Being in the Closet. Correlates of Outness Among MSM in 13 European Cities

ABSTRACT

Data for MSM continue to show a high risk of acquiring HIV-STIs. Within this population, outness seems to have an impact on both risk-taking and on health seeking behaviors. The objective of this study was to assess the relationship between socio-demographic, behavioral characteristics, testing behaviors, and outness level among MSM using data from a multi-center bio-behavioral cross-sectional study carried out in 13 EU cities. A multilevel analysis was conducted to identify factors associated with being open (“out”) versus not being open (“in”). A total of 4,901 MSM were enrolled in the study and were classified as “out” in 71% of the cases. MSM “out” were more likely to report HIV testing and being reached by HIV prevention programs compared to MSM who were “in.” The results confirm the key role of outness in relation to different healthy and risky behavior, ranging from testing to party-drug use.

KEYWORDS:

• MSM
• outness
• bio-behavioral survey
• Time-Location Sampling
• respondent-driven sampling
• risk behaviors
• HIV testing

Authors’ contributions

LGI, MMI, NSH, ITO, SDI, DST, CFO, SSC, CNO, WVB, ENA, IAL participated in the design of the survey questionnaire and the organization and implementation of the survey in the survey cities.

This analysis was conceived by LGI and MMI. Data were analyzed by MMI and LGI.

The first manuscript draft was jointly written by LGI and MMI.

All authors contributed writing to the following drafts.

All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

The Sialon II Network (extended list)

Massimo Mirandola, Lorenzo Gios, Stefano Benvenuti, Ruth Joanna Davis, Massimo Lunardi, Silvana Menichelli, Michele Breveglieri, Martina Furegato (Coordinamento Regionale per il Management e la Progettazione Europea, Azienda Ospedaliera Universitaria Integrata, Verona, Italy); Wim Vanden Berghe, Peter de Groot, Christiana Nöstlinger, Veronica van Wijk, Katrien Fransen, Tine Vermoesen, Michiel Vanackere (Institute of Tropical Medicine, Antwerp, Belgium); Fourat Benchikha, Sandra Van den Eynde, Boris Cruyssaert, Mark Sergeant, Karel Blondeel, Pieter Damen (Sensoa, Antwerp, Belgium); François Massoz, Erwin Carlier (Rainbowhouse Brussels, Belgium); Michael François, Stephen Karon (Ex Aequo, Belgium); Safia Soltani, Thierry Martin (Belgium); Alan De Bruyne (The Belgian Pride, Belgium); Françoise Bocken (Alias, Belgium); Myriam Dieleman (Observatoire du sida et des sexualités, Belgium); Ivailo Alexiev, Reneta Dimitrova, Anna Gancheva, Dobromira Bogeva, Maria Nikolova, Mariya Muhtarova, Todor Kantarjiev (National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria); Viara Georgieva (National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria; Ministry of Health, Sofia, Bulgaria); Emilia Naseva, Petar Tsintsarski, Hristo Taskov, Tonka Varleva (Program “Prevention and Control of HIV/AIDS,” Ministry of Health, Sofia, Bulgaria); Elena Birindjieva, Aneliya Angelova, Manol Antonov (Association “Health without borders,” Bulgaria); Ulrich Marcus, Susanne Barbara Schink, Sandra Dudareva-Vizule, Matthias an der Heiden, Sami Marzougui, Viviane Bremer, Andrea Kühne, Kerstin Schönerstedt-Zastrau, Ruth Zimmermann (Robert Koch Institute, Berlin, Germany); Andreas Wille (Institut für Hygiene und Umwelt, Hamburg, Germany); Kai Eckstein, Norman Buch, Philipp Moskophidis, Marc Grenz, Danilo Schmogro (Hein & Fiete, Hamburg, Germany); Giuseppe Cornaglia, Antonella Zorzi, Elisabetta Tonolli, Giuliana Lo Cascio, Teresa Todeschini, Manuela Recchia, Lorella Pattini, Maria Rocca, Alessandra Bighignoli, Anita Galardi, Loredana Martini, Sandro Caffi, Pier Paolo Benetollo, Francesco Cobello, Chiara Bovom, Umberta Benvenuti (Azienda Ospedaliera Universitaria Integrata, Verona, Italy); Giulia Bisoffi, Oscar Bortolami, Laura Crestani (Unità Supporto alla Ricerca e Biostatistica, Azienda Ospedaliera Universitaria Integrata, Verona, Italy); Fabiano Comperini (Italy); Ercole Concia, Emanuela Lattuada, Massimiliano Lanzafame, Stefania Leonardi, Paola Del Bravo (Infectious Diseases Section, Department of Pathology, Verona University Hospital, Veneto Region, Verona, Italy); Maddalena Cordioli, Fabio Rigo, Emanuele Guardalben, Ivan Marchesoni (Università degli studi di Verona, Verona, Italy); Barbara Suligoi, Vincenza Regine, Lucia Pugliese (Centro Operativo AIDS, Istituto Superiore di Sanità, Rome, Italy); Saulius Caplinskas, Irma Caplinskiene, Rima Krupenkaite (Centre for Communicable Diseases and AIDS, Vilnius, Lithuania); Gediminas Sargelis, Arturas Rudomanskis (“Tolerant Youth Association,” Vilnius, Lithuania); Sónia Dias, Ana Gama, Oriana Brás (Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Portugal); João Piedade (Medical Microbiology Unit, Instituto de Higiene e Medicina Tropical, Lisbon, Portugal); Ricardo Fuertes, Nuno Pinto, João Brito, Júlio Esteves, Jesus Rojas, Fernando Ferreira, Miguel Rocha, Hugo Machado, Maria José Campos (CheckpointLX, Portugal); Luís Mendão (Grupo Português de Ativistas sobre Tratamentos de VIH/SIDA – Pedro Santos, Portugal); Magdalena Rosińska, Bożena Kucharczyk, Marta Niedźwiedzka-Stadnik, Łukasz Henszel, Andrzej Zieliński, Michał Czerwiński (National Institute of Public Health – National Institute of Hygiene, NIPH-NIH, Warsaw, Poland); Michał Pawlęga, Ewelina Burdon, Małgorzata Gajdemska, Agnieszka Guściora, Nikodem Klasik, Katarzyna Rżanek, Michał Sawicki, Michał Tęcza (Lambda Warszawa, Warsaw, Poland); Mateusz Dębski, Anna Maciejewska, Izabela Pazdan (SKA Warsaw, Poland); Alexandru Rafila, Daniela Pitigoi, Adrian Abagiu (National Institute for Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania); Carolina Marin, Ioana Panzariu, Alexandru Miroiu (ACCEPT Association, Bucharest, Romania); Madalina Popa, Monica Likker (National Institute for Infectious Diseases Prof. Dr. Matei Bals, Bucharest, Romania); Maria Georgescu, Galina Musat, Dan Cojocaru, Mihai Lixandru, Raluca Teodorescu (Romanian Anti-AIDS Association – ARAS, Bucharest, Romania); Danica Staneková, Monika Hábeková, Tatiana Drobková, Zuzana Chabadová, Soňa Wimmerova, Maria Mojzesová (Slovak Medical University, NRC for HIV/AIDS Prevention, Bratislava, Slovakia); Filip Kunč, Michal Skurák, Peter Bodnar, Katarína Horniaková, Mária Krahulcová, Jarmila Präsensová (Slovakia); Martin Smoleň, Peter Záhradník, Pavol Tibaj (NGO Dúhové srdce, Bratislava, Slovakia); Irena Klavs, Tanja Kustec, Claudia Adamič (National Institute of Public Health, Ljubljana, Slovenia); Mario Poljak, Robert Krošelj, Jana Mlakar (Institute of Microbiology and Immunology, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia); Miran Šolinc (Association SKUC, Ljubljana, Slovenia); Cinta Folch, Laia Ferrer, Alexandra Montoliu, Jordi Casabona, Anna Esteve, Montserrat Galdon (Centre for Epidemiological Studies on HIV/STI in Catalonia CEEISCAT, Dept Salut, Generalitat de Catalunya, Barcelona, Spain); Victoria Gonzalez (Microbiology Service, Hospital Universitari Germans Trias i Pujol, Barcelona, Spain); Rafael Muñoz (StopSida, Barcelona, Spain); Maria Axelsson, Torsten Berglund, Sharon Kuhlmann-Berenzon, Achilleas Tsoumanis, Inga Velicko, Christer Janson, Bartek Lindh, Kajsa Aperia (Public Health Agency of Sweden, Stockholm, Sweden); Buddha Babulanam, Hans Carlberg, Malte Davidsson, Nedo Entenza Gutierrez, Viktor Hildingsson, Henrik Klasson, Moises Peña Ramos, Cristian Quintero Rojas, Sven-Olof Sandberg, Andreas Samuelson, Eric Sjöberg, Tommy Sjölund,Simon Svensson, Iván Valencia (Sweden); Filip Garcia, Olov Lindblad (RFSL Stockholm, Sweden); Jon Voss (Stockholm Gay Life, Sweden); Ronnie Ask, Anders Blaxhult, Maarit Maliniemi (Venhälsan, Stockholm South General Hospital, Stockholm, Sweden); Monica Ideström, Nils Blom (Public Health Agency of Sweden, Stockholm, Sweden); Nigel Sherriff, Christina Panton, Glynis Flood (Centre for Health Research, University of Brighton, Brighton, UK); Katrien Fransen, Tine Vermoesen (Aids Reference Laboratory, Institute of Tropical Medicine, Antwerp, Belgium); Ross Boseley, Marc Tweed (Terrence Higgins Trust, South, UK); Jonathon Roberts (Claude Nicol Centre, Royal Sussex County Hospital, Brighton, UK); Cinthia Menel Lemos (Executive Agency for Health and Consumers); Paolo Guglielmetti, Wolfgang Philipp, Matthias Schuppe (DG SANTE); Andrew Amato, Irina Dinca, Karin Haar, Anastasia Pharris, Teymur Noori (European Centre for Disease Prevention and Control ECDC); Igor Toskin, Armando Seuc, Natalie Maurer (Department of Reproductive Health & Research of the World Health Organization, WHO); Lev Zohrabyan, Alexandrina Iovita, Maddalena Campioni, Patrick Noack (Joint United Nations Programme on HIV/AIDS UNAIDS); Rosanna Peeling (London School of Hygiene and Tropical Medicine); Lisa Johnston (USA).

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Prior to data collection, research protocols were submitted to, and approved by, an appropriate institutional ethical review board in each participating city, as well as by the WHO Research Project Review Panel (RP2) and the WHO Research Ethics Review Committee (ERC) during 2012-13.

Informed consent

According to the study protocol procedures, informed consent was obtained from all individual participants included in the study.

Additional information

Funding

This manuscript is based on data from the Sialon II project, co-funded under the Second Programme of Community Action in the field of Health (2008-2013) (Work Plan 2010) (Grant Agreement Number: 2010 12 11). The sole responsibility lies with the authors of this manuscript and the Commission is not responsible for any use that may be made of the information contained therein.