverbeendiagnosedwithasexuallytransmitteddis-ease.
Relatingtotype,0.
5–8.
7%ofrespondentshadhadsomeformofsexuallytransmitteddisease:chlamydia(8.
7%),genitalwarts(8.
4%),gonorrhea(7.
2%),herpes(3.
1%),syphilis(2.
8%)andhepatitisC(0.
5%).
MostoftherespondentshadnotbeentreatedwithaPEPpre-ventivemedication(98.
7%).
Respondents'awarenessofHIVinfectionandsexuallytransmitteddiseasesByandlarge,therespondentswerewellawareofHIVinfectionandsexuallytransmitteddiseases,albeitthatonlyabouthalfofthemknewthattheeffectivetreat-mentofHIVinfectionreducestheriskofpassingiton(Table1).
LessthanhalfoftherespondentswereawarethattheriskofpassingonanHIVinfectionisgreaterinsexbetweenanHIV-positiveandanHIV-negativeman,ifoneortheotheralsohasanotherformofsexuallytransmitteddisease(Table2).
Thestatementsascertain-ingtherespondents'knowledgewerecorrectlyanswered(Tables1and2)by18.
3%(n=370)ofthetotalofFinnishresponses.
OftherespondentsdiagnosedasHIV-positive,24.
6%(n=65)respondedcorrectlytotheknowledgestatements,andofthosewhowerediagnosedasHIV-negative,19.
8%(n=1,227)respondedcorrectly.
Onefifth(20%)oftherespondentsdidnotknowthatseveralothersexuallytransmitteddiseasesmaybepassedonmoreeasilythanHIV.
Additionally,about15%ofrespondentsdidnotknowthatevenwithoutejaculation,oralsexexposesparticipantstobeingin-fectedwithbothsyphilisandgonorrhea(Table2).
LittlewasknownaboutPostExposureProphylaxis(PEP).
PreExposureProphylaxis(PrEP)wasnotaskedabout,whilenotavailableatthetimeofthestudy.
Oneinfour(26.
5%)knewthatPEPattemptstostopHIVinfec-tiontakingplaceafterapersonisexposedtothevirus,Asimilaramount(25.
4%)knewthatPEPshouldbestartedassoonaspossibleafterexposure,andaroundoneinsix(15.
2%)knewthatPEPisaonemonthcourseofanti-HIVdrugs.
Only1.
3%ofrespondentshadbeentreatedwithPEP.
Overall,13.
5%oftherespondents(n=279)respondedcorrectlytothestatementsaboutPEP.
OftherespondentswhowerediagnosedasHIV-positive(34:n=65),justoverhalf(52.
3%)respondedcorrectlytothePEPstatements.
ThecorrespondingfigureforHIV-negativere-spondentswas13.
6%(167:n=1,227).
Therewasastatisticallysignificanteffectcorrespond-ingtothesizeoftherespondent'sareaofresidence,theirage,highestqualificationandemploymentstatus,onhowoftentheysoughtinformationonHIV,testsandtreatments,andwhattheyknewaboutthespreadofin-fection(Table3).
Especially,itwasnotedthatthosere-spondentswhohadhadasexuallytransmitteddiseasewerestatisticallysignificantlybetterinformedaboutHIV,tests,treatments,thespreadofinfectionandPEPmedication.
Suominenetal.
BMCInfectiousDiseases(2017)17:121Page3of6InformationseekingActiveinformationseekingaboutHIVinfectionandothersexuallytransmitteddiseaseswasnotfoundtobeacommonpractice.
Ofthoselivinginruralareas,onefifthhadneversoughtinformation(Table3).
Seekinginformationthroughatelephonehelplinewasnotacommonpractice,andabout9/10hadneversoughttele-phoneadvice(Table4).
However,respondentswhowerediagnosedwithasexuallytransmitteddiseaseweresig-nificantlymoreactiveinseekinginformationandusinghelplines.
DiscussionTheinstrumentusedinthestudywasdevelopedininternationalco-operationamong38countriesaspartoftheEMISResearchProject[27],anditsvaliditywasextensivelychecked.
Theinstrumentwaspre-testedineachcountryandthetranslationintoFinnishwasmadeusingadoubletranslationapproach[28].
Thedatacollectionwasinternet-basedwhichcouldbeseenasalimitation,butitwasadvertisedanddeliverednation-widethroughoutFinland.
MenlivinginFinlandanden-gaginginsexwithmenwereabletoparticipateinthequestionnaire,whichwasofferedin25differentlanguages.
Byandlargetherespondentsshowedagoodaware-nessofHIVinfectionandsexuallytransmitteddis-eases.
Thiscorrespondswiththefindingsofearlierresearchdata[10],butcontradictorystudiesalsore-portthatlittleisknown[9].
Therehavebeenearlierconnectionsdrawnbetweentherespondents'ageandthesizeoftheirplaceofresidenceand,relatingtothosewholiveincramped/sharedaccommodationbutnoextensivestudyhaspreviouslybeencarriedoutinFinland.
LittlewasknownaboutPostExposureProphylaxis(PEP).
OfthosediagnosedasHIV-positive,34(52.
3%:n=65)respondedcorrectlytoallofthestatementsTable1WhatisknownaboutHIV,testsandtreatmentsDidyouknowthisaboutHIV,testsandtreatmentsIalreadyknewthis%Iwasnotcertainaboutthis%Ididnotyetknowthis%Idon'tunderstandthis%Idon'tbelievethis%AIDSiscausedbyaviruscalledHIV(n=2066)98.
90.
60.
10.
00.
3YoucannotbeconfidentaboutwhethersomeonehasHIVornotfromtheirappearance(n=2066)96.
71.
40.
30.
11.
5ThereisamedicaltestthatcanshowwhetherornotyouhaveHIV(n=2062)98.
70.
70.
10.
10.
3IfsomeonebecomesinfectedwithHIVitmaytakeseveralweeksbeforeitcanbedetectedinatest(n=2061)93.
45.
01.
60.
00.
1ThereiscurrentlynocureforHIVinfection(n=1399)93.
84.
40.
40.
11.
4HIVinfectioncanbecontrolledwithmedicinessothatitsimpactonhealthismuchless(n=2065)96.
03.
30.
40.
00.
2EffectivetreatmentofHIVinfectionreducestheriskofHIVbeingtransmitted(n=2066)54.
321.
913.
91.
38.
6Table2KnowledgeoftransmissionDidyouknowthisaboutHIVandsexuallytransmittedinfectionsIalreadyknewthis%Iwasnotcertainaboutthis%Ididnotyetknowthis%Idon'tunderstandthis%Idon'tbelievethis%HIVcannotbepassedduringkissing,includingdeepkissing,becausesalivadoesnottransmitHIV(n=2059)77.
017.
22.
40.
33.
1YoucanpickupHIVthroughyourpeniswhilebeing'active'inunprotectedanalorvaginalsex(fucking)withaninfectedpartner,evenifyoudon'tejaculate(n=2054)93.
05.
60.
90.
00.
4YoucanpickupHIVthroughyourrectumwhilebeing'passive'inunprotectedanalsex(beingfucked)withaninfectedpartner(n=2058)98.
01.
50.
30.
00.
1Evenwithoutejaculation,oralsex(suckingandbeingsucked)carriesariskofinfectionwithsyphilisorgonorrhoea(n=2059)85.
311.
92.
50.
00.
2WhenHIVinfectedanduninfectedmenhavesextogether,thechancesofHIVbeingpassedonaregreaterifeitherpartnerhasanothersexuallytransmittedinfection(n=2055)49.
223.
124.
41.
31.
9MostsexuallytransmittedinfectionscanbepassedonmoreeasilythanHIV(n=2053)77.
814.
36.
00.
41.
5Suominenetal.
BMCInfectiousDiseases(2017)17:121Page4of6aboutPEP.
ItseemsthattheavailabilityofPEPisnotwellknown,however,ensuringthatallMSMareawareofPEPisachallengingundertakinginruralareas.
Furthermore,insomecountrieslikeFinland,PEPisnotavailablefreeofchargeaftersexualexpos-ure.
InformationseekingonHIVandothersexuallytransmitteddiseaseswasalsonotfoundtobeexten-siveamongthosewithoutexperienceofsuchinfec-tions(See[19,23]).
ConclusionsPreventiveinformationdisseminationshouldbesteppedup,asthoserespondentswhodidnothave/hadnothadanyinfectiondidnotknowmuchaboutHIVinfectionandothersexuallytransmitteddiseases,howtheyspread,orhowtheycanbetreated.
Maxi-mizingtheopportunitiesaffordedbytheinternettoimprovethelevelofknowledgeamongmenengaginginsexwithmenshouldbeconsidered,whileinsomeareas,likeineasternandnorthernpartsofFinlandthedistancesarelongtomeethealthcareprofessionals.
Thisisparticularlysoinsmallareasthatmaynotofferanywidespreadaccesstoinformation,orhavelimitedcommunitieswheresuchknowledgecanbesharedinperson.
Thepossibilityofusinginternet-basedinter-ventionsshouldespeciallybeconsideredinsmallerandnortherncatchmentareas,andtheirimpactevalu-atedinfurtherstudies.
Table3InformationseekingandknowledgeAgePlaceofresidenceHighesteducationEmploymentUnder2525-40Over40Pop.
Over500000Pop.
100000-499999Pop.
Under100000CollegelevelorhigherOthersFulltimeOthersInformationseekingDuringlastmonth213915261681860.
4%1.
3%1.
5%2.
0%0.
3%0.
9%1.
6%0.
8%1.
6%0.
6%Moreseldom37985751667351352188985896877778.
8%86.
3%87.
8%88.
3%85.
9%80.
8%88.
5%81.
7%87.
6%81.
9%Never1001236374821189918411916620.
8%12.
4%10.
7%9.
7%13.
7%18.
3%9.
9%17.
5%10.
8%17.
5%KnowledgeaboutHIV,testsandtreatmentsAlreadyknowing4729855857585916379971035110193297.
5%98.
7%99.
2%99.
1%98.
8%98.
0%99.
1%98.
3%99.
3%98.
0%Notcertain,know,understand,believe1213577139188192.
5%1.
3%0.
8%0.
9%1.
2%2.
0%0.
9%1.
7%0.
7%2.
0%KnowledgeaboutinfectiontransmissionAlreadyknowing446951562741567599971983106988592.
1%95.
3%95.
3%96.
9%94.
8%92.
2%96.
5%93.
4%96.
4%93.
1%Notcertain,know,understand,believe384728243151357040667.
9%4.
7%4.
7%3.
1%5.
2%7.
8%3.
5%6.
6%3.
6%6.
9%KnowledgeaboutPEPAlreadyknowing7724212118611013023520524919015.
9%24.
2%20.
5%24.
3%18.
4%20.
0%23.
4%19.
5%22.
5%20.
0%Notcertain,know,understand,believe40775646957948852077184886076184.
1%75.
8%79.
5%75.
7%81.
6%80.
0%76.
6%80.
5%77.
5%80.
0%p-value0.
05Table4InformationseekingInformationseekingaboutHIVandsexuallytransmittedinfections(STI)Withinthelastmonth%Notsooften%Never%WhenwasthelasttimeyousaworheardanyinformationaboutHIVorSTIsspecificallyformenwhohavesexwithmen(n=2058)43.
151.
45.
5WhenwasthelasttimeyousawanyinformationaboutHIVorSTIsinamagazineornewspaper(n=2054)31.
062.
16.
9WhenwasthelasttimeyouactivelylookedforinformationaboutHIVorSTIsontheinternet(n=2048)15.
570.
514.
0WhendidyoulastcallatelephonehelplineforinformationaboutHIVorSTIs(n=2061)0.
57.
092.
4Suominenetal.
BMCInfectiousDiseases(2017)17:121Page5of6AbbreviationsAIDS:Acquiredimmunedeficiencysyndrome;EMIS:EuropeanMSMInternetSexSurvey;HIV:Humanimmunodeficiencyvirus;MSM:Menwhohavesexwithmen;PEP:Postexposureprophylaxis;PrEP:Pre-exposureprophylactics;SD:Standarddeviation;STI:SexuallytransmittedinfectionAcknowledgementsTheEuropeanMSMInternetSurvey(EMIS)hasbeenfundedbytheExecutiveAgencyforHealthandConsumers(EAHC)oftheEuropeanCommission,intheframeworkoftheHealthProgramme2008-2013.
InFinland,furtherfinan-cialsupportwasreceivedfromtheMinistryofSocialAffairsandHealth,andtheSukupuolitautienVastustamisyhdistys(AssociationforthePreventionofSexuallyTransmittedDiseases).
FundingTheEuropeanMSMInternetSurvey(EMIS)hasbeenfundedbytheExecutiveAgencyforHealthandConsumers(EAHC)oftheEuropeanCommission,intheframeworkoftheHealthProgramme2008-2013.
InFinland,furtherfinan-cialsupportwasreceivedfromtheMinistryofSocialAffairsandHealth,andtheSukupuolitautienVastustamisyhdistys(AssociationforthePreventionofSexuallyTransmittedDiseases).
AvailabilityofdataandmaterialsThedatawillnotbemadeavailableatthispointastheauthorsstillwishtopublishfurtherstudiesbasedonthisdata.
Authors'contributionsTS,TH,MP,A-MS,JKmadethedesignofthisstudy.
A-MSanalyzedthedata.
TSandJKweredraftingthemanuscript.
TH,MP,A-MSrevisedthetextcritic-ally.
Allauthorsreadandapprovedthefinalmanuscript.
CompetinginterestsTheauthorsdeclarethattheyhavenocompetinginterests.
ConsentforpublicationNotapplicable.
EthicsapprovalandconsenttoparticipatePermissiontoconductthestudywasobtainedfromtheResearchEthicsCommitteeoftheUniversityofPortsmouth,UnitedKingdom(RECapplicationnumber08/09:21)[26,27]concerning38Europeancountries.
Finnishethicsguidelinesexemptthisstudyfromtheneedforformalethicalapproval.
Authordetails1UniversityofTampere,SchoolofHealthSciences,Tampere,Finland.
2FinnishAIDSCouncil,Tampere,Finland.
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