Using Survey Data to Understand the Health Needs of Difficult to Reach Populations: Evidence from a Community Survey Regarding the Individual and Contextual Correlates of Sex Life Happiness Among European Men Who Have Sex With Men

Alexander Hamilton, Ford Hickson and Axel J Schmidt

No 11382, Policy Research Working Paper Series from The World Bank

Abstract: Being happy with one’s sex life is an important facet of sexual health. Several studies have found associations between sex life happiness and a range of individual (or proximate) and contextual (usually country-level) factors amongst men who have sex with men (MSM). Using a novel dataset, the 2017 European Men-Who-Have-Sex-With-Men Internet Survey (EMIS-2017), this paper simultaneously explores the association of both individual and contextual variables, sex life happiness, and health. Understanding and quantifying this link is important for policy makers concerned with improving health outcomes in minority, and often marginalized, populations. Results: Recency of sex and/or being in a steady sexual relationship had the largest positive associations with higher self-reported sex life happiness. Being single had the largest negative association. Among individual-level factors, not having experienced homophobia and being out to a majority of one’s social network were most strongly associated with sex life happiness. At the country-level, there is evidence that living in a country with a more authoritarian political regime is associated with less sex life happiness. Mediation analysis shows that authoritarian regimes are also indirectly negatively associated with sex life happiness via the likelihood of being open about one’s sexuality. This study provides a strong basis for further research exploring the potentially complex associations between proximate and contextual variables in determining sex life happiness amongst populations of men who have sex with men.

Date: 2026-05-18
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