Increases in new HIV infections among men who have sex with men (MSM) are now reported from nearly every industrialised country context,1 and the news from resource-poor settings is worse still—extremely high background prevalence, increases in new infections and only very limited access to care and prevention.2 3 With the weakening commitment of MSM to consistent condom use (at the population level),4 5 and with the growing popularity of different behavioural risk-reduction strategies (negotiated agreements, serosorting and strategic positioning),6 7 8 and the increasing uptake and enactment of pharmacoprophylaxis by MSM (pre and postexposure prophylaxis),9 10 it is little wonder public health and prevention practitioners are highly sensitive to changes in the HIV testing practice and patterns of MSM. From a public health perspective HIV testing rates are a factor in estimating the scale of the problem in this population group.

For MSM as individuals knowing their HIV status is something quite different. It is no longer important just because it permits them to maximise the benefits of early HIV treatment interventions (if it ever was?). Regular and repeated HIV testing are becoming increasingly understood as gateway behaviours that open a range of potentially effective HIV prevention options, which may not include condoms, but for which knowledge of HIV status is the essential starting point. Whether as public health and prevention practitioners this was our intention, whether we choose to acknowledge and support it, and whether we are willing to step up and work to support MSM who enact these practices to do so as effectively as possible is the point …