{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T14:04:29Z","timestamp":1792850669852,"version":"4.5.0"},"reference-count":33,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T00:00:00Z","timestamp":1585267200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T00:00:00Z","timestamp":1585267200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Acci\u00f3n estrat\u00e9gica intramural","award":["PI17CIII\/00037"],"award-info":[{"award-number":["PI17CIII\/00037"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"published-print":{"date-parts":[[2020,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>We analyse unprotected anal intercourses (UAI) self-reported by a sample of men who have sex with men (MSM), by their future testing intentions and past testing history to identify undertested subpopulations that could be contributing to onward transmission.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We recruited MSM through gay dating websites in Spain from September 2012 to April 2013. For MSM at risk of acquiring or unknowingly transmitting HIV (at risk hereafter) we calculate time at risk, number of UAI in the last 12\u2009months and last 5\u2009years by testing intention (low intention (LI), Medium intention (MI), high intention (HI)) and past testing history. For never testers we analyse the reasons for not having been tested.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>Of 3272 MSM at risk, 19.8% reported LI of testing. MSM with LI reported the longest period at risk (8.49\u2009years (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001)) and reported 3.20 UAI\/person in the last 12\u2009months (vs. 3.23 and 2.56 in MSM with HI and MI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001)) and 12.90 UAI\/person in the last 5\u2009years (vs. 8.07 and 9.82 in MSM with HI and MI (<jats:italic>p<\/jats:italic>\u2009&lt;\u20090.001)). Those with LI accounted for 21 and 27% of all the UA acts occurring in the last 12\u2009months and the last 5\u2009years. Among never testers (40.6%), those with LI reported lower risk perception (<jats:italic>p<\/jats:italic>\u2009=\u20090.006).<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>We identified a group of high risk and undertested MSM that could be behind a substantial proportion of the UAIs with potential of transmission\/acquisition of HIV. Given their low willingness to seek an HIV test and low risk perception, they constitute a population that will probably require approaches other than client initiated strategies.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12889-020-8440-3","type":"journal-article","created":{"date-parts":[[2020,3,27]],"date-time":"2020-03-27T04:25:03Z","timestamp":1585283103000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["High risk men who have sex with men in Spain are reporting low intentions of actively seeking HIV testing: results from a cross-sectional study"],"prefix":"10.1186","volume":"20","author":[{"given":"Juan","family":"Hoyos","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kostas","family":"Koutentakis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tom\u00e1s","family":"Mat\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jose","family":"Pulido","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis","family":"Sordo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan-Miguel","family":"Guerras","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda-Jos\u00e9","family":"Belza","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2020,3,27]]},"reference":[{"key":"8440_CR1","volume-title":"Vigilancia Epidemiol\u00f3gica del VIH\/SIDA en Espa\u00f1a. Sistema de informaci\u00f3n sobre Nuevos Diagn\u00f3sticos de VIH y Registro Nacional de SIDA. Actualizaci\u00f3n 30 junio de","author":"Centro Nacional de Epidemiolog\u00eda","year":"2016","unstructured":"Centro Nacional de Epidemiolog\u00eda: Vigilancia Epidemiol\u00f3gica del VIH\/SIDA en Espa\u00f1a. Sistema de informaci\u00f3n sobre Nuevos Diagn\u00f3sticos de VIH y Registro Nacional de SIDA. Actualizaci\u00f3n 30 junio de 2016. http:\/\/www msssi gob es\/ciudadanos\/enfLesiones\/enfTransmisibles\/sida\/vigilancia\/InformeVIHSida_Junio2014 pdf. 2016. Accesed: 20 Dec 2018."},{"issue":"12","key":"8440_CR2","doi-asserted-by":"publisher","first-page":"1797","DOI":"10.1097\/QAD.0000000000000270","volume":"28","author":"V Supervie","year":"2014","unstructured":"Supervie V, Ndawinz JD, Lodi S, Costagliola D. The undiagnosed HIV epidemic in France and its implications for HIV screening strategies. AIDS. 2014;28(12):1797\u2013804.","journal-title":"AIDS"},{"key":"8440_CR3","unstructured":"Kirwan PD, Chau C, Brown AE, Gill ON. V.C. D: HIV in the UK - 2016 report. London; 2016. https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/602942\/HIV_in_the_UK_report.pdf Accesed: 20 Dec 2018."},{"issue":"18","key":"8440_CR4","doi-asserted-by":"publisher","first-page":"1815","DOI":"10.1056\/NEJMoa0807252","volume":"360","author":"MM Kitahata","year":"2009","unstructured":"Kitahata MM, Gange SJ, Abraham AG, Merriman B, Saag MS, Justice AC, Hogg RS, Deeks SG, Eron JJ, Brooks JT, et al. Effect of early versus deferred antiretroviral therapy for HIV on survival. N Engl J Med. 2009;360(18):1815\u201326.","journal-title":"N Engl J Med"},{"issue":"6","key":"8440_CR5","doi-asserted-by":"publisher","first-page":"973","DOI":"10.1097\/QAD.0b013e32835cae9c","volume":"27","author":"AJ Rodger","year":"2013","unstructured":"Rodger AJ, Lodwick R, Schechter M, Deeks S, Amin J, Gilson R, Paredes R, Bakowska E, Engsig FN, Phillips A. Mortality in well controlled HIV in the continuous antiretroviral therapy arms of the SMART and ESPRIT trials compared with the general population. AIDS. 2013;27(6):973\u20139.","journal-title":"AIDS"},{"issue":"6","key":"8440_CR6","doi-asserted-by":"publisher","first-page":"493","DOI":"10.1056\/NEJMoa1105243","volume":"365","author":"MS Cohen","year":"2011","unstructured":"Cohen MS, Chen YQ, McCauley M, Gamble T, Hosseinipour MC, Kumarasamy N, Hakim JG, Kumwenda J, Grinsztejn B, Pilotto JH, et al. Prevention of HIV-1 infection with early antiretroviral therapy. N Engl J Med. 2011;365(6):493\u2013505.","journal-title":"N Engl J Med"},{"issue":"4","key":"8440_CR7","doi-asserted-by":"publisher","first-page":"446","DOI":"10.1097\/01.qai.0000151079.33935.79","volume":"39","author":"G Marks","year":"2005","unstructured":"Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446\u201353.","journal-title":"J Acquir Immune Defic Syndr"},{"key":"8440_CR8","unstructured":"WHO. Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Geneva; 2014. https:\/\/www.who.int\/hiv\/pub\/guidelines\/keypopulations\/en\/ Accesed: 22 Jul 2019."},{"key":"8440_CR9","unstructured":"ECDC. HIV and STI prevention among men who have sex with men. Stockholm; 2015. https:\/\/ecdc.europa.eu\/sites\/portal\/files\/media\/en\/publications\/Publications\/hiv-sti-prevention-among-men-who-have-sex-with-men-guidance.pdf .Accesed: 20 Dec 2018."},{"issue":"4","key":"8440_CR10","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1177\/1403494813483216","volume":"41","author":"RC Berg","year":"2013","unstructured":"Berg RC. Predictors of never testing for HIV among a national online sample of men who have sex with men in Norway. Scand J Public Health. 2013;41(4):398\u2013404.","journal-title":"Scand J Public Health"},{"issue":"Suppl 3","key":"8440_CR11","doi-asserted-by":"publisher","first-page":"15","DOI":"10.1111\/hiv.12058","volume":"14","author":"C Carvalho","year":"2013","unstructured":"Carvalho C, Fuertes R, Lucas R, Martins A, Campos MJ, Mendao L, Schmidt AJ, Barros H. HIV testing among Portuguese men who have sex with men--results from the European MSM internet survey (EMIS). HIV Med. 2013;14(Suppl 3):15\u20138.","journal-title":"HIV Med"},{"issue":"1","key":"8440_CR12","doi-asserted-by":"publisher","first-page":"e009480","DOI":"10.1136\/bmjopen-2015-009480","volume":"6","author":"DM den DC","year":"2016","unstructured":"den DC DM, Schmidt AJ, de CE O. Determinants of never having tested for HIV among MSM in the Netherlands. BMJ Open. 2016;6(1):e009480.","journal-title":"BMJ Open"},{"issue":"Suppl 3","key":"8440_CR13","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1111\/hiv.12060","volume":"14","author":"P Fernandez-Davila","year":"2013","unstructured":"Fernandez-Davila P, Folch C, Ferrer L, Soriano R, Diez M, Casabona J. Who are the men who have sex with men in Spain that have never been tested for HIV? HIV Med. 2013;14(Suppl 3):44\u20138.","journal-title":"HIV Med"},{"issue":"7","key":"8440_CR14","doi-asserted-by":"publisher","first-page":"496","DOI":"10.1177\/0956462413515193","volume":"25","author":"G Prati","year":"2013","unstructured":"Prati G, Breveglieri M, Lelleri R, Furegato M, Gios L, Pietrantoni L. Psychosocial correlates of HIV testing among men who have sex with men in Italy: a cross-sectional study. Int J STD AIDS. 2013;25(7):496\u2013503.","journal-title":"Int J STD AIDS"},{"issue":"9","key":"8440_CR15","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011372","volume":"6","author":"TC Witzel","year":"2016","unstructured":"Witzel TC, Melendez-Torres GJ, Hickson F, Weatherburn P. HIV testing history and preferences for future tests among gay men, bisexual men and other MSM in England: results from a cross-sectional study. BMJ Open. 2016;6(9):e011372.","journal-title":"BMJ Open"},{"key":"8440_CR16","first-page":"11","volume-title":"Action-control: From cognition to behavior","author":"I Azjen","year":"1975","unstructured":"Azjen I. From intentions to actoin: A theory of planned behavior. In: Action-control: From cognition to behavior. Heidelberg: Springer; 1975. p. 11\u201339."},{"key":"8440_CR17","doi-asserted-by":"publisher","first-page":"196","DOI":"10.1186\/1472-6963-11-196","volume":"11","author":"AH Mirkuzie","year":"2011","unstructured":"Mirkuzie AH, Sisay MM, Moland KM, Astrom AN. Applying the theory of planned behaviour to explain HIV testing in antenatal settings in Addis Ababa - a cohort study. BMC Health Serv Res. 2011;11:196.","journal-title":"BMC Health Serv Res"},{"key":"8440_CR18","unstructured":"WHO\/UNAIDS. Guidance on provider-initiated HIV testing and counselling in health facilities. Geneva; 2007. https:\/\/motherchildnutrition.org\/nutrition-hiv-aids\/pdf\/mcn-guidance-on-provider-initiated-hiv-testing.pdf. Accesed: 20 Dec 2018."},{"issue":"1","key":"8440_CR19","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1080\/09540121.2017.1344351","volume":"30","author":"M Evangeli","year":"2018","unstructured":"Evangeli M, Ferris K, Kenney NM, Baker LLE, Jones B, Wroe AL. A systematic review of psychological correlates of HIV testing intention. AIDS Care. 2018;30(1):18\u201326.","journal-title":"AIDS Care"},{"issue":"1","key":"8440_CR20","doi-asserted-by":"publisher","first-page":"45","DOI":"10.1080\/1369105031000152706","volume":"6","author":"C Knussen","year":"2004","unstructured":"Knussen C, Flowers P, Church S. The intentions of gay men in taking an HIV test. Cult Health Sex. 2004;6(1):45\u201359.","journal-title":"Cult Health Sex"},{"issue":"5","key":"8440_CR21","doi-asserted-by":"publisher","first-page":"419","DOI":"10.1097\/OLQ.0b013e31820369dd","volume":"38","author":"DA MacKellar","year":"2010","unstructured":"MacKellar DA, Hou SI, Whalen CC, Samuelsen K, Sanchez T, Smith A, Denson D, Lansky A, Sullivan P. Reasons for not HIV testing, testing intentions, and potential use of an over-the-counter rapid HIV test in an internet sample of men who have sex with men who have never tested for HIV. Sex Transm Dis. 2010;38(5):419\u201328.","journal-title":"Sex Transm Dis"},{"issue":"1","key":"8440_CR22","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1080\/09540120600908440","volume":"19","author":"FM Burns","year":"2007","unstructured":"Burns FM, Imrie JY, Nazroo J, Johnson AM, Fenton KA. Why the(y) wait? Key informant understandings of factors contributing to late presentation and poor utilization of HIV health and social care services by African migrants in Britain. AIDS Care. 2007;19(1):102\u20138.","journal-title":"AIDS Care"},{"issue":"4","key":"8440_CR23","doi-asserted-by":"publisher","first-page":"431","DOI":"10.1007\/s10461-006-9068-8","volume":"10","author":"J Mikolajczak","year":"2006","unstructured":"Mikolajczak J, Hospers HJ, Kok G. Reasons for not taking an HIV-test among untested men who have sex with men: an internet study. AIDS Behav. 2006;10(4):431\u20135.","journal-title":"AIDS Behav"},{"key":"8440_CR24","doi-asserted-by":"crossref","unstructured":"Diaz A, del RJ RC, Alastrue I, Belda J, Bru FJ, Camara MM, Junquera ML, Sanz I, Viloria LJ, et al. Effects of region of birth, educational level and age on late presentation among men who have sex with men newly diagnosed with HIV in a network of STI\/HIV counselling and testing clinics in Spain. Euro Surveill. 2015;20(14).","DOI":"10.2807\/1560-7917.ES2015.20.14.21088"},{"issue":"2","key":"8440_CR25","doi-asserted-by":"publisher","first-page":"525","DOI":"10.1007\/s10461-016-1597-1","volume":"21","author":"S Fernandez-Balbuena","year":"2017","unstructured":"Fernandez-Balbuena S, Hoyos J, Belza MJ, Pujol F, Alvarez J, Zulaica D, Zamora C, Rifa B, Garcia-de-Olalla P, Esteso R, et al. HIV rapid testing programs in non-clinical settings have the potential to constitute a major diagnostic option for MSM in Spain. AIDS Behav. 2017;21(2):525\u201333.","journal-title":"AIDS Behav"},{"key":"8440_CR26","volume-title":"HIV testing: increasing uptake among people who may have undiagnosed HIV","author":"National Institute for Health and Care Excellence","year":"2016","unstructured":"National Institute for Health and Care Excellence. HIV testing: increasing uptake among people who may have undiagnosed HIV. London: NICE; 2016."},{"issue":"11","key":"8440_CR27","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0140845","volume":"10","author":"D Raben","year":"2015","unstructured":"Raben D, Mocroft A, Rayment M, Mitsura VM, Hadziosmanovic V, Sthoeger ZM, Palfreeman A, Morris S, Kutsyna G, Vassilenko A, et al. Auditing HIV testing rates across Europe: results from the HIDES 2 study. PLoS One. 2015;10(11):e0140845.","journal-title":"PLoS One"},{"issue":"1","key":"8440_CR28","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0052845","volume":"8","author":"AK Sullivan","year":"2013","unstructured":"Sullivan AK, Raben D, Reekie J, Rayment M, Mocroft A, Esser S, Leon A, Begovac J, Brinkman K, Zangerle R, et al. Feasibility and effectiveness of indicator condition-guided testing for HIV: results from HIDES I (HIV indicator diseases across Europe study). PLoS One. 2013;8(1):e52845.","journal-title":"PLoS One"},{"issue":"9","key":"8440_CR29","doi-asserted-by":"publisher","first-page":"e431","DOI":"10.1016\/S2352-3018(16)30037-6","volume":"3","author":"A Aghaizu","year":"2016","unstructured":"Aghaizu A, Wayal S, Nardone A, Parsons V, Copas A, Mercey D, Hart G, Gilson R, Johnson AM. Sexual behaviours, HIV testing, and the proportion of men at risk of transmitting and acquiring HIV in London, UK, 2000-13: a serial cross-sectional study. Lancet HIV. 2016;3(9):e431\u201340.","journal-title":"Lancet HIV"},{"issue":"4","key":"8440_CR30","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1097\/COH.0b013e32833a88a3","volume":"5","author":"O Dosekun","year":"2010","unstructured":"Dosekun O, Fox J. An overview of the relative risks of different sexual behaviours on HIV transmission. Curr Opin HIV AIDS. 2010;5(4):291\u20137.","journal-title":"Curr Opin HIV AIDS"},{"issue":"2","key":"8440_CR31","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1097\/QAI.0000000000000947","volume":"72","author":"CM Khosropour","year":"2016","unstructured":"Khosropour CM, Dombrowski JC, Swanson F, Kerani RP, Katz DA, Barbee LA, Hughes JP, Manhart LE, Golden MR. Trends in Serosorting and the association with HIV\/STI risk over time among men who have sex with men. J Acquir Immune Defic Syndr. 2016;72(2):189\u201397.","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"3","key":"8440_CR32","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1097\/QAI.0000000000000051","volume":"65","author":"W van den Boom","year":"2014","unstructured":"van den Boom W, Konings R, Davidovich U, Sandfort T, Prins M, Stolte IG. Is serosorting effective in reducing the risk of HIV infection among men who have sex with men with casual sex partners? J Acquir Immune Defic Syndr. 2014;65(3):375\u20139.","journal-title":"J Acquir Immune Defic Syndr"},{"issue":"6","key":"8440_CR33","doi-asserted-by":"publisher","first-page":"455","DOI":"10.1136\/sextrans-2015-052389","volume":"92","author":"P Prah","year":"2016","unstructured":"Prah P, Hickson F, Bonell C, McDaid LM, Johnson AM, Wayal S, Clifton S, Sonnenberg P, Nardone A, Erens B, et al. Men who have sex with men in Great Britain: comparing methods and estimates from probability and convenience sample surveys. Sex Transm Infect. 2016;92(6):455\u201363.","journal-title":"Sex Transm Infect"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-8440-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s12889-020-8440-3\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-020-8440-3.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,3,27]],"date-time":"2021-03-27T00:06:02Z","timestamp":1616803562000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcpublichealth.biomedcentral.com\/articles\/10.1186\/s12889-020-8440-3"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,3,27]]},"references-count":33,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,12]]}},"alternative-id":["8440"],"URL":"https:\/\/doi.org\/10.1186\/s12889-020-8440-3","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,3,27]]},"assertion":[{"value":"28 November 2018","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 March 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"27 March 2020","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The study was approved by the Carlos III health institute ethical committee (CEI PI 70_2015). Candidates were asked to click on an \u201cI agree to participate button\u201d before having access to the questionnaire.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"398"}}