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Low HIV-testing rates among younger high-risk homosexual men in Amsterdam

¹ Department of Research, Cluster of Infectious Diseases, Health Service of Amsterdam, Amsterdam, The Netherlands
² Department of Social and Organizational Psychology, University of Utrecht, Utrecht, The Netherlands
³ Cluster of Infectious Diseases, STI Outpatient Clinic, Municipal Health Service of Amsterdam, Amsterdam, The Netherlands
⁴ Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands

Correspondence to:
Dr I G Stolte
Health Service Amsterdam, Cluster of Epidemiology, Documentation and Health Promotion, Nieuwe Achtergracht 100, PO box 2200 1000 CE Amsterdam, The Netherlands;istolte{at}ggd.amsterdam.nl

ABSTRACT
Objective: To investigate HIV-testing behaviour and HIV prevalence among homosexual visitors of a sexually transmitted infection (STI) outpatient clinic, and to investigate determinants of unknown HIV status, and of HIV testing separately for men with unknown and negative HIV status.

Design: Cross-sectional survey conducted from March 2002 to December 2003 among homosexual men with negative or unknown HIV status visiting the Amsterdam STI clinic.

Methods: A convenience sample of 1201 men with negative or unknown HIV status answered a written questionnaire about history of HIV testing, sexual risk behaviour and behavioural determinants (non-response, 35%). Information was matched to the STI registration system. Associations were determined using logistic regression.

Results: 817 men reported a negative HIV status, and 384 reported an unknown HIV status. The overall HIV prevalence among the 523 men who tested at new STI consultation was 2.8%. The proportion of men with unknown HIV status was relatively high among those diagnosed with infectious syphilis and those reporting unprotected anal intercourse with a casual partner. Their testing rates at new STI clinic visit were lower. Among men with an unknown HIV status, those aged <30 years and reporting risky sexual behaviour tested the least (OR 0.13, 95% CI 0.03 to 0.61).

Conclusion: Although HIV testing rates have increased, they are still lower than in other industrialised countries. Moreover, some men still undertake high-risk sex without knowing their own HIV status, which might pose a risk for ongoing HIV transmission. Therefore, more active testing promotion is needed.

Abbreviations: CP, casual partner; HAART, highly active antiretroviral therapy; RG, rectal gonorrhoea; SP, sexual partner; STI, sexually transmitted infection; UAI, unprotected anal intercourse; VDRL, Venereal Disease Research Laboratory

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