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Opting out increases HIV testing in a large sexually transmitted infections outpatient clinic
  1. R L J Heijman1,2,
  2. I G Stolte2,3,
  3. H F J Thiesbrummel1,
  4. E van Leent1,4,
  5. R A Coutinho3,5,
  6. J S A Fennema6,
  7. M Prins2,3
  1. 1
    Cluster of Infectious Diseases, STD Outpatient Clinic, Health Service of Amsterdam, Amsterdam, The Netherlands
  2. 2
    Cluster of Infectious Diseases, HIV and STD Research, Health Service of Amsterdam, Amsterdam, The Netherlands
  3. 3
    Department of Internal Medicine, CINIMA, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  4. 4
    Department of Dermatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  5. 5
    National Institute for Public Health and Environment, Center for Infectious Disease Control, Bilthoven, The Netherlands
  6. 6
    Cluster of Infectious Diseases, Health Service of Amsterdam, Amsterdam, The Netherlands
  1. Dr R L J Heijman, PO Box 2200, 1000 CE Amsterdam, The Netherlands; theijman{at}


Objectives: In January 2007, opt-out HIV testing replaced provider-initiated testing at the sexually transmitted infections (STI) outpatient clinic in Amsterdam, The Netherlands. The effect of the opt-out strategy on the uptake of HIV testing was studied and factors associated with refusal of HIV testing were identified.

Study Design: Data routinely collected at the STI clinic were analysed separately for men who have sex with men (MSM) and heterosexuals. Logistic regression analysis was used to identify factors associated with opting out.

Results: In 2007, 12% of MSM and 4% of heterosexuals with (presumed) negative or unknown HIV serostatus declined HIV testing. Refusals gradually decreased to 7% and 2% by the year end. In 2006, before the introduction of opt-out, 38% of MSM and 27% of heterosexuals declined testing. The proportion of HIV-positive results remained stable among MSM, 3.4% in 2007 versus 3.7% in 2006, and among heterosexuals, 0.2% in 2007 versus 0.3% in 2006. In both groups factors associated with opting out were: age ⩾30 years, no previous HIV test, the presence of STI-related complaints and no risky anal/vaginal intercourse. Among heterosexuals, men and non-Dutch visitors refused more often; among MSM, those warned of STI exposure by sexual partners and those diagnosed with gonorrhoea or syphilis refused more often.

Conclusions: An opt-out strategy increased the uptake of HIV testing. A sharp increase in testing preceeded a more gradual increase, suggesting time must pass to optimise the new strategy. A small group of visitors, especially MSM, still opt out. Counselling will focus on barriers such as fear and low risk perception among high-risk visitors considering opting out.

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  • Competing interests: None.

  • Contributors: RLJH analysed and interpreted the data and drafted the manuscript; JSAF and RAC contributed to the idea and the manuscript; EvL and HFJT contributed to the acquisition of data; IGS and MP supervised the study, the interpretation of data and contributed to the final manuscript.

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