In the majority of European countries, most
sexual health check-ups for men who have sex with men (MSM) do not include
basic physical examinations or diagnostic procedures that would enable
clinicians to diagnose rectal gonorrhoea, chlamydia or warts, Axel J. Schmidt
and Johanna Rankin told the 14th annual CHAPS conference in Manchester last week.
But some countries
perform much better than others - and these countries have well developed
networks of specialised sexual health clinics.
Moreover, men whose most recent HIV test
took place in a specialised sexual health clinic or at a community testing
service were more likely to be satisfied with the experience in terms of
confidentiality and the opportunity to discuss their sexual behaviour.
These data are some of the first to come
from the European MSM Internet Sex Survey (EMIS), an internet-based
questionnaire that was made available in 25 languages across Europe
in 2010. With a total of a total of 180,988 responses, it is probably the
largest international study of the sexual health of gay and bisexual men ever
conducted. The response rate was particularly high in Germany, Switzerland,
Luxembourg, Ireland, Portugal,
Slovenia and Austria. It was
lowest in Turkey, Moldova and Russia.
Depending on the country, between 20 and 50%
of men had had a sexually transmitted infection (STI) check-up in the previous
twelve months. Men in central European countries were particularly unlikely to
have had a recent check-up. In general, testing took place in the absence of
Men who had been tested for sexually
transmitted infections other than HIV were asked for more detail about what
happened, specifically the kind of diagnostic procedures that were performed.
While in all countries 80% or more of check-ups included blood tests, the
authors point out that apart from HIV, the only sexually transmitted infections
which can be detected this way are syphilis and viral hepatitis.
In 33 of the 38 countries surveyed, less
than 40% of check-ups included an inspection of the anal and penile area. In
over half the European countries, less than 20% of check-ups included this type
Similarly, in 32 countries, less than 40%
of check-ups included “something inserted in the anus” (an anal swab). In over
two-thirds of European countries, less than 20% of check-ups featured anal
swabs. The countries which didn’t perform physical
examinations were generally the same ones which didn’t do anal swabs.
researchers point out that in these countries, there is a high chance that anal
warts, genital warts, rectal chlamydia and rectal gonorrhoea remain profoundly
under-diagnosed. As a result, men’s sexual health will suffer, the risk of HIV
infection or transmission is greater and comparisons of STI rates in different
countries will be misleading.
Four countries had notably better
performance in these areas than the others - Malta,
Ireland, the United Kingdom and Sweden. The researchers pointed out
that each country has a network of specialised sexual health clinics.
Some rich countries such as Germany and France had particularly poor
performance. Taking men in Germany
as a point of comparison, men in the UK
were over six times more likely to have had a genital and anal examination
during their last check-up. Moreover men in Ireland
were eight times more likely to have had an anal swab, and men in the UK were almost
ten times more likely to have had one. Men in France
were even less likely than those in Germany to have been given an anal
swab. (These figures do not include men with diagnosed HIV, who tend to have
more sexual health check-ups).
Men completing the survey were asked a
separate set of questions about HIV testing, including where they had had their
most recent test.
Overall, around 35% had taken an HIV test
in the previous twelve months. Testing for HIV in the last year was most common
in Spain, Portugal, Belgium
In each of these countries, the most common place to test was with a
practice-based physician (such as a family doctor). In several countries of
central and eastern Europe, the most common place for men who have sex with men
to take an HIV test was at a community service such as a testing site run by a
gay community organisation. In Bulgaria,
the most common place to test was at a mobile outreach van.
measures of the quality of the testing experience varied depending on the place
where testing occurred. In terms of confidentiality, the highest levels of
dissatisfaction were among those testing as an in-patient at a hospital or
clinic (13.5%), followed by those testing as an out-patient (9.3%). There was
less dissatisfaction among those testing with a practice-based physician
(5.2%), at a community service (4.0%) or at a sexual health clinic (3.3%).
Respondents were also asked if they had
been given the opportunity to talk about their sexual behaviour when they
tested and, if they had done so, whether they had mentioned that they have sex
with men. This was least likely to be the case when testing as an in-patient
(23%), as an out-patient (28%) or with a practice-based physician (30%).
Discussions of sex were far more common when testing at a community service
(52%) or at a sexual health clinic (64%).