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In 9 Beiträgen arbeiten berufsmäßig wie z.T. auch persönlich betroffene HIV/AIDS-Experten, Mediziner zumeist, die Geschichte der Epidemie seit ihrem ersten Auftreten in Deutschland von rund 20 Jahren auf. Die Aufsätze zu den individuellen, sozialen, medienrelevanten und therapeutischen Entwicklungen der Problematik münden übereinstimmend in der positiven Prognose, dass die allenthalben befürchtete und vorausgesagte Katastrophe zwar durch frühzeitig ergriffene Präventiv- und Therapiemaßnahmen sowie die nicht hoch genug einzuschätzenden Selbsthilfeaktivitäten der Betroffenen ausgeblieben ist; der hintersinnige Titel "Glück gehabt?" verweist jedoch darauf, dass ein selbstzufriedenes Rückfahren der Präventiv- und Forschungsaktivitäten in diesem Bereich in Deutschland vieles Erreichte wieder infrage stellen würde. Mit dem klärenden Rückblick erhält man zugleich einen aktuellen Überblick über die epidemiologische, soziographische und therapeutische Situation auf dem Feld. (3) (Uwe-F. Obsen)

Vom RKI werden regelmäßig Schätzungen zum Verlauf der HIV-Epidemie erstellt. Die Schätzung soll insbesondere die Planung von Präventionsmaßnahmen erleichtern und die Evidenzgrundlage für die Bereitstellung einer ausreichenden medizinischen Versorgung und für weitere gesundheitspolitische Entscheidungen verbessern. Die Zahl der HIV-Neuinfektionen in Deutschland und bei Menschen deutscher Herkunft, die sich im Ausland mit HIV infiziert haben, wird 2018 auf 2.400 geschätzt und geht damit weiter zurück (2015: ca. 2.800). Allerdings liegt die Zahl der Menschen mit HIV, die noch nicht diagnostiziert wurden, seit 2013 konstant bei etwa 10.600. Wie das Epidemiologische Bulletin 46/2019 weiter ausführt, ist der Anteil der Personen, die mit einer HIV-Infektion diagnostiziert wurden und eine ART erhalten von 78% im Jahr 2006 auf 93% im Jahr 2018 angestiegen. Der Anteil erfolgreicher Therapien liegt bei etwa 95%.

AbstractIntroductionUntil September 2019, pre‐exposure prophylaxis (PrEP) with tenofovir disoproxil/emtricitabine for HIV prevention was not covered by health insurance plans in Germany, and was only available through private prescriptions with self‐pay or through informal non‐prescription sources. The objective of this study was to investigate the proportion of informal PrEP use among PrEP users and to identify factors of public health relevance that might be associated with informal PrEP use.MethodsWe conducted a cross‐sectional study recruiting PrEP users independent of their PrEP source. Clients from anonymous community testing checkpoints, users of three dating apps for men who have sex with men residing in Germany and users of a PrEP community website, were recruited to complete a short anonymous online survey. Participants were recruited between 24 July and 3 September 2018. The results were analysed using univariable and multivariable logistic regressions.ResultsWe recruited 2005 participants currently using PrEP. The median age was 38 years, and 80.3% of the participants identified themselves as male (missing: 19.1%). Overall, 71.6% obtained PrEP through medical services with a private prescription or a clinical trial, and 17.4% obtained PrEP through informal sources (missing: 11.0%). The most common informal sources were ordering online from another country (8.8%), travel abroad (3.6%), and friends (2.5%). Factors associated with informal PrEP use were on demand/intermittent dosing (adjusted OR: 3.5, 95% CI 2.5 to 5.0) and not receiving medical tests during PrEP use (adjusted OR: 3.2, 95% CI 2.0 to 5.2). In addition, informal PrEP users who did not take PrEP daily had a strongly increased risk of starting PrEP without prior medical tests (adjusted stratum‐specific OR = 31.7, 95% CI 4.6 to 219.5).ConclusionsInformal PrEP use was associated with a higher risk of not getting tested before and during PrEP use, which could lead to HIV infections resistant to tenofovir and emtricitabine if people with undiagnosed HIV use PrEP. Health insurance plans that cover PrEP and the accompanying routine tests could ensure adequate medical supervision of PrEP users and reduce barriers to PrEP use. Our findings strongly support the implementation of PrEP programmes in countries with similar patterns of informal PrEP use.

AbstractIntroductionThe population of men‐who‐have‐sex‐with‐men (MSM) includes people who are on the masculine spectrum but were assigned female at birth (AFAB), that is trans MSM. This study aims to identify current circumstances regarding sexual happiness and safety among German trans MSM. To date, there is no health information about trans MSM in Germany, limiting the ability of MSM sexual health programmes to meet their needs.MethodsData were used from the European MSM Internet Survey (EMIS‐2017), where people identifying as men and/or trans men were recruited through dating apps for MSM, community websites and social media to participate in an online survey. We analysed parameters on sexual happiness and satisfaction with sexual safety among Germany‐based trans MSM and compared those to outcomes of MSM assigned male at birth (cis MSM) living in Germany using descriptive methods and logistic regression models adjusting for age.ResultsIn total, 23,001 participants from Germany were included, of which 122 (0.5%) indicated to be AFAB (i.e. trans MSM). Trans MSM were markedly younger than cis participants (median age: 28.5 vs. 39 years).Trans MSM more often reported being unhappy with their current sex life (adjusted odds ratio [aOR] = 1.82, 95% CI 1.24–2.67), had higher odds of disagreeing with the statements "the sex I have is always as safe as I want" ([aOR] = 1.82, 95% CI 1.24–2.67) and "I find it easy to say no to sex that I don't want" ([aOR] = 1.80, 95% CI 1.18–2.77).Trans MSM were more likely to not be living comfortably financially ([aOR] = 2.43, 95% CI 1.60–3.67) and to be living with severe anxiety and/or depression ([aOR] = 3.90, 95% CI 2.22–6.83). Trans MSM were less likely to have ever tested for HIV ([aOR] = 0.63, 95% CI 0.43–0.93).ConclusionsSexual happiness, control of sexual boundaries, satisfaction with sexual safety, financial security, mental wellbeing and HIV testing were all lower in German trans MSM compared with cis MSM. Tailored sexual health interventions, contextualized with regard to needs and vulnerabilities, could address this inequality.

BACKGROUND: Globally, the HIV epidemic continues to represent a pressing public health issue in Europe and elsewhere. There is an emerging and progressively urgent need to harmonise HIV and STI behavioural surveillance among MSM across European countries through the adoption of common indicators, as well as the development of trend analysis in order to monitor the HIV-STI epidemic over time. The Sialon II project protocols have been elaborated for the purpose of implementing a large-scale bio-behavioural survey among MSM in Europe in line with a Second Generation Surveillance System (SGSS) approach. METHODS/DESIGN: Sialon II is a multi-centre biological and behavioural cross-sectional survey carried out across 13 European countries (Belgium, Bulgaria, Germany, Italy, Lithuania, Poland, Portugal, Romania, Slovakia, Slovenia, Spain, Sweden, and the UK) in community settings. A total of 4,966 MSM were enrolled in the study (3,661 participants in the TLS survey, 1,305 participants in the RDS survey). Three distinct components are foreseen in the study protocols: first, a preliminary formative research in each participating country. Second, collection of primary data using two sampling methods designed specifically for 'hard-to-reach' populations, namely Time Location Sampling (TLS) and Respondent Driven Sampling (RDS). Third, implementation of a targeted HIV/STI prevention campaign in the broader context of the data collection. DISCUSSION: Through the implementation of combined and targeted prevention complemented by meaningful surveillance among MSM, Sialon II represents a unique opportunity to pilot a bio-behavioural survey in community settings in line with the SGSS approach in a large number of EU countries. Data generated through this survey will not only provide a valuable snapshot of the HIV epidemic in MSM but will also offer an important trend analysis of the epidemiology of HIV and other STIs over time across Europe. Therefore, the Sialon II protocol and findings are likely to contribute significantly to increasing the comparability of data in EU countries through the use of common indicators and in contributing to the development of effective public health strategies and policies in areas of high need. ; publishersversion ; published