Abstract Background Transactional sex, which includes exchanging sex for material goods, services, or money, is a key HIV risk factor. Risk patterns associated with transactional sex among men who have sex with men (MSM) in Sweden, where buying sexual services is illegal, have not been examined earlier. This study aims to assess whether transactional sex (both buying and selling), country of birth, and migration-related factors (described by country of origin) are associated with self-reported HIV status among MSM in Sweden. Methods We analyzed secondary data from the 2017 European MSM Internet Survey (EMIS-2017), including participants reporting to live in Sweden (n = 4443). Using multivariate logistic regression analysis, we aimed to understand factors related to involvement in transactional sex and risk of HIV acquisition. Results Among the respondents, 5.4% reported living with HIV, with 8.8% of foreign-born MSM and 4.8% of Swedish-born MSM. The multivariable analysis showed that both selling and buying sex in the past five years increased the odds of reporting a positive HIV serostatus among all participants. Stratifying by transactional sex exposure and country of birth showed an HIV prevalence increase for all groups. Foreign-born selling or buying sex ever in the last five years had the highest prevalence of all groups (ranging from 17.8 to 19.1%). Other factors associated with a positive HIV status were age, outness, sex with a woman in the past twelve months, and condom use. Conclusions The relatively high reported HIV prevalence supports the need for HIV prevention, including the scale-up of access to pre-exposure prophylaxis to foreign-born MSM. A transparent discussion about risk factors and socioeconomic structures contributing to risk behaviors, including transactional sex, is needed. Key messages • Engaging in transactional sex increases the HIV risk among MSM in Sweden, particularly among foreign-born MSM. • HIV prevention needs to address the socioeconomic factors contributing to risky behaviors, such as transactional sex.

Abstract The Sustainable Development Goals are far off track. The convergence of global threats such as climate change, conflict and the lasting effects of the COVID-19 pandemic—among others—call for better data and research evidence that can account for the complex interactions between these threats. In the time of polycrisis, global and national-level data and research evidence must address complexity. Viewed through the lens of ‘systemic risk’, there is a need for data and research evidence that is sufficiently representative of the multiple interdependencies of global threats. Instead, current global published literature seems to be dominated by correlational, descriptive studies that are unable to account for complex interactions. The literature is geographically limited and rarely from countries facing severe polycrisis threats. As a result, country guidance fails to treat these threats interdependently. Applied systems thinking can offer more diverse research methods that are able to generate complex evidence. This is achievable through more participatory processes that will assist stakeholders in defining system boundaries and behaviours. Additionally, applied systems thinking can draw on known methods for hypothesising, modelling, visualising and testing complex system properties over time. Application is much needed for generating evidence at the global level and within national-level policy processes and structures.

Extreme heat, massive floods, and ever-longer droughts caused by climate change are intensifying in magnitude and intensity across the globe. Forests are threatened by increases in the average global temperature and human-driven economic activity. Artificial intelligence and Earth observation technologies present opportunities to improve environmental sustainability, promoting Sustainable Development Goals through more efficient forest management and stewardship. These technologies can potentially improve the mapping, understanding, and monitoring of forests’ ecosystem services, directly aiding humanity’s efforts to combat climate change. However, increased use of these technologies could also create new risks, making these efforts counterproductive. This perspective article identifies opportunities and risks of using artificial intelligence and Earth observation technologies to protect forests globally. It discusses how risks can be mitigated and what governance mechanisms should be used to design sustainable forest-focused artificial intelligence.

ABSTRACT Background Young migrants face multiple challenges that can affect their mental, sexual and reproductive health. Objective To assess the prevalence of self-reported poor mental health and its associated demographic, post-migration and sexual risk behaviour factors among young migrants (aged 15–25) in Sweden. Methods Data were drawn from a cross-sectional survey conducted with migrants aged 15–65 years old in Sweden between December 2018 and November 2019 (n = 6449). Among these, 990 participants aged 15–25 were eligible for the study. Mental health was measured using the Refugee Health Screener-13. Missing data indicator analysis and multivariable logistic regression models were conducted to estimate the association between mental health, sexual risk behaviour, demographic and migration-related variables. Results Of the 990 participants, 59% reported poor mental health. Participants reporting poor mental health were more likely to be female (AOR:1.63, 95% CI:1.18–2.25), to have lived in Sweden more than three years (AOR:2.16, 95% CI:1.17–3.97), to engage in any sexual risk behaviour (AOR:1.99, 95% CI:1.25–3.17), and to live alone (AOR:1.95, 95% CI:1.25–3.03) or with friends they already knew (AOR:1.60, 95% CI:1.37–4.91). People arriving from the Americas (AOR:0.54, 95% CI:0.33–0.88), Asia (AOR:0.44, 95% CI:0.22–0.86), Europe (AOR:0.30, 95% CI:0.14–0.61) and Africa (AOR 0.37, 95% CI: 0.23–0.60) had lower odds of poor mental health than those arriving from Syria. Conclusion The prevalence of poor mental health among young migrants in Sweden was high, with specific subgroups (women, asylum seekers, people arriving from Syria, and those residing longer in Sweden) being particularly vulnerable. Our results indicate the interconnectedness between poor mental health and sexual risk behaviour in this population. Thus, policies targeting young migrants should ensure that healthcare services screen for both poor sexual and mental health at the same time.

Background Little is known about transactional sex (TS) (selling and buying sex) among men who have sex with men (MSM) in Sweden, especially among foreign-born MSM. This study aims to assess the prevalence and risk factors of TS (ever and in the previous five years) among MSM living in Sweden and to determine if there is a difference between Swedish-born MSM and foreign-born MSM. Methods Swedish data from a multicountry online banner survey (EMIS-2017) was used (n = 4443). Multivariable regression analysis was applied to analyse the data. Results The prevalence of ever-selling sex among all MSM participants was 13.2% and 5.9% in the previous five years. Selling sex ever and in the previous five years was higher among foreign-born MSM (16% and 8.4%, respectively) than Swedish-born MSM (12.7% and 5.4%, respectively). Among all participants, younger age (aOR:3.19, 95% CI:1.57–6.45) and really struggling to live on current income (aOR:3.37, 95% CI:2.29–4.96) increased the odds of selling sex. Being foreign-born MSM (aOR:1.33, 95% CI:1.02–1.73) and having had sex with a woman in the previous 12 months increased the odds of selling sex (aOR:1.44, 95% CI:1.00–2.07). The prevalence of ever buying sex among MSM participants in Sweden was 10.8% and 6.7% in the previous five years, with the same trend among foreign-born MSM (11.6% and 6.9%, respectively) and Swedish-born MSM (10.7% and 6.6%, respectively). Higher education and not having a current partner increased the odds of buying sex. Younger age was protective for buying sex (aOR:0.05, 95% CI:0.02–0.14). Among the foreign-born MSM, the length of stay in Sweden decreased the odds of buying sex (aOR: 0.98, 95% CI: 0.96–0.99). Conclusions The comparatively high prevalence of TS among MSM participants in Sweden, where buying sex is illegal, with a higher prevalence among foreign-born MSM participants, calls for sexual and reproductive health and rights interventions in this population. Increased attention, including HIV prevention programming and education, should be aimed at younger MSM, MSM struggling with their current income, and foreign-born MSM, as they are more likely to report selling sex.

Background Migration is a complex process of high uncertainty with adjustments to new contexts and experiences influencing individuals’ health. This study aims to assess the prevalence of self-reported sexual risk-taking behaviors among migrant youth population in Sweden, fulfilling the research gap in that field. Methods A pre-tested, web-based self-administered cross-sectional survey was used to collect data among 1563 migrant youth (15–25 years old) in Sweden. The survey was conducted in high schools and Swedish language schools for foreigners between December 2018 and November 2019. Pearson chi-square and t-tests were used to compare whether sociodemographic characteristics and migration status varied between those engaging in sexual risk behaviors or not. Multivariate logistic regression was used to determine the adjusted odds ratio of the key outcome variable and independent variables. Results There is a profound heterogeneity in migrant youth characteristics related to engagement in different sexual risk-taking behaviors. Those engaging in condomless sex were older, coming from the Americas and Europe, living longer in Sweden and came to live with their family. Belonging to the Islamic religion was a protective factor. Sex under the influence of drugs was related to those from Europe, and Middle East and North Africa (MENA) and coming to Sweden to work/study, where age was a protective factor. Living longer in Sweden, coming for work/study or to live with family had higher odds to engage in sex in exchange for gifts/money. Conclusion The results highlight the needed reconsideration of the broader system response that can influence migrant youth health outcomes and public health implications. The approach should consider and relate to sexual risk-taking behavior’s long-term consequences. Migrant youth background needs and knowledge should guide this response.