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Original research
Enhancing help-seeking behaviour among men who have sex with men at risk for sexually transmitted infections: the randomised controlled trial
  1. Roeland Christiaan Alfons Achterbergh1,
  2. Martijn S van Rooijen1,
  3. Wim van den Brink2,
  4. Anders Boyd3,4,
  5. Henry John Christiaan de Vries1,5
  1. 1 STI Outpatient Clinic, Infectious Diseases Department, Public Health Sevice of Amsterdam, Amsterdam, North Holland, The Netherlands
  2. 2 Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, North Holland, The Netherlands
  3. 3 Department of Infectious Diseases Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Noord-Holland, The Netherlands
  4. 4 Stichting HIV Monitoring, Amsterdam, Noord-Holland, The Netherlands
  5. 5 Department of Dermatology, Amsterdam Institute for Infection and Immunity (AI&II), location Academic Medical Centre, Amsterdam UMC, University of Amsterdam, Amsterdam, North Holland, The Netherlands
  1. Correspondence to Professor Henry John Christiaan de Vries, Department of Dermatology, Amsterdam UMC Locatie AMC, Amsterdam 1105 AZ, The Netherlands; h.j.devries{at}


Objectives Men who have sex with men (MSM) are at increased risk for STIs and mental disorders. Syndemic theory holds that psychosocial issues co-occur and interact, and thus increase sexual risk behaviour. Psychosocial issue identification, referral and management might reduce risk behaviour.

Methods In the syndemic-based intervention study, an open-label randomised controlled trial, MSM were enrolled at the STI outpatient clinic of the Public Health Service of Amsterdam. We screened participants using validated questionnaires on the following problem domains: alcohol and substance use, sexual compulsivity, anxiety, depression, attention deficit hyperactivity disorder, alexithymia, intimate partner violence and childhood sexual abuse. Individuals were randomly assigned (1:1) to receive either tailored, face-to-face feedback and help-seeking advice on mental health screening, or no feedback and no help-seeking advice. Participants were followed trimonthly for a year. The primary outcomes were self-reported and confirmed help-seeking behaviour.

Results We included 155 MSM: 76 in the intervention group and 79 in the control group. At inclusion, 128 participants (83.1%) scored positive in at least one problem domain. We found no significant differences in self-reported or confirmed help-seeking behaviour between the intervention and the control group: 41% vs 29% (p=0.14) and 28% vs 22% (p=0.44), respectively. There were also no differences in STI incidence and condomless anal sex acts between the two groups.

Conclusion Screening showed high prevalence of problems related to mental health and substance use, while tailored feedback, advice and referral did not significantly increase help-seeking behaviour. Other interventions are needed to tackle the high burden of mental disorders among MSM.

Trial registration number NCT02859935.

  • homosexuality
  • sexual health
  • substance misuse

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Handling editor Jamie Scott Frankis

  • Contributors RCAA, WvdB and HJCdV conceived the study. RCAA did data collection. RCAA, MSvR and AB did data analysis. RCAA drafted the manuscript. MSvR, WvdB, AB and HJCdV revised the manuscript and all authors approved the final version.

  • Funding The study received funding from The Public Health Service of Amsterdam, Department of Infectious Diseases project 2372394.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study design and protocol of this syndemic-based intervention ( have been approved by the Academic Medical Centre, Amsterdam (2016_039#C20182065, NL56157.018.16).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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