{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T20:07:23Z","timestamp":1792181243934,"version":"4.4.0"},"reference-count":49,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2020,10,10]],"date-time":"2020-10-10T00:00:00Z","timestamp":1602288000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100007565","name":"Consumers, Health, Agriculture and Food Executive Agency","doi-asserted-by":"publisher","award":["2015 71 01"],"award-info":[{"award-number":["2015 71 01"]}],"id":[{"id":"10.13039\/501100007565","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Some men who have sex with men (MSM) were assigned female at birth (AFB) and\/or identify as trans men. Little is known about how these men differ from other MSM. We compared sexual and mental health indicators from the European MSM Internet Survey (EMIS-2017), comparing men AFB and\/or currently identifying as trans men with those assigned male at birth (AMB) who identified as men. EMIS-2017 was an opportunistic 33-language online sexual health survey for MSM recruiting throughout Europe. We used regression models adjusting for age, country of residence and employment status to examine differences across groups. An analytic sample of 125,720 men living in 45 countries was used, of which 674 (0.5%) were AFB and 871 (0.7%) identified as trans men. The two sub-groups were not coterminous, forming three minority groups: AFB men, AFB trans men and AMB trans men. Minority groups were younger and more likely unemployed. Anxiety, depression, alcohol dependence and sexual unhappiness were more prevalent in sex\/gender minority men. Conversely HIV and STI diagnoses were less common. AMB trans men were most likely to have sexual risk behavior with steady partners and to have unmet health promotion needs, and were least likely to be reached by interventions. Sex assigned at birth and trans identification were associated with different sexual and mental health needs. To facilitate service planning and to foster inclusion, sex-assigned-at-birth and current gender identity should be routinely collected in health surveys.<\/jats:p>","DOI":"10.3390\/ijerph17207379","type":"journal-article","created":{"date-parts":[[2020,10,13]],"date-time":"2020-10-13T22:02:02Z","timestamp":1602626522000},"page":"7379","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Sexual and Mental Health Inequalities across Gender Identity and Sex-Assigned-at-Birth among Men-Who-Have-Sex-with-Men in Europe: Findings from EMIS-2017"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0395-374X","authenticated-orcid":false,"given":"Ford","family":"Hickson","sequence":"first","affiliation":[{"name":"Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene &amp; Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Appenroth","sequence":"additional","affiliation":[{"name":"Institute of Public Health, Charit\u00e9 Universit\u00e4tsmedizin Berlin, 10117 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9718-5811","authenticated-orcid":false,"given":"Uwe","family":"Koppe","sequence":"additional","affiliation":[{"name":"Department of Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6910-4399","authenticated-orcid":false,"given":"Axel J.","family":"Schmidt","sequence":"additional","affiliation":[{"name":"Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene &amp; Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Reid","sequence":"additional","affiliation":[{"name":"Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene &amp; Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4950-6163","authenticated-orcid":false,"given":"Peter","family":"Weatherburn","sequence":"additional","affiliation":[{"name":"Department of Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene &amp; Tropical Medicine, London WC1H 9SH, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Bauer, G.R., Braimoh, J., Scheim, A.I., and Dharma, C. (2017). Transgender-inclusive measures of sex\/gender for population surveys: Mixed-methods evaluation and recommendations. PLoS ONE, 12.","DOI":"10.1371\/journal.pone.0178043"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1177\/1363460717716426","article-title":"Gay, bisexual and queer trans men navigating sexual fields","volume":"22","author":"Scheim","year":"2017","journal-title":"Sexualities"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"152","DOI":"10.1215\/23289252-8141985","article-title":"Trans Pornography","volume":"7","author":"Pezzutto","year":"2020","journal-title":"Transgend. Stud. Q."},{"key":"ref_4","first-page":"290","article-title":"Physical health inequalities among gay and bisexual men in England: A large community-based cross-sectional survey","volume":"39","author":"Bourne","year":"2016","journal-title":"J. Public Health"},{"key":"ref_5","first-page":"645","article-title":"Mental health inequalities among gay and bisexual men in England, Scotland and Wales: A large community-based cross-sectional survey","volume":"39","author":"Hickson","year":"2017","journal-title":"J. Public Health"},{"key":"ref_6","unstructured":"James, S., Herman, J., Rankin, S., Keisling, M., Mottet, L., and Anafi, M. (2016). The 2015 US Transgender Survey, National Centre for Transgender Equality."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"58","DOI":"10.3109\/09540261.2015.1073143","article-title":"Non-suicidal self-injury and suicidality in trans people: A systematic review of the literature","volume":"28","author":"Marshall","year":"2016","journal-title":"Int. Rev. Psychiatry"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.2105\/AJPH.2018.304727","article-title":"Estimating the prevalence of HIV and sexual behavors among the US transgender population: A systematic review and meta-analysis, 2006\u20132017","volume":"109","author":"Becasen","year":"2019","journal-title":"Am. J. Public Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"67","DOI":"10.15585\/mmwr.mm6803a3","article-title":"Transgender identity and experiences of violence victimization, substance use, and sexual risk behaviors among high school students\u201419 states and large urban school districts","volume":"68","author":"Johns","year":"2019","journal-title":"Morb. Mortal. Wkly. Rep."},{"key":"ref_10","unstructured":"Vance, C. (1984). Pleasure and Danger: Exploring Female Sexuality, Routledge, Keagan & Paul."},{"key":"ref_11","first-page":"238","article-title":"Existen otras formas de tener sexo? Sexualidad en hombres transexuales","volume":"50","year":"2016","journal-title":"Interam. J. Psychol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"389","DOI":"10.1080\/15532739.2018.1463584","article-title":"Sexuality and gender affirmation in transgender men who have sex with cisgender men","volume":"19","author":"Puckett","year":"2018","journal-title":"Int. J. Transgend."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1521\/aeap.2011.23.6.508","article-title":"Transmen: The HIV risk of gay identity","volume":"23","author":"Rowniak","year":"2011","journal-title":"AIDS Educ. Prev."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"398","DOI":"10.1016\/j.jana.2009.06.001","article-title":"There\u2019s no pamphlet for the kind of sex I have: HIV-related risk factors and protective behaviors among transgender men who have sex with non-transgender men","volume":"20","author":"Sevelius","year":"2009","journal-title":"J. Assoc. Nurses AIDS Care"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"501","DOI":"10.1089\/apc.2010.0059","article-title":"A mixed methods study of the sexual health needs of New England transmen who have sex with nontransgender men","volume":"24","author":"Reisner","year":"2010","journal-title":"AIDS Patient Care STDS"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Jones, T., del Pozo de Bolger, A., Dune, T., Lykins, A., and Hawkes, G. (2015). Female-to-Male Transgender People\u2019s Experiences in Australia, Springer.","DOI":"10.1007\/978-3-319-13829-9"},{"key":"ref_17","unstructured":"European Union Agency for Fundamental Rights (2014). FRA Being Trans in the European Union. Comparative Analysis of EU LGBT Survey Data, European Union Agency for Fundamental Rights. Available online: http:\/\/fra.europa.eu\/sites\/default\/files\/fra-2014-being-trans-eu-comparative-0_en.pdf."},{"key":"ref_18","unstructured":"Whittle, S., Turner, L., Combs, R., and Rhodes, S. (2008). Transgender EuroStudy: Legal Survey and Focus on the Transgender Experience of Health Care, ILGA Europe\/TransGender Europe. Available online: https:\/\/tgeu.org\/wp-content\/uploads\/2009\/11\/transgender_web.pdf."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1080\/19359705.2014.960990","article-title":"Trans people\u2019s experiences of mental health and gender identity services: A UK study","volume":"19","author":"Ellis","year":"2015","journal-title":"J. Gay Lesbian Ment. Health"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/OLQ.0000000000000917","article-title":"Chlamydia, gonorrhea, and human immunodeficiency virus Infection among transgender women and transgender men attending clinics that provide sexually transmitted disease services in six US cities: Results from the sexually transmitted disease surveillance network","volume":"46","author":"Pitasi","year":"2019","journal-title":"Sex. Transm. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1097\/QAI.0000000000001222","article-title":"HIV-related sexual risk among transgender men who are gay, bisexual, or have sex with men","volume":"74","author":"Scheim","year":"2017","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"52","DOI":"10.7448\/IAS.19.3.20779","article-title":"Inequities in access to HIV prevention services for transgender men: Results of a global survey of men who have sex with men","volume":"19","author":"Scheim","year":"2016","journal-title":"J. Int. AIDS Soc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Weatherburn, P., Hickson, F., Reid, D.S., Marcus, U., and Schmidt, A.J. (2019). European Men-who-have-sex-with-men Internet Survey (EMIS-2017): Design and methods. Sex. Res. Soc. Policy.","DOI":"10.1037\/t88452-000"},{"key":"ref_24","unstructured":"Sausa, L.A., Sevelius, J., Keatley, J., I\u00f1iguez, J.R., and Reyes, M. (2009). Recommendations for Inclusive Data Collection of Trans People in HIV Prevention, Care & Services, Center of Excellence for Transgender Health."},{"key":"ref_25","first-page":"613","article-title":"An ultra-brief screening scale for anxiety and depression: The PHQ-4","volume":"50","author":"Kroenke","year":"2009","journal-title":"Psychosomatics"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1177\/0013164403261814","article-title":"A reliability induction and reliability generalization study of the CAGE questionnaire","volume":"64","author":"Shields","year":"2004","journal-title":"Educ. Psychol. Meas."},{"key":"ref_27","first-page":"37","article-title":"The provisions of social relationships and adaptation to stress","volume":"Volume 1","author":"Jones","year":"1987","journal-title":"Advances in Personal Relationships"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1080\/00224499.2017.1380158","article-title":"Structural validation and multiple group assessment of the short internalized homonegativity scale in homosexual and bisexual men in 38 European countries: Results from the European MSM Internet Survey","volume":"55","author":"Tran","year":"2018","journal-title":"J. Sex Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2428","DOI":"10.1016\/S0140-6736(19)30418-0","article-title":"Risk of HIV transmission through condomless sex in serodifferent gay couples with the HIV-positive partner taking suppressive antiretroviral therapy (PARTNER): Final results of a multicentre, prospective, observational study","volume":"393","author":"Rodger","year":"2019","journal-title":"Lancet"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"575","DOI":"10.1136\/sextrans-2012-050973","article-title":"The EMIS Network. Comparison of the performance of STI screening services for gay and bisexual men across 40 European cities: Results from the European MSM Internet Survey (EMIS)","volume":"89","author":"Schmidt","year":"2013","journal-title":"Sex. Transm. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"455","DOI":"10.1136\/sextrans-2015-052389","article-title":"Men who have sex with men in Britain: Comparison of estimates from a probability sample and community-based surveys","volume":"92","author":"Prah","year":"2016","journal-title":"Sex. Transm. Infect."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Marcus, U., Hickson, F., Weatherburn, P., and Schmidt, A.J. (2013). Age biases in a large HIV and sexual behaviour-related internet survey among MSM. BMC Public Health, 13.","DOI":"10.1186\/1471-2458-13-826"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Rothblum, E.D. (2020). Bisexual mental health. The Oxford Handbook of Sexual and Gender Minority Mental Health, Oxford University Press.","DOI":"10.1093\/oxfordhb\/9780190067991.001.0001"},{"key":"ref_34","unstructured":"Hickson, F., and Boxford, R. (1999). Assert Yourself: Evaluating the Performance of An HIV Prevention Intervention, Sigma Research. Available online: http:\/\/sigmaresearch.org.uk\/reports\/item\/report1999j."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1136\/sextrans-2020-054474","article-title":"Sociodemographic and behavioural factors associated with testing for HIV and STIs in a US nationwide sample of transgender men who have sex with men","volume":"96","author":"Talan","year":"2020","journal-title":"Sex. Transm. Infect."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"990","DOI":"10.1080\/09540121.2016.1271937","article-title":"Barriers and facilitators to HIV and sexually transmitted infections testing for gay, bisexual, and other transgender men who have sex with men","volume":"29","author":"Scheim","year":"2017","journal-title":"AIDS Care"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1080\/13691058.2017.1299882","article-title":"Sexual HIV risk among gay, bisexual, and queer transgender men: Findings from interviews in Vancouver, Canada","volume":"19","author":"Rich","year":"2017","journal-title":"Cult. Health Sex."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1080\/09540121.2018.1479027","article-title":"The people living with HIV Stigma Survey UK 2015: HIV-related sexual rejection and other experiences of stigma and discrimination among gay and heterosexual men","volume":"30","author":"Hibbert","year":"2018","journal-title":"AIDS Care"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"3346","DOI":"10.1007\/s10461-017-1735-4","article-title":"HIV prevalence, sexual partners, sexual behavior and HIV acquisition risk among trans men, San Francisco, 2014","volume":"21","author":"McFarland","year":"2017","journal-title":"AIDS Behav."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1136\/sextrans-2018-053570","article-title":"HIV and trans and non-binary people in the UK","volume":"94","author":"Jaspal","year":"2018","journal-title":"Sex. Transm. Infect."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"e1","DOI":"10.1097\/QAI.0000000000002116","article-title":"High Rates of PrEP Eligibility but Low Rates of PrEP Access Among a National Sample of Transmasculine Individuals","volume":"82","author":"Golub","year":"2019","journal-title":"J. Acquir. Immune Defic. Syndr."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e25391","DOI":"10.1002\/jia2.25391","article-title":"High Risk and low Uptake of pre-exposure prophylaxis to prevent HIV acquisition in a national online sample of transgender men who have sex with men in the United States","volume":"22","author":"Reisner","year":"2019","journal-title":"J. Int. Aids Soc."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1177\/0956462415602418","article-title":"Syndemics and gender affirmation: HIV sexual risk in female-to-male trans masculine adults reporting sexual contact with cisgender males","volume":"27","author":"Reisner","year":"2016","journal-title":"Int. J. STD AIDS"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1037\/men0000125","article-title":"Cisgender men and trans prejudice: Relationships with sexual orientation and gender self-esteem","volume":"19","author":"Anderson","year":"2018","journal-title":"Psychol. Men Masc."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1080\/0966369X.2010.503118","article-title":"Trans lives in the \u2018gay capital of the UK\u2019","volume":"7","author":"Brown","year":"2010","journal-title":"Gend. Place Cult."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1007\/s10461-019-02749-5","article-title":"Gender non-affirmation from cisgender male partners: Development and validation of a brief stigma scale for HIV research with transgender men who have sex with men (Trans MSM)","volume":"24","author":"Reisner","year":"2019","journal-title":"AIDS Behav."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"351","DOI":"10.1080\/14681994.2014.902925","article-title":"Gender, stage of transition and situational avoidance: A UK study of trans people\u2019s experiences","volume":"29","author":"Ellis","year":"2014","journal-title":"Sex. Relatsh. Ther."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1007\/s11121-013-0393-7","article-title":"Minority stress and substance use in sexual minority adolescents: A meta-analysis","volume":"15","author":"Goldbach","year":"2014","journal-title":"Prev. Sci."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1136\/tobaccocontrol-2011-050181","article-title":"A systematic review of the aetiology of tobacco disparities for sexual minorities","volume":"22","author":"Blosnich","year":"2013","journal-title":"Tob. Control"}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7379\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T10:18:05Z","timestamp":1760177885000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/17\/20\/7379"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,10,10]]},"references-count":49,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2020,10]]}},"alternative-id":["ijerph17207379"],"URL":"https:\/\/doi.org\/10.3390\/ijerph17207379","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,10,10]]}}}