SIALON II

Project timeframe

Project aims

Project findings and impact

SIALON and SIALON II have developed a client friendly method of gathering biological and social data in MSM communities that can be used by a wide audience range. Policy and decision makers can make use of the data to design policies and strategies for building comprehensive approaches to addressing the immediate and long term prevention treatment and care services for MSM.

Health care services can use the SIALON and SIALON II method for building local and regional representations of the health care needs of MSM throughout the health system. The SIALON II methodology could be applied in any country. One of the two different sampling methodologies (Time and Location Sampling and Respondent Driven Sampling) can be chosen as an appropriate method for collecting biological and social data in MSM communities in each local context, according to SIALON II experience.

Furthermore, the SIALON II study demonstrates how Global AIDS Response Progress (GARP) and the European Centre for Disease Prevention and Control (ECDC) indicators can be used to provide a key measure for basic monitoring of HIV.

Reports were published in 2016. The Sialon II final report presents the findings from this large-scale bio-behavioural survey implemented across 13 European countries. This project was set within a context of rising HIV infections among MSM in many countries across Europe. The survey is without precedence in Europe in terms of its size and from the point of view of the practical implementation of the WHO – Joint United Nations Programme on HIV/AIDS (UNAIDS) Second Generation Surveillance System (SGSS) approach and behavioural surveillance recommendations from the ECDC.

Data from the Sialon II survey have provided a wealth and diversity of insights regarding access to prevention programmes and testing in each partner country, sexual behaviour and health. In terms of HIV prevalence, data suggested a range between 2 per cent and 20 per cent, with higher prevalence among individuals older than 25 years of age. A relevant proportion (ranging between 12 per cent and 88 per cent) of participants were unaware of being HIV-positive.

On the one hand, the findings confirm the already identified trend of rising infection among MSM in Europe. On the other hand, the data reveal some alarming findings with regard to prevention, treatment and support to MSM and underline the disparities within Europe.

The high number of MSM who were tested for the first time in the context of this survey, in particular in the Eastern European survey cities and the high estimates of HIV positive participants unaware of their real serum-status, seem to suggest critical conditions in terms of future increase of the HIV epidemic. The situation seems to be particularly concerning in Eastern European cities, where a low level of condom use is reported, as well as a high level of perceived discrimination.

The lack and/or delay in diagnosis is also a crucial factor in general. In several cities, the treatment coverage is less than optimal among individuals who know they are HIV positive indicating potential challenges in linkage to care and continuity of care.

This scenario reflects the marked diversity of the societal and political contexts of the countries involved, in particular with respect to the social and legal conditions for sexual minority emancipation. This will obviously have an impact on both surveillance and prevention activities and needs to be taken into consideration in the definition of policy in this area. This means that in addition to concrete measures such as increased condom distribution networks and promotion of testing and treatment, policy actions must also address the social determinants of high risk behaviour and low uptake of testing for HIV and other STIs such as homophobia and stigma.

Similarly, the segmentation and the complexity of the MSM population which this survey has contributed to identifying, point to the need to design targeted HIV prevention and health promotion interventions by subgroups.

To conclude, the findings of Sialon II survey represent a valid contribution to the pool of epidemiological research that has been has undertaken to date in the area of HIV/STI prevention among MSM. However, at the same time, the results also point to the urgent need for continued and more widespread data collection (in line with the SGGS) to better understand the marked differences in prevention needs across Europe and among sub-populations of MSM and hence to better define more effective and efficient prevention strategies.

For further information, read the full Sialon II final report on a bio-behavioural survey among MSM in 13 European cities.

For further information, read the full Sialon II City Profiles report outlining recommendations on HIV prevention gaps and opportunities for health promotion among men who have sex with men.

Read the Making gay business the frontline in the fight against HIV article in The Conversation