HIV testing behaviour and associated factors in men who have sex with men by level of urbanisation: a cross-sectional study in the Netherlands

Jeanine Leenen; Juliën N A P Wijers; Chantal Den Daas; John de Wit; Christian J P A Hoebe; Nicole H T M Dukers-Muijrers

doi:10.1136/bmjopen-2021-049175

HIV testing behaviour and associated factors in men who have sex with men by level of urbanisation: a cross-sectional study in the Netherlands

BMJ Open. 2022 Jan 13;12(1):e049175. doi: 10.1136/bmjopen-2021-049175.

Authors

Jeanine Leenen^{1

2}, Juliën N A P Wijers^{1

2}, Chantal Den Daas^{3

4}, John de Wit^{5

6}, Christian J P A Hoebe^{1

7}, Nicole H T M Dukers-Muijrers^{8

9}

Affiliations

¹ Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands.
² Department of Medical Microbiology, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.
³ Institute of Applied Health Sciences, Health Psychology, University of Aberdeen, Aberdeen, UK.
⁴ Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
⁵ Centre for Social Research in Health, University of New South Wales, Sydney, New South Wales, Australia.
⁶ Department of Interdisciplinary Social Science, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, The Netherlands.
⁷ Department of Social Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.
⁸ Department of Sexual Health Infectious Diseases and Environmental Health, GGD South Limburg, Heerlen, The Netherlands nicole.dukers@ggdzl.nl.
⁹ Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht Universitair Medisch Centrum+, Maastricht, The Netherlands.

Abstract

Objectives: Regular HIV testing in men who have sex with men (MSM) enables timely entry into care and reduces the likelihood of HIV transmission. We aimed to assess HIV-testing behaviour and associated factors in MSM by urbanisation of place of residence.

Design: Data were derived from online survey ('Men & Sexuality') in the Netherlands, which was mainly advertised on social media (Facebook and Instagram), dating websites, apps for MSM (Grindr and PlanetRomeo) and gay media.

Primary and secondary outcome measures: HIV testing was defined as recent (<1 year), not recent (≥1 year) or never. Using multinominal regression analyses, factors associated with not recent testing and never testing, compared with recent testing, were assessed among MSM living in highly (>2500 residences/km²) or non-highly (≤2500 residences/km²) urbanised areas.

Participants: The study sample included 3815 MSM, currently living in the Netherlands. The mean age was 36 years (SD 14.7), and 67.6% were highly educated.

Results: In highly urbanised areas, 11.8% was never and 19.8% was not recently HIV-tested. In non-highly urbanised areas, this was 25.2% and 19.6%. Among MSM living in highly urbanised areas, independently associated with never and not recent testing were younger age, self-identification as bisexual, fewer sex partners, never notified of HIV and no recent condomless anal intercourse. Among MSM living in non-highly urbanised areas, lower perceived HIV severity, higher perceived HIV risk and a lower proportion gay friends were associated with never and not recent testing. Among never tested MSM, those in non-highly urbanised areas preferred self-sampling/self-testing over facility-based testing; those in highly urbanised areas preferred testing at healthcare facilities.

Conclusions: The proportion of never tested MSM was high (25%) in non-highly urbanised areas in the Netherlands. MSM living in non-highly urbanised areas may possibly be reached with targeted approaches to increase HIV testing uptake such as self-testing/self-sampling strategies.

Keywords: HIV & AIDS; epidemiology; public health.

MeSH terms

Adult
Cross-Sectional Studies
HIV Infections* / diagnosis
HIV Infections* / epidemiology
HIV Testing
Homosexuality, Male
Humans
Male
Netherlands / epidemiology
Sexual Behavior
Sexual and Gender Minorities*
Urbanization