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Interventions that reduce the proportion of undiagnosed HIV are likely to be beneficial both to the individuals, who can receive improved management and better outcomes, and to the population, as onward transmission may be reduced. The introduction of opt-out HIV testing into a large sexually transmitted disease clinic in Amsterdam led to a steep increase in uptake (fig 1). Interestingly, those more likely to opt out included some likely to be at highest risk, such as men who have sex with men (MSM) and people with symptoms of a sexually transmitted infection. MSM who attended through partner notification, and those with a diagnosis of gonorrhoea or syphilis, were more likely to opt out, indicating persistent reluctance to test in a minority of people with ongoing risk behaviour.

Figure 1

Number of new consultations and proportion of HIV testing among men who have sex …

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