**1. Introduction**

The following chapter describes the process and results of a survey conducted in six cities in Southern and Eastern Europe to obtain data on (i) the prevalence of HIV and Syphilis among Men who have Sex with Men (MSM), (ii) sexual behaviour risk patterns of MSM and (iii) the determinants of access to Voluntary Counselling and Testing (VCT) by MSM.

The chapter describes how the survey was undertaken against a backdrop of evidence indicating a rising incidence of HIV infection in Europe and in the context of a gap in information on HIV incidence and prevalence amongst the MSM community which has been identified as an at risk population for HIV infection.

In this context, the methodology used for obtaining reliable information and data, represents a key factor in the process. The Time-Location Sampling (TLS) method has proven to be an effective means for gathering both behavioural and biological data in hidden or hard to reach populations, such as MSM.

The chapter provides a description of the implementation of TLS for epidemiological purposes and a summary of the main results of the survey which reveal (i) a high unawareness of HIV positive serostatus, (ii) a higher risk among younger people of obtaining the HIV infection due to their risk behaviour (e.g. unprotected anal intercourse)


 \* Jean-Pierre Foschia2, Michele Breveglieri2, Martina Furegato2, Enrica Castellani2, Ruth Joanna Davis1, Lorenzo Gios1, Dunia Ramarli3 and Paola Coato4

*<sup>2</sup>ULSS20, Veneto Region, Verona, Italy* 

*<sup>3</sup>UO immunologia (Department of Pathology, Immunology), Azienda Ospedaliera Universitaria Integrata Verona (The Hospital Trust of Verona), Verona, Italy* 

*<sup>4</sup>UO immunologia (Department of Pathology, Microbiology), Azienda Ospedaliera Universitaria Integrata Verona (The Hospital Trust of Verona), Verona, Italy*

The SIALON Project: Report on HIV Prevalence

and Risk Behaviour Among MSM in Six European Cities 209

In this framework, a specific Declaration of Commitment on HIV/AIDS and a Political Declaration on HIV/AIDS were proposed and adopted by the UN General Assembly in 2001. In these documents, a specific set of epidemiological and surveillance activities are suggested, as well as the adoption of the so-called UNGASS indicators. UNGASS indicators are a set of measures to be used among different countries in order to effectively monitor the HIV epidemic (Joint United Nations Programme on HIV/AIDS UNAIDS & World Health Organization WHO, 2009). The Declaration provides a comprehensive framework to achieve

In addition, specific indications for developing and implementing a more effective surveillance system are provided in UNAIDS and WHO publications (UNAIDS & WHO, 2002, 2005). These documents suggest the adoption of the so-called Second Generation Surveillance System (SGSS), which foresees a set of detailed managerial and epidemiological procedures, as well as standardized processes and actions for managing surveillance studies . The SGSS foresees the implementation of surveys repeated on a regular basis according to different indicators, which require the collection of both behavioural and biological data. The SGSS provides a meaningful tool for developing prevention initiatives according to reliable data on HIV epidemics and

The "Capacity building in HIV/Syphilis prevalence estimation using non-invasive methods among MSM in Southern and Eastern Europe" – SIALON project was developed and implemented according to the main procedures and processes foreseen in the UNGASS declaration and in the SGSS approach. The SIALON project was funded in the framework of the 2003-2008 Public Health Programme (Work Plan 2007) and implemented by a team of European Public Institutions under the leadership of the Veneto Region in close collaboration with local partners ranging from Universities, teaching hospitals, epidemiological centres and Gay NGOs. In particular, the SIALON study was carried out in six cities of Southern and Eastern European countries: Barcelona (Spain), Bratislava (Slovakia), Bucharest (Romania),

The study conducted during the SIALON project was a cross-sectional study targeting MSM who have had sex with another man during the last 12 months. The data collection was conducted according to the Time-Location (or Time-Space) Sampling (TLS) procedure. This method was used to recruit men visiting the selected gay settings in each participating city, allowing to construe a representative sample with known properties. The cross-sectional study was conducted using a self-administered pen-and-paper questionnaire and an oral

The study design was planned and implemented in line with the Second Generation Surveillance System (SGSS) criteria (UNAIDS & WHO, 2002, 2005) and the United Nations

According to data and the results of some seroprevalence studies, levels of HIV prevalence are between 10 and 20% among MSM. As mentioned in section 2, this specific

fluid collector to gather both behavioural and biological data for each participant.

General Assembly Special Session (UNGASS) Indicators (UNAIDS & WHO, 2009).

the Millennium Development Goal in order to reverse the HIV epidemic by 2015.

behavioural patterns, which represent the major challenge for the coming years.

Ljubljana (Slovenia), Prague (Czech Republic), Verona (Italy).

**3. Methods** 

**3.1 Study design** 

**3.1.1 Study population** 

and a more limited access to HIV screening services and prevention programmes, (iii) the correlation between HIV infection and STIs and Syphilis and (iv) the association between HIV risk and alcohol and drug use.

This chapter also discusses the use of UNGASS indicators and the Second Generation Surveillance System (SGSS) approach in the survey and in general as key features to be considered as part of a comprehensive surveillance system.

Finally, a number of conclusions are drawn with regard to the need for repeated epidemiological studies focusing on hard to reach populations as well as to the need for targeted health promotion and prevention campaigns.
