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Original article
The Denominator problem: estimating the size of local populations of men-who-have-sex-with-men and rates of HIV and other STIs in Switzerland
  1. Axel Jeremias Schmidt1,2,
  2. Ekkehardt Altpeter2
  1. 1Sigma Research, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
  2. 2Communicable Diseases Division, Swiss Federal Office of Public Health, Bern, Switzerland
  1. Correspondence to Dr Axel Jeremias Schmidt, Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, London WC1H 9SH, UK; axel.j.schmidt{at}emis-project.eu

Abstract

Objectives There is no estimate of the current number of men who have sex with men (MSM) in Switzerland, or of their geographical distribution. We aimed to (1) estimate MSM concentration factors and population sizes for 83 Swiss postal code areas (PCA), including the nine largest Swiss cities, and (2) calculate MSM-specific local HIV prevalence and yearly rates of diagnosed HIV, hepatitis C virus (HCV), syphilis and gonorrhoea.

Methods We triangulated data from general population estimates, MSM online surveys, published data on HIV prevalence and Swiss notification data for HIV and STDs. We compared two different formulae for the estimation of local MSM populations and calculated Bayesian 95%-credible-intervals (CrI) for each PCA.

Results Across Switzerland, we estimate the MSM population aged 15–64 at roughly 80 000 men (95% CrI 64 000–96 000). (1) MSM in Switzerland were most concentrated in the five largest cities of Zurich, Geneva, Lausanne, Bern and Basel. (2) We estimate that in 2012, 6300 MSM, or 8.0%, were living with HIV, both diagnosed and undiagnosed and 1700 MSM, or 2.2%, had non-suppressed HIV infection. Between 2010 and 2013, average yearly rates of diagnosed HIV, HCV, syphilis and gonorrhoea were 0.3%, 0.02%, 0.4 % and 0.4 %, respectively.

Conclusions Combining general population data, MSM online surveys and notification data allows the calculation of realistic estimates of local MSM populations and thus proportions of MSM with diagnosed HIV and other STIs, with implications for prevention planning, commissioning of health services and counselling MSM on HIV/STI risk. Our methodology for Switzerland is transferable to other countries with similar data sources.

  • sexual and gender minorities
  • homosexuality, male
  • STD
  • HCV
  • incidence
  • HIV infections
  • prevalence
  • Bayes theorem

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Handling editor Prof Nicola Low

  • Contributors AJS: designed the study, performed all calculations except Bayesian analyses, co-ordinated the EMIS project and wrote the manuscript. EA: performed the Bayesian analyses and contributed to the manuscript.

  • Funding EMIS-2010 was funded by the Executive Agency for Health and Consumers, EU Health Programme 2008–2013 (funding period: 14 March 2009 to 13 September 2011).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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