Abstract
BackgroundMeasurement of prevalence and incidence of infections in a hard to reach population like men who have sex with men (MSM) is hampered by its unknown size and regional distribution. Population-based surveys have recently been used to estimate the total number of MSM, but these surveys are usually not large enough to measure regional differences in the proportion of MSM in the population. We explored the use of the proportional regional distribution of participants of large internet-based surveys among MSM from Germany to estimate the regional distribution of MSM in Germany.MethodsWe compared participants from two separate MSM behavioural surveys with each other and with the distribution of user profiles of the largest contact and dating website for gay and other MSM in Germany in terms of the representativeness of the regional distribution. In addition, we compared the regional distribution of reportedly HIV positive survey participants with the regional distribution of HIV notifications within the national surveillance system that can be attributed to transmission through homosexual contacts.ResultsRegional distribution of survey participants was almost identical in both surveys, despite little overlap between survey participants. Slight discrepancies between surveys and user profiles could be observed. Proportional regional distribution of survey participants with HIV diagnosis resembled national surveillance data.ConclusionConsidering the difficulties to obtain representative data by other sampling methods for "hidden" populations like MSM, internet-based surveys may provide an easy and low cost tool to estimate the regional population distribution – at least in Western post-industrialized countries. Some uncertainties remain about the exact place of residence of MSM in larger cities or catchment areas of these cities. Slightly different results from different datasets may be due to unequal popularity of MSM websites in different regions. The total population size of the MSM population can be estimated based on e.g. data from representative national population surveys. Both estimates can then be combined to calculate the absolute size of regional MSM populations.
Highlights
Measurement of prevalence and incidence of infections in a hard to reach population like men who have sex with men (MSM) is hampered by its unknown size and regional distribution
The total population size of the MSM population can be estimated based on e.g. data from representative national population surveys
Both estimates can be combined to calculate the absolute size of regional MSM populations
Summary
Measurement of prevalence and incidence of infections in a hard to reach population like men who have sex with men (MSM) is hampered by its unknown size and regional distribution. National infectious disease surveillance data for sexually transmitted infections, if they collect information on the gender of sexual partners, usually refer diagnosis or infection incidence in MSM to the general population or the general male population. This approach neglects specific migration processes that lead to a concentration of sexual minorities such as men who have sex with men in larger cities, especially if they self-identify as gay. The measurement of prevalence and incidence of health conditions or infections in subpopulations such as men who have sex with men (MSM) is hampered by the unknown size and regional distribution of this "hidden" population. Some approaches rely on a multitude of local and regional studies with differing methodologies [3], and some use samples of gay men recruited in health care institutions or community venues, which may contain numerous biases and are not representative for MSM
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