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

Abstract

ObjectivesRegular 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.DesignData 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 measuresHIV 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.ParticipantsThe 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.ResultsIn 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.ConclusionsThe 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.

Mpox vaccination willingness, determinants, and communication needs in gay, bisexual, and other men who have sex with men, in the context of limited vaccine availability in the Netherlands (Dutch Mpox-survey)

“…Local stakeholder networks, community based organizations and local communities can be engaged to maximize access to information (for all) and access to PPV (for those at highest risk). Respondents who lacked connectedness to the gay/queer community were less likely to want PPV, in line with research findings on HIV testing and COVID-19 testing uptake ( 28 , 29 ). Disconnected people are also known to less engage in preventive healthcare.…”

“…Those who live in less urbanized areas and those who lack connection to a gay/queer community might benefit from strengthened public health efforts tailored to their context. Disparities by urbanization level in mpox PPV uptake and in other mpox mitigation strategies were demonstrated in two US studies ( 26 , 27 ), and were also observed in HIV testing uptake ( 28 ). Local stakeholder networks, community based organizations and local communities can be engaged to maximize access to information (for all) and access to PPV (for those at highest risk).…”

Monkeypox vaccination willingness, determinants, and communication needs in gay, bisexual, and other men who have sex with men, in the context of limited vaccine availability in the Netherlands (Dutch MPX-survey)

“…Public health efforts should be strengthened in less urbanized areas together with local stakeholder networks, community based organizations and local communities. Furthermore, respondents who lacked connectedness to the gay/queer community were less likely to want PPV, in line research findings on HIV testing and COVID-19 testing uptake [27,28]. Disconnected people are also known to less engage in preventive healthcare.…”

“…Subgroups less likely to want vaccination were defined by were they were born and live (born in the Netherlands, live in lower urbanized areas), their social networks (no MPX-vaccinated social network members, lack of connection to the gay/queer community), and by their sexual behavior (at most one recent partner). Disparities by urbanization level in MPX prevention behavior (PPV uptake and other MPX mitigation strategies) were demonstrated in two US studies [25,26], and was also observed in HIV testing uptake [27]. Public health efforts should be strengthened in less urbanized areas together with local stakeholder networks, community based organizations and local communities.…”

PrEP Use in Times of COVID-19 in the Netherlands: Men Who Have Sex With Men (MSM) on PrEP Test Less for HIV and Renal Functioning During a COVID-19 Related Lockdown

“…It is possible that access to sexual health care during the COVID-19 pandemic within the Netherlands was unevenly distributed, for example between urban and rural areas [ 24 ]. A recent spatial analysis found greater PrEP use in the main urban areas of the Netherlands (Amsterdam, Utrecht, Leiden, the Hague, and Rotterdam) compared to the rest of the country before the pandemic [ 25 ].…”