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Background Testing is a key strategy towards elimination of HIV; preferably by regional targeted approaches. Regular HIV testing enables timely care and reduces HIV transmission. We assessed HIV-testing behaviour in men who have sex with men (MSM), and factors associated with never and not recent testing by urbanisation-level. Methods The online ‘Men & Sexuality’ survey was conducted in 3,815 MSM (mean age 36 years; the Netherlands, 2018). HIV-testing was defined as recent ( 2,500 living addresses/km2] and non-high-urban [≤2,500 living addresses/km2]]). Results In high-urban areas, 68.4% of MSM, and in non-high-urban areas, 54.9%, recently tested; 11.8% in high-urban and 25.2% in non-high-urban areas, never tested (aOR: 1.89; 1.55–2.31, p In high-urban areas: factors associated with never and not recent testing were younger age, fewer new sex partners, never notified for HIV, no condomless anal intercourse, and self-identification as bisexual (versus gay). In non-high-urban areas: additionally associated were moderate/low perceived HIV severity, moderate/low HIV risk perception, and moderate/low share of MSM among friends (versus ‘high’). In non-high-urban areas 27% reported a high share of MSM among friends (high-urban: 38%). In non-high-urban areas, never tested MSM would prefer self-sampling/self-testing (high-urban: facility-based testing). Conclusion The proportion of MSM who never tested was high (25%) in non-high-urban areas in The Netherlands; twofold compared to high-urban areas. In non-high urban areas, MSM who have a more restricted MSM-defined social context, may be less likely to test, and may benefit from targeted outreach and test-barrier-reducing strategies, e.g. by self-testing/self-sampling testing. A regional approach, accounting for urbanization-related factors, to eliminate HIV is warranted. |
