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

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