Background
Methods
Study design and procedures
Measures
Lab testing of biological samples
Secondary variables
-
Demographic variables such as age (calculated using the self-reported year of birth), education level (secondary school or lower, high school or post-secondary or university/ higher), migration status (native: born & living in the study country; emigrant: born in the study country & living abroad; immigrant: born abroad & living in the study country; visitor: born & living abroad);
-
Behavioural variables such as number of sexual partners and number of partners with whom condomless anal intercourse (AI) had been practiced in the previous 6 months, frequency of visiting gay sex venues in the last 3 months, type and number of drugs used during last AI (categorised as alcohol; cannabis; sexual performance enhancing substances: erectile dysfunction medication and inhaled amyl nitrite; party drugs: cocaine, ecstasy, amphetamines; chemsex drugs: GHB, ketamine, mephedrone, crystal meth);
-
Type of partners for last AI (steady, non-steady, more than one), self-reported HIV serostatus disclosure to the last AI partner, sexual role during last AI (top, bottom, versatile), condom use during last AI;
-
HIV and STI testing in the previous 12 months, and “outness” about sexual orientation towards relatives, friends, and co-workers.
Statistical analysis
Results
Study sample
city | HIV negative (n) | percentage tested for HIV in the last 12 months (%) | undiagnosed HIV infection (n) | percentage with undiagnosed HIV (%) | undiagnosed HIV, negative HIV pre-test within recent 12 months (n) | undiagnosed HIV infection, no pre-test or test longer ago than 12 months (n) | percentage of undiagnosed HIV that may not be recent (%) | Total (N) |
---|---|---|---|---|---|---|---|---|
Barcelona | 334 | 66.2% | 21 | 5.9% | 16 | 5 | 23.8% | 355 |
Bratislava | 376 | 35.5% | 15 | 3.8% | 6 | 9 | 60.0% | 391 |
Brighton | 331 | 56.7% | 15 | 4.3% | 10 | 5 | 33.3% | 346 |
Brussels | 327 | 63.5% | 7 | 2.1% | 5 | 2 | 28.6% | 334 |
Bucharest | 146 | 42.9% | 15 | 9.3% | 7 | 8 | 53.3% | 161 |
Hamburg | 336 | 52.1% | 15 | 4.3% | 11 | 4 | 26.7% | 351 |
Lisbon | 300 | 63.8% | 29 | 8.8% | 23 | 6 | 20.7% | 329 |
Ljubljana | 329 | 50.9% | 7 | 2.1% | 5 | 2 | 28.6% | 336 |
Sofiaa | 344 | 12 | 3.4% | 356 | ||||
Stockholm | 334 | 49.9% | 3 | 0.9% | 2 | 1 | 33.3% | 337 |
Verona | 367 | 41.9% | 10 | 2.7% | 2 | 8 | 80.0% | 377 |
Vilnius | 314 | 38.9% | 5 | 1.6% | 2 | 3 | 60.0% | 319 |
Warsaw | 346 | 57.9% | 22 | 6.0% | 17 | 5 | 22.7% | 368 |
Total | 4184 | 176 | 4.0% | 4360 | ||||
Total w/o Sofia | 3840 | 51.9% | 164 | 106 | 58 | 33.0% | 4004 |
Undiagnosed HIV infections and associations with demographics and behaviours
uHIV - study sample | uHIVunk - last HIV test not within 12 months of recruitment into the study | ||||
---|---|---|---|---|---|
Year of last reported test | HIV negative | HIV positive, undiagnosed | Year of last reported test | HIV negative | HIV positive, undiagnosed |
1987 | 1 | 0 | 1987 | 1 | 0 |
1988 | 1 | 0 | 1988 | 1 | 0 |
1989 | 2 | 0 | 1989 | 2 | 0 |
1990 | 5 | 0 | 1990 | 5 | 0 |
1991 | 1 | 0 | 1991 | 1 | 0 |
1992 | 3 | 0 | 1992 | 3 | 0 |
1993 | 2 | 0 | 1993 | 2 | 0 |
1994 | 1 | 0 | 1994 | 1 | 0 |
1995 | 4 | 1 | 1995 | 4 | 1 |
1996 | 2 | 1 | 1996 | 2 | 1 |
1997 | 5 | 1 | 1997 | 5 | 1 |
1998 | 7 | 0 | 1998 | 7 | 0 |
1999 | 6 | 0 | 1999 | 6 | 0 |
2000 | 18 | 0 | 2000 | 18 | 0 |
2001 | 10 | 0 | 2001 | 10 | 0 |
2002 | 13 | 1 | 2002 | 13 | 1 |
2003 | 15 | 0 | 2003 | 15 | 0 |
2004 | 14 | 0 | 2004 | 14 | 0 |
2005 | 39 | 2 | 2005 | 39 | 2 |
2006 | 22 | 2 | 2006 | 22 | 2 |
2007 | 39 | 0 | 2007 | 39 | 0 |
2008 | 61 | 0 | 2008 | 61 | 0 |
2009 | 80 | 4 | 2009 | 80 | 4 |
2010 | 151 | 13 | 2010 | 151 | 13 |
2011 | 267 | 8 | 2011 | 267 | 8 |
2012 | 785 | 47 | 2012 | 205 | 10 |
2013 | 1306 | 70 | 2013 | 30 | 2 |
2014 | 32 | 0 | never tested/year missing | 864 | 13 |
year missinga | 1292 | 26 | Total | 1868 | 58 |
Total | 4184 | 176 | |||
uHIVinc - last test within 12 months before recruitment into the study | |||||
2012 | 580 | 37 | |||
2013 | 1276 | 68 | |||
2014 | 32 | 0 | |||
year missing, test within the last 12 months reported | 84 | 1 | |||
Total | 1972 | 106 |
uHIVinc | uHIVunk | uHIV | N | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
Odds Ratio | p-value | [95% Conf. Interval] | Odds Ratio | p-value | [95% Conf. Interval] | Odds Ratio | p-value | [95% Conf. Interval] | ||||||
Age group | 18–24 | ref. | 923 | |||||||||||
25–34 |
3.34
|
0.00
| 1.58 | 7.07 | 1.69 | 0.25 | 0.70 | 4.07 |
2.65
|
0.00
| 1.56 | 4.50 | 1730 | |
35–44 |
3.05
|
0.01
| 1.37 | 6.80 |
2.82
|
0.02
| 1.18 | 6.73 |
2.90
|
0.00
| 1.66 | 5.06 | 970 | |
45–54 | 2.37 | 0.07 | 0.94 | 5.97 | 2.00 | 0.19 | 0.72 | 5.59 |
2.16
|
0.02
| 1.11 | 4.19 | 488 | |
55+ | 1.36 | 0.66 | 0.35 | 5.20 | 1.39 | 0.64 | 0.35 | 5.46 | 1.34 | 0.54 | 0.52 | 3.44 | 244 | |
Migration status | native | ref. | 3565 | |||||||||||
emigrant | 2.14 | 0.20 | 0.63 | 7.20 |
6.78
|
0.02
| 1.45 | 31.84 |
3.06
|
0.01
| 1.29 | 7.27 | 54 | |
immigrant | 1.03 | 0.92 | 0.58 | 1.81 | 1.32 | 0.48 | 0.61 | 2.83 | 1.17 | 0.49 | 0.75 | 1.84 | 503 | |
visitor: born & live abroad | 0.70 | 0.45 | 0.28 | 1.96 | 1.78 | 0.73 | 0.19 | 3.26 | 0.78 | 0.53 | 0.36 | 1.69 | 226 | |
Any STI test in last 12 months | no | ref. | 2249 | |||||||||||
yes | 1.15 | 0.62 | 0.67 | 1.95 |
3.01
| 0.00 | 1.56 | 5.84 |
1.94
|
0.00
| 1.42 | 2.66 | 2007 | |
STI diagnoses | no diagnosis | ref. | 3946 | |||||||||||
1 diagnosis | 0.71 | 0.36 | 0.34 | 1.48 |
6.31
|
0.00
| 2.10 | 18.05 | 1.24 | 0.43 | 0.72 | 2.14 | 310 | |
2 diagnoses | 1.03 | 0.97 | 0.31 | 3.35 | 4.96 | 0.14 | 0.60 | 41.01 | 1.40 | 0.52 | 0.50 | 3.88 | 74 | |
3 diagnoses | 1.07 | 0.95 | 0.14 | 8.10 | 1.00 | – | – | – | 1.44 | 0.73 | 0.19 | 10.88 | 18 | |
4 diagnoses | 1.00 | – | – | – | 1.00 | – | – | – | 1.00 | – | – | – | 8 | |
5 diagnoses | 6.04 | 0.12 | 0.62 | 58.66 | 1.00 | – | – | – | 8.15 | 0.07 | 0.84 | 78.82 | 4 | |
any STI diagnosis | 0.82 | 0.52 | 0.46 | 1.49 |
5.98
|
0.00
| 2.23 | 16.06 | 1.31 | 0.26 | 0.82 | 2.09 | 414 | |
Number of sex partners | no partner | ref. | 269 | |||||||||||
1 partner | 0.64 | 0.38 | 0.24 | 1.72 | 4.82 | 0.13 | 0.62 | 37.34 | 1.37 | 0.46 | 0.59 | 3.17 | 819 | |
2–3 partners | 0.78 | 0.59 | 0.31 | 1.96 | 3.73 | 0.21 | 0.47 | 29.34 | 1.34 | 0.48 | 0.59 | 3.07 | 981 | |
4–5 partners | 0.79 | 0.63 | 0.30 | 2.08 | 4.57 | 0.16 | 0.56 | 37.45 | 1.49 | 0.36 | 0.64 | 3.51 | 626 | |
6–10 partners | 0.67 | 0.43 | 0.25 | 1.80 |
8.35
|
0.04
| 1.08 | 64.42 | 1.62 | 0.26 | 0.70 | 3.73 | 701 | |
> 10 partners | 0.99 | 0.89 | 0.40 | 2.47 |
10.21
|
0.03
| 1.30 | 79.90 |
2.28
|
0.05
| 1.01 | 5.14 | 748 | |
Number of partners with condomless anal intercourse | no partner | ref. | 1499 | |||||||||||
1 partner | 0.57 | 0.06 | 0.32 | 1.02 | 1.30 | 0.54 | 0.57 | 2.96 | 0.85 | 0.49 | 0.55 | 1.33 | 1108 | |
2–3 partners | 1.13 | 0.65 | 0.67 | 1.90 |
2.11
|
0.07
| 0.95 | 4.68 | 1.36 | 0.16 | 0.89 | 2.07 | 839 | |
4–5 partners | 0.67 | 0.46 | 0.24 | 1.92 |
5.03
|
0.00
| 1.92 | 13.16 | 1.50 | 0.22 | 0.79 | 2.85 | 235 | |
6–10 partners | 1.17 | 0.75 | 0.45 | 3.05 | 2.94 | 0.10 | 0.80 | 10.67 | 1.79 | 0.09 | 0.92 | 3.50 | 182 | |
> 10 partners |
2.68
|
0.02
| 1.14 | 6.30 |
12.84
|
0.00
| 3.75 | 43.93 |
3.55
|
0.00
| 1.83 | 6.88 | 106 | |
Type of partners in last 6 months | steady partner(s) | ref. | 653 | |||||||||||
non-steady partner(s) | 1.18 | 0.65 | 0.58 | 2.38 | 1.08 | 0.86 | 0.49 | 2.35 | 1.12 | 0.66 | 0.68 | 1.85 | 1297 | |
s + ns partner(s) | 1.31 | 0.42 | 0.68 | 2.55 | 1.00 | 1.00 | 0.49 | 2.04 | 1.23 | 0.39 | 0.77 | 1.97 | 2001 | |
no partner | 1.67 | 0.35 | 0.56 | 4.97 | 0.22 | 0.15 | 0.03 | 1.71 | 0.78 | 0.60 | 0.31 | 1.95 | 216 | |
Anal sex in last 6 months | no anal sex | ref. | 857 | |||||||||||
anal intercourse (with condom) | 0.87 | 0.65 | 0.47 | 1.59 | 1.21 | 0.67 | 0.50 | 2.95 | 1.12 | 0.65 | 0.69 | 1.84 | 1005 | |
condomless anal intercourse | 0.80 | 0.43 | 0.47 | 1.38 |
1.95
|
0.05
| 0.99 | 3.85 | 1.30 | 0.21 | 0.86 | 1.98 | 2498 | |
Type of partner at last anal sex | steady partner | ref. | 1880 | |||||||||||
non-steady partner | 1.01 | 0.96 | 0.65 | 1.67 | 1.04 | 0.07 | 0.95 | 3.17 | 1.30 | 0.13 | 0.93 | 1.82 | 1760 | |
more than one partner |
2.06
|
0.04
| 1.03 | 4.11 | 2.33 | 0.13 | 0.77 | 7.04 |
2.22
|
0.01
| 1.24 | 3.97 | 207 | |
Sexual role with last AI partner | top | ref. | 1324 | |||||||||||
bottom | 1.11 | 0.71 | 0.64 | 1.94 | 1.07 | 0.93 | 0.49 | 1.94 | 0.98 | 0.93 | 0.65 | 1.48 | 1265 | |
versatile |
2.08
|
0.00
| 1.27 | 3.42 | 1.00 | 1.00 | 0.48 | 2.09 |
1.61
|
0.02
| 1.09 | 2.37 | 1035 | |
Serostatus disclosure to last AI partner | no disclosure | ref. | 2400 | |||||||||||
disclosure |
0.27
|
0.00
| 0.15 | 0.48 | 1.18 | 0.82 | 0.56 | 2.06 |
0.50
|
0.00
| 0.33 | 0.75 | 1262 | |
Number of drugs consumed at last anal sex | 0 | ref. | 1959 | |||||||||||
1 |
2.31
|
0.00
| 1.37 | 3.91 | 0.91 | 0.75 | 0.50 | 1.66 |
1.50
|
0.03
| 1.04 | 2.16 | 1394 | |
2 |
2.98
|
0.00
| 1.58 | 5.61 | 0.99 | 0.99 | 0.41 | 2.42 |
1.74
|
0.02
| 1.08 | 2.79 | 516 | |
3 |
4.30
|
0.00
| 2.03 | 9.09 | 1.00 | – | – | – |
2.31
|
0.01
| 1.19 | 4.49 | 167 | |
4 |
5.59
|
0.00
| 1.79 | 11.80 | 2.04 | 0.50 | 0.26 | 15.97 |
3.33
|
0.00
| 1.46 | 7.55 | 76 | |
5 |
4.69
|
0.02
| 1.32 | 16.70 | 1.00 | – | – | – | 2.66 | 0.11 | 0.80 | 8.87 | 40 | |
6 |
9.38
|
0.01
| 1.89 | 54.64 | 7.66 | 0.07 | 0.83 | 70.60 |
8.19
|
0.00
| 2.25 | 29.82 | 15 | |
7 | 4.17 | 0.18 | 0.51 | 34.29 | 1.00 | – | – | – | 2.98 | 0.30 | 0.38 | 23.46 | 12 | |
8 | 1.00 | – | – | – | 1.00 | – | – | – | 1.00 | – | – | – | 6 | |
9 |
18.76
|
0.02
| 1.64 | 214.37 | 1.00 | – | – | – |
10.93
|
0.04
| 1.12 | 106.62 | 4 | |
Type of drugs | no party drug | ref. | 3875 | |||||||||||
party |
2.90
|
0.00
| 1.77 | 4.77 | 0.36 | 0.32 | 0.05 | 2.66 |
2.04
|
0.00
| 1.29 | 3.22 | 307 | |
no chemsex drug | ref. | 4063 | ||||||||||||
chemsex |
2.14
|
0.04
| 1.04 | 4.39 | 1.89 | 0.54 | 0.25 | 14.45 |
2.42
|
0.01
| 1.24 | 4.71 | 111 | |
no sexual performance substance | ref. | 3326 | ||||||||||||
sexual performance substance |
2.41
|
0.00
| 1.61 | 3.61 | 1.79 | 0.07 | 0.95 | 3.37 |
2.15
|
0.00
| 1.55 | 2.98 | 853 | |
no cannabis | ref. | 3869 | ||||||||||||
cannabis |
2.20
|
0.01
| 1.27 | 3.79 | 0.89 | 0.85 | 0.27 | 2.91 |
1.75
|
0.02
| 1.08 | 2.83 | 304 | |
no alcohol | ref. | 2.324 | ||||||||||||
alcohol |
1.90
|
0.00
| 1.26 | 2.84 | 0.70 | 0.23 | 0.40 | 1.25 | 1.33 | 0.07 | 0.98 | 1.80 | 1859 | |
Satisfaction with sex life | unsatisfied | ref. | 950 | |||||||||||
satisfied | 1.70 | 0.08 | 0.94 | 3.08 | 1.16 | 0.67 | 0.59 | 2.27 | 1.48 | 0.06 | 0.98 | 2.22 | 3.124 |
Odds Ratio | p-value | [95% Conf. Interval] | |||
---|---|---|---|---|---|
uHIVinc (n = 1713) | |||||
Age group | 18–24 | ref. | |||
25–34 |
2.27
|
0.04
| 1.03 | 4.99 | |
35–44 | 1.62 | 0.29 | 0.67 | 3.90 | |
45–54 | 1.37 | 0.56 | 0.48 | 3.96 | |
55+ | 1.08 | 0.91 | 0.26 | 4.46 | |
Sexual role with last AI partner | top | ref. | |||
bottom | 1.12 | 0.73 | 0.60 | 2.07 | |
versatile |
2.05
|
0.01
| 1.18 | 3.55 | |
Type of drugs during last anal sex | no use of ecstasy, cocaine, amphetamine | ref. | |||
ecstasy, cocaine, amphetamine |
2.22
|
0.02
| 1.17 | 4.21 | |
no use of sexual performance substances (poppers, erectile dysfunction medication) | ref. | ||||
sexual performance substances (poppers, erectile dysfunction medication) |
1.96
|
0.01
| 1.17 | 3.28 | |
Serostatus disclosure to last AI partner | disclosure | ref. | |||
no disclosure |
3.94
|
0.00
| 2.14 | 7.27 | |
_cons |
0.01
|
0.00
|
0.00
|
0.01
| |
city |
0.40
|
–
|
0.11
|
1.45
| |
uHIVunk (n = 1639) | |||||
Age group | 18–24 | ref. | |||
25–34 | 2.00 | 0.16 | 0.76 | 5.27 | |
35–44 |
3.73
|
0.01
| 1.41 | 9.84 | |
45–54 |
3.31
|
0.04
| 1.08 | 10.12 | |
55+ | 0.90 | 0.93 | 0.10 | 7.84 | |
Number of partners with condomless anal intercourse | no partner | ref. | |||
1 partner | 1.46 | 0.38 | 0.63 | 3.36 | |
2–3 partners |
2.66
|
0.02
| 1.17 | 6.04 | |
4–5 partners |
6.08
|
0.00
| 2.26 | 16.40 | |
6–10 partners | 2.01 | 0.38 | 0.43 | 9.44 | |
> 10 partners |
12.83
|
0.00
| 3.60 | 45.65 | |
STI testing in last 12 months | no testing | ref. | |||
any STI testing |
3.61
|
0.00
| 1.74 | 7.50 | |
_cons |
0.02
|
0.00
|
0.01
|
0.07
| |
city |
0.00
|
–
|
–
|
–
| |
uHIV (n = 3745) | |||||
Age group | 18–24 | ref. | |||
25–34 |
2.36
|
0.00
| 1.33 | 4.19 | |
35–44 |
2.22
|
0.01
| 1.19 | 4.13 | |
45–54 | 1.90 | 0.09 | 0.91 | 3.94 | |
55+ | 0.85 | 0.78 | 0.27 | 2.66 | |
HIV test in last 12 months and knowing the result | not tested | ref. | |||
tested and knowing the result |
1.51
|
0.03
| 1.04 | 2.19 | |
Number of partners with condomless anal intercourse | no partner | ref. | |||
1 partner | 0.85 | 0.50 | 0.54 | 1.35 | |
2–3 partners | 1.28 | 0.30 | 0.81 | 2.03 | |
4–5 partners | 1.35 | 0.39 | 0.68 | 2.69 | |
6–10 partners | 1.56 | 0.25 | 0.74 | 3.29 | |
> 10 partners |
2.80
|
0.01
| 1.34 | 5.85 | |
Type of drugs during last anal sex | no use of sexual performance substances (poppers, erectile dysfunction medication) | ref. | |||
sexual performance substances (poppers, erectile dysfunction medication) |
1.91
|
0.00
| 1.32 | 2.76 | |
_cons |
0.01
|
0.00
|
0.01
|
0.02
| |
city |
0.32
|
–
|
0.10
|
1.01
|
Discussion
Limitations
Conclusions
Acknowledgements
Availability of data and materials
Funding
Ethics approval and consent to participate
Country | City | Date of approval | Number of the doc | Name of the Ethics Committee |
---|---|---|---|---|
Belgium | Brussels | 18/3/2013 | ITG 860/13 | Ethics Committee – University of Antwerp |
Bulgaria | Sofia | 26/3/2013 | – | Ethics Committee – National Centre of Infectious and Parasitic Diseases Sofia |
Germany | Hamburg | 28/2/2013 | EA1/024/ 13 | Ethics Committee – Charité University |
Italy | Verona | 22/05/2013 | Prot.N.25334; N.Prog. 2341 | Ethics Committee - Verona University Hospital |
Lithuania | Vilnius | 14/05/2013 | N. 158,200–13–608-188 | Regional Ethics Committee Biomedical Research – Vilnius |
Poland | Warsaw | 18/4/2013 | 1/2013 | Ethics Committee – Warsaw |
Portugal | Lisbon | 14/6/2013 | 12–2013-PI | Ethics Committee - Instituto de Higiene e Medicina Tropical |
Romania | Bucharest | 18/04/2013 | C. 1937 | Ethics Committee Institute M. Bals – Bucharest |
Slovakia | Bratislava | 16/05/2013 | – | Ethics Committee of the Slovak Medical University |
Slovenia | Ljubljana | 16/4/2013 | 87/04/13 | Ethics Committee Republic of Slovenia |
Spain | Barcelona | 17/4/2013 | PI 13014 | Ethics Committee – Germans Trias i Pujol Hospital |
Sweden | Stockholm | 14/5/2013 | 2013/3:5–2013–05-02 | Ethics Committee – Folkhalsomyndigheten |
UK | Brighton | 26/01/2013 | FREGC-13-001.R1 | Faculty of Health and Social Science Research Ethics and Governance Committee |