title: Determinants of never having tested for HIV among MSM in the Netherlands.
abstract: OBJECTIVE
  Men who have sex with men (MSM) who are unaware of their HIV infection are more likely to infect others, and unable to receive treatment. Therefore, we aimed to identify the proportion and characteristics of Dutch MSM who never tested for HIV.
  
  
  METHODS
  In 2010, the European MSM Internet Survey (EMIS) recruited 174,209 men from 38 countries through an anonymous online questionnaire in 25 languages. We analysed data from participants living in the Netherlands (N=3787). The outcome we investigated was having never (lifetime) been tested for HIV.
  
  
  RESULTS
  A total of 770 MSM (20.4%) had never been tested for HIV. In multivariate regression analyses, not being from Amsterdam (adjusted OR, aOR 1.54, CI 1.17 to 2.03), with low education (aOR 1.28, CI 1.04 to 1.57) and low knowledge on HIV-testing (aOR 2.23, CI 1.37 to 3.64) were significantly associated with never having tested. Lower sexual risk (including having fewer sexual partners (aOR 2.19, CI 1.57 to 3.04) and no anal intercourse (aOR 5.99, CI 3.04 to 11.77)), and less social engagement (including being less out (aOR 1.93, CI 1.55 to 2.40)) were also associated with having never been tested. Additionally, 36.1% of MSM who never tested for HIV reported high-risk sexual behaviour that may have put them at HIV risk.
  
  
  CONCLUSIONS
  MSM make their own risk assessments that inform their choices about HIV-testing. Nevertheless, MSM who were never tested may have been at risk for HIV, and remain important to target for HIV interventions.
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Chantal
authors.initials: C
authors.lastname: den Daas
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Martine
authors.initials: M
authors.lastname: Doppen
authors.affiliation: Sigma Research, Department of Social & Environmental Health Research, London School of Hygiene and Tropical Medicine, UK.
authors.forename: Axel J
authors.initials: AJ
authors.lastname: Schmidt
authors.affiliation: Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
authors.forename: Eline
authors.initials: E
authors.lastname: Op de Coul
mesh_terms: D000328:Adult; D001364:Awareness; D015658:HIV Infections / Q000175:diagnosis* / Q000635:transmission; D007722:Health Knowledge, Attitudes, Practice; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009426:Netherlands; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: EPIDEMIOLOGY; PUBLIC HEALTH