{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T20:17:07Z","timestamp":1788380227519,"version":"build-2803163510"},"reference-count":29,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2021,1,21]],"date-time":"2021-01-21T00:00:00Z","timestamp":1611187200000},"content-version":"unspecified","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,12,19]]},"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Portugal has the highest HIV incidence rate in Western Europe. The proportion assigned to sexual contact between men recently increased to more than 30% of all HIV infections. Men who have sex with men (MSM) are vulnerable to the acquisition of other sexually transmitted infections (STIs), increasing the per-contact risk of HIV infection. Building on syndemic theory, the aim of this analysis was to identify patterns of current sexual behaviour in MSM, and explore their relationship with self-reported current, past STI diagnoses and HIV positive serostatus.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A cross-sectional behavioural survey was conducted in Portugal among MSM, using a community-based participatory research approach. Hierarchical cluster analysis was used to identify patterns including behavioural and demographic factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The analysis resulted in six clusters. Three clusters showed higher rates of current STI diagnosis (ranging from 11.7% to 17.1%), past STI diagnosis (ranging from 25.5% to 41.5%) and HIV positive serostatus (ranging from 13.0% to 16.7%). From the three clusters scoring lower on current and past STI and HIV diagnoses, one was characterised by a high number of sexual partners (62% had more than 12 partners in the last year), a high proportion (94.6%) of frequent visits to gay venues to meet sexual partners and high alcohol use (46.1%). The other two clusters scored lower on high risk sexual behaviour.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Factors other than sexual behaviour appear to reinforce the vulnerability to STIs and HIV of some MSM in this study, suggesting a syndemic of STIs, HIV and other adverse conditions. More research is needed to better understand the drivers of the STI\/HIV epidemic in Portuguese MSM, using a concept that goes beyond risk behaviour, to develop effective combination prevention interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-033290","type":"journal-article","created":{"date-parts":[[2021,1,22]],"date-time":"2021-01-22T14:45:06Z","timestamp":1611326706000},"page":"e033290","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["Sexual behaviour patterns and STI risk: results of a cluster analysis among men who have sex with men in Portugal"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6900-9124","authenticated-orcid":false,"given":"Karel","family":"Blondeel","sequence":"first","affiliation":[{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland"},{"name":"Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sonia","family":"Dias","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal"},{"name":"National School of Public Health, Universidade Nova de Lisboa, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2168-8396","authenticated-orcid":false,"given":"Martina","family":"Furegato","sequence":"additional","affiliation":[{"name":"Applied Diagnostic Research and Evaluation Unit (ADREU), University of London, St George's Molecular and Clinical Sciences Research Institute, London, UK"},{"name":"Blood Safety, Hepatitis, Sexually Transmitted Infections (STI) and HIV Service, National Infection Service, Public Health England, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armando","family":"Seuc","sequence":"additional","affiliation":[{"name":"Instituto Nacional de Higiene Epidemiolog\u00eda y Microbiolog\u00eda, Habana, Cuba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Gama","sequence":"additional","affiliation":[{"name":"Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo","family":"Fuertes","sequence":"additional","affiliation":[{"name":"Grupo de Ativistas em Tratamentos, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lu\u00eds","family":"Mend\u00e3o","sequence":"additional","affiliation":[{"name":"Grupo de Ativistas em Tratamentos, Lisbon, Portugal"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marleen","family":"Temmerman","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Health Sciences, Ghent University, Gent, Belgium"},{"name":"Medical College, Aga Khan University, Nairobi, Kenya"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Igor","family":"Toskin","sequence":"additional","affiliation":[{"name":"UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, WHO, Geneve, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2021,1,22]]},"reference":[{"key":"2025121407571536000_11.1.e033290.1","unstructured":"European Centre for Disease Prevention and Control\/ WHO Regional Office for Europe . 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