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HIV incidence and HIV testing behavior in men who have sex with men: using three incidence sources, The Netherlands, 19842005

Dukers, Nicole HTMa,b,c; Fennema, Han SAa; van der Snoek, Eric Md; Krol, Annekea; Geskus, Ronald Ba; Pospiech, Marjae; Jurriaans, Suzannef; van der Meijden, Willem Ic; Coutinho, Roel Aa,b,c,g; Prins, Mariaa,b,c

doi: 10.1097/QAD.0b013e328011dade
Epidemiology and Social

Background: In The Netherlands, the western part, including Rotterdam and Amsterdam harbors the majority of the known HIV-infected population, of whom men who have sex with men (MSM) comprise the largest transmission category. Given a general rise in sexually transmitted infections (STI) and risky sexual behavior, we examine the HIV incidence among MSM in the Netherlands with data from three different sources.

Methods: To describe the HIV epidemic among MSM we use: a prospective cohort study in Rotterdam (ROHOCO: 1998–2003, n = 265) and another in Amsterdam (ACS: 1984–2005, n = 1498]) plus an anonymous HIV surveillance study (Amsterdam STI clinic: 1991–2004, n = 3733) in which HIV-positive MSM were tested with a less-sensitive HIV assay. We evaluated calendar trends in HIV incidence, also focusing on age effects.

Results: Since the start of the HIV epidemic in the early 1980s, incidence has declined strongly in the ACS. In recent years, an increase was noted among older MSM attending the Amsterdam STI clinic (P = 0.0334). In both cohort studies, HIV incidence was lower and recent time-trends were not statistically significant. Among recently infected men at the STI clinic, only 40% accepted named HIV testing at their STI consultation.

Conclusions: Data suggest that among MSM in the Netherlands, the HIV incidence is between one and four infections per 100 person-years. The epidemic expands among older STI clinic attendees. Prevention should be developed specifically for older men, along with a more efficient HIV testing approach such as routine HIV testing of MSM when they are screened for STI.

Author Information

From the aDepartment of Research, Cluster Infectious Diseases, Health Service of Amsterdam

bDepartment of Internal Medicine

cCenter for Infection and Immunity Amsterdam (CINIMA), Academic Medical Center Amsterdam

dDepartment of Dermatology and Venereology, Erasmus MC, Rotterdam

ePublic Health Laboratory, Cluster Infectious Diseases, Municipal Health Service of Amsterdam

fDepartment of Human Retrovirology, Academic Medical Center Amsterdam

gNational Institute for Public Health and the Environment, Bilthoven, The Netherlands.

Received 29 June, 2006

Revised 1 August, 2006

Accepted 11 October, 2006

Correspondence to Nicole H.T.M. Dukers, Department of Research, Cluster Infectious Diseases, Health Service of Amsterdam, P.O. Box 2200, 1000 CE Amsterdam, The Netherlands. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.