title: Trends in HIV testing, prevalence among first-time testers, and incidence in most-at-risk populations in Spain: the EPI-VIH Study, 2000 to 2009.
abstract: During 2000 to 2009, data on people undergoing HIV testing and on those newly diagnosed with HIV were collected in a network of 20 Spanish clinics specialising in sexually transmitted infections and/or HIV testing and counselling. The number of tests performed, overall and disaggregated by different variables, was obtained. HIV prevalence among first-time testers and HIV incidence among repeat testers were calculated. To evaluate trends, joinpoint regression models were fitted. In total, 236,939 HIV tests were performed for 165,745 individuals. Overall HIV prevalence among persons seeking HIV testing was 2.5% (95% CI: 2.4 to 2.6). Prevalence was highest in male sex workers who had sex with other men (19.0% (95% CI: 16.7 to 21.4)) and was lowest in female sex workers (0.8% (95% CI: 0.7 to 0.9)). Significant trends in prevalence were observed in men who have sex with men (MSM) (increasing) and heterosexual individuals (decreasing). The incidence analysis included 30,679 persons, 64,104 person-years (py) of follow-up and 642 seroconversions. The overall incidence rate (IR) was 1.0/100 py (95% CI: 0.9/100 to 1.1/100). Incidence was significantly higher in men and transgender females than in women (1.8/100 py (95% CI: 1.6 to 1.9), 1.2/100 py (95% CI: 0.5 to 2.8) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively) and increased with age until 35–39 years. IRs in MSM and people who inject drugs were significantly greater than in heterosexual individuals (2.5/100 py (95% CI: 2.3 to 2.7), 1.6/100 py (95% CI: 1.1 to 2.2) and 0.1/100 py (95% CI: 0.09 to 0.2) respectively), and an upward trend was observed in MSM. Our results call for HIV prevention to be reinforced in MSM and transgender women in Spain.
authors.affiliation: Plan Nacional sobre el sida, Ministerio de Sanidad, Servicios Sociales e Igualdad, Madrid, Spain.
authors.forename: M
authors.initials: M
authors.lastname: Diez
authors.forename: M J
authors.initials: MJ
authors.lastname: Bleda
authors.forename: J R
authors.initials: JR
authors.lastname: Varela
authors.forename: J
authors.initials: J
authors.lastname: Ordonana
authors.forename: M A
authors.initials: MA
authors.lastname: Azpiri
authors.forename: M
authors.initials: M
authors.lastname: Vall
authors.forename: C
authors.initials: C
authors.lastname: Santos
authors.forename: L
authors.initials: L
authors.lastname: Viloria
authors.forename: C
authors.initials: C
authors.lastname: de Armas
authors.forename: J M
authors.initials: JM
authors.lastname: Urena
authors.forename: J
authors.initials: J
authors.lastname: Trullen
authors.forename: I
authors.initials: I
authors.lastname: Pueyo
authors.forename: B
authors.initials: B
authors.lastname: Martinez
authors.forename: T
authors.initials: T
authors.lastname: Puerta
authors.forename: M
authors.initials: M
authors.lastname: Vera
authors.forename: I
authors.initials: I
authors.lastname: Sanz
authors.forename: M L
authors.initials: ML
authors.lastname: Junquera
authors.forename: M C
authors.initials: MC
authors.lastname: Landa
authors.forename: E
authors.initials: E
authors.lastname: Martinez
authors.forename: M M
authors.initials: MM
authors.lastname: Camara
authors.forename: J
authors.initials: J
authors.lastname: Belda
authors.forename: F J
authors.initials: FJ
authors.lastname: Bru
authors.forename: A
authors.initials: A
authors.lastname: Diaz
mesh_terms: D015492:AIDS Serodiagnosis / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology*; D015528:HIV Seroprevalence / Q000639:trends*; D020010:Heterosexuality / Q000706:statistics & numerical data*; D018451:Homosexuality, Male / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D060386:Sex Workers; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000453:epidemiology; D013030:Spain / Q000453:epidemiology; D015819:Substance Abuse, Intravenous; D063106:Transgender Persons; D035862:Vulnerable Populations; D055815:Young Adult