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Abstract

BACKGROUND

With widespread HIV pre-exposure prophylaxis (PrEP) implementation, the population with increased chance of HIV acquisition may have shifted.

AIM

This study aimed to explore the characteristics of people diagnosed with HIV in Amsterdam, the Netherlands before and during the national PrEP programme (NPP).

METHODS

Using data from the Public Health Service of Amsterdam, we included 647 individuals diagnosed with HIV between 1 January 2015 and 30 June 2024. Sociodemographic, sexual and PrEP-related characteristics collected at diagnosis were analysed cross-sectionally. We used multivariable logistic regression to assess determinants of being diagnosed with HIV during (1 August 2019–30 June 2024) vs before the NPP (1 January 2015–31 July 2019).

RESULTS

The number of newly diagnosed HIV infections decreased from 425 before the NPP(range: 92–103 diagnoses/year) to 222 during the NPP(range: 34–52 diagnoses per year). In multivariable analysis, transgender and gender-diverse persons (aOR = 12.74; 95% CI: 2.84–57.11) and individuals who engaged in sex work (aOR = 4.88; 95% CI: 2.67–8.91) or condomless sex (aOR = 1.95; 95% CI: 1.15–3.30) in the 6 months before diagnosis were more likely to be diagnosed during than before the NPP. Of 270 individuals with available data, 42 (15.6%) had used PrEP before their diagnosis.

CONCLUSIONS

In the period after NPP implementation, the proportion of individuals diagnosed with HIV who were transgender or gender-diverse, engaged in sex work, or had condomless sex increased. Accessibility of PrEP services needs to be improved and timely PrEP uptake facilitated among specific subpopulations.

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/content/10.2807/1560-7917.ES.2026.31.23.2500769
2026-06-11
2026-07-18
/content/10.2807/1560-7917.ES.2026.31.23.2500769
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References

  1. Celum C, Baeten J. PrEP for HIV prevention: evidence, global scale-up, and emerging options. Cell Host Microbe. 2020;27(4):502-6.  https://doi.org/10.1016/j.chom.2020.03.020  PMID: 32272075 
  2. Tassi MF, Laurent E, Gras G, Lot F, Barin F, de Gage SB, et al. PrEP monitoring and HIV incidence after PrEP initiation in France: 2016-18 nationwide cohort study. J Antimicrob Chemother. 2021;76(11):3002-8.  https://doi.org/10.1093/jac/dkab263  PMID: 34293116 
  3. Schmidt D, Kollan C, Bartmeyer B, Bremer V, Schikowski T, Friebe M, et al. . Low incidence of HIV infection and decreasing incidence of sexually transmitted infections among PrEP users in 2020 in Germany. Infection. 2023;51(3):665-78.  https://doi.org/10.1007/s15010-022-01919-3  PMID: 36168098 
  4. HIV Transmission Elimination AMsterdam (H-TEAM) Initiative. A 95% decline in estimated newly acquired HIV infections, Amsterdam, 2010 to 2022. Euro Surveill. 2023;28(40):2300515. PMID: 37796442 
  5. Cambiano V, Miners A, Lampe FC, McCormack S, Gill ON, Hart G, et al. The effect of combination prevention strategies on HIV incidence among gay and bisexual men who have sex with men in the UK: a model-based analysis. Lancet HIV. 2023;10(11):e713-22.  https://doi.org/10.1016/S2352-3018(23)00204-7  PMID: 37923485 
  6. Pandey A, Galvani AP. The global burden of HIV and prospects for control. Lancet HIV. 2019;6(12):e809-11.  https://doi.org/10.1016/S2352-3018(19)30230-9  PMID: 31439533 
  7. van Sighem A, Wit FWNM, Smit C, Jongen VW, Shalev N, Blomaard C. HIV monitoring report 2025. Human immunodeficiency virus (HIV) infection in the Netherlands. Amsterdam: Stichting hiv monitoring; 2025. Available from: https://www.hiv-monitoring.nl/en/resources/monitoring-report-2025
  8. Hoornenborg E, Achterbergh RC, van der Loeff MFS, Davidovich U, van der Helm JJ, Hogewoning A, et al. Men who have sex with men more often chose daily than event-driven use of pre-exposure prophylaxis: baseline analysis of a demonstration study in Amsterdam. J Int AIDS Soc. 2018;21(3):e25105.  https://doi.org/10.1002/jia2.25105  PMID: 29603900 
  9. Wijstma E, Jongen VW, Boyd A, de Vries HJC, Schim van der Loeff MF, Prins M, et al. Outcomes of a policy to prioritize populations with expected healthcare barriers for subsidized preexposure prophylaxis care in Amsterdam, the Netherlands. AIDS. 2025;39(1):75-84.  https://doi.org/10.1097/QAD.0000000000004027  PMID: 39352137 
  10. van Dijk M, de Wit JBF, Kamps R, Guadamuz TE, Martinez JE, Jonas KJ. Socio-sexual experiences and access to healthcare among informal PrEP users in the Netherlands. AIDS Behav. 2021;25(4):1236-46.  https://doi.org/10.1007/s10461-020-03085-9  PMID: 33196938 
  11. Wang H, Shobowale O, den Daas C, Op de Coul E, Bakker B, Radyowijati A, et al. Determinants of PrEP uptake, intention and awareness in the Netherlands: A socio-spatial analysis. Int J Environ Res Public Health. 2022;19(14):8829-42.  https://doi.org/10.3390/ijerph19148829  PMID: 35886681 
  12. de la Court F, van Wees D, van Benthem B, Hoornenborg E, Prins M, Boyd A. Characterizing subgroups of sexual behaviors among men who have sex with men eligible for, but not using, PrEP in the Netherlands. PLoS One. 2023;18(4):e0284056.  https://doi.org/10.1371/journal.pone.0284056  PMID: 37023009 
  13. El-Jobouri R, Kayaert L, Visser M, Sarink D, Op de Coul ELM, Alexiou ZW, et al. Sexually transmitted infections in the Netherlands in 2024. Bilthoven: RIVM; 2025. Available from: https://www.rivm.nl/publicaties/sexually-transmitted-infections-in-netherlands-in-2024
  14. Hulstein SH, Matser A, van der Loeff MFS, Hoornenborg E, Prins M, de Vries HJC. Eligibility for HIV preexposure prophylaxis, intention to use preexposure prophylaxis, and informal use of preexposure prophylaxis among men who have sex with men in Amsterdam, the Netherlands. Sex Transm Dis. 2021;48(2):86-93.  https://doi.org/10.1097/OLQ.0000000000001291  PMID: 32932386 
  15. Ogbuagu O, Ruane PJ, Podzamczer D, Salazar LC, Henry K, Asmuth DM, et al. Long-term safety and efficacy of emtricitabine and tenofovir alafenamide vs emtricitabine and tenofovir disoproxil fumarate for HIV-1 pre-exposure prophylaxis: week 96 results from a randomised, double-blind, placebo-controlled, phase 3 trial. Lancet HIV. 2021;8(7):e397-407.  https://doi.org/10.1016/S2352-3018(21)00071-0  PMID: 34197772 
  16. Hoornenborg ERB, Wielinga GJ, Hogewoning A, Burger D, Hermanussen R, Heijnen A, et al. HIV Pre-expositie profylaxe (PrEP) richtlijn Nederland. [HIV Pre-exposure prophylaxis (PrEP) guideline, the Netherlands]. Bilthoven: RIVM; 2019. Dutch. Available from: https://nvhb.nl/wp-content/uploads/2019/04/PrEP-richtlijn-Nederland-versie-2-dd-15-april-2019.pdf
  17. Statistics Netherlands (CBS). Herkomstland. [Country of origin]. The Hague: CBS. [Accessed: 27 May 2026]. Dutch. Available from: https://www.cbs.nl/nl-nl/onze-diensten/methoden/begrippen/herkomstland
  18. Tate CC, Ledbetter JN, Youssef CP. A two-question method for assessing gender categories in the social and medical sciences. J Sex Res. 2013;50(8):767-76.  https://doi.org/10.1080/00224499.2012.690110  PMID: 22989000 
  19. Trans United Europe. Trans United Clinic. [Accessed: 11 Sep 2025]. Available from: https://transunitedeurope.eu/trans-united-clinic
  20. Ma PHX, Chan ZCY, Loke AY. The socio-ecological model approach to understanding barriers and facilitators to the accessing of health services by sex workers: a systematic review. AIDS Behav. 2017;21(8):2412-38.  https://doi.org/10.1007/s10461-017-1818-2  PMID: 28631228 
  21. Brookfield S, Dean J, Forrest C, Jones J, Fitzgerald L. Barriers to accessing sexual health services for transgender and male sex workers: a systematic qualitative meta-summary. AIDS Behav. 2020;24(3):682-96.  https://doi.org/10.1007/s10461-019-02453-4  PMID: 30868447 
  22. Sevelius JM, Keatley J, Calma N, Arnold E. ‘I am not a man’: Trans-specific barriers and facilitators to PrEP acceptability among transgender women. Glob Public Health. 2016;11(7-8):1060-75.  https://doi.org/10.1080/17441692.2016.1154085  PMID: 26963756 
  23. Bass SB, Kelly PJ, Brajuha J, Gutierrez-Mock L, Koester K, D’Avanzo P, et al. Exploring barriers and facilitators to PrEP use among transgender women in two urban areas: implications for messaging and communication. BMC Public Health. 2022;22(1):17.  https://doi.org/10.1186/s12889-021-12425-w  PMID: 34991548 
  24. Jongen VW, Bezemer D, van Sighem A, Boyd A, Rokx C, Grintjes K, et al. Oral HIV pre-exposure prophylaxis use and resistance-associated mutations among men who have sex with men and transgender persons newly diagnosed with HIV in the Netherlands: results from the ATHENA cohort, 2018 to 2022. Euro Surveill. 2024;29(38):2400083.  https://doi.org/10.2807/1560-7917.ES.2024.29.38.2400083  PMID: 39301743 
  25. Zhang J, Li C, Xu J, Hu Z, Rutstein SE, Tucker JD, et al. Discontinuation, suboptimal adherence, and reinitiation of oral HIV pre-exposure prophylaxis: a global systematic review and meta-analysis. Lancet HIV. 2022;9(4):e254-68.  https://doi.org/10.1016/S2352-3018(22)00030-3  PMID: 35364026 
  26. Unger ZD, Golub SA, Borges C, Edelstein ZR, Hedberg T, Myers J. Reasons for PrEP discontinuation after navigation at sexual health clinics: interactions among systemic barriers, behavioral relevance, and medication concerns. J Acquir Immune Defic Syndr. 2022;90(3):316-24.  https://doi.org/10.1097/QAI.0000000000002952  PMID: 35286280 
  27. Vanbaelen T, Rotsaert A, Jacobs BKM, Florence E, Kenyon C, Vuylsteke B, et al. Why do HIV pre-exposure prophylaxis users discontinue pre-exposure prophylaxis care? A mixed methods survey in a pre-exposure prophylaxis clinic in Belgium. AIDS Patient Care STDs. 2022;36(4):159-67.  https://doi.org/10.1089/apc.2021.0197  PMID: 35438524 
  28. Whitfield THF, John SA, Rendina HJ, Grov C, Parsons JT, Why I. Why I quit pre-exposure prophylaxis (PrEP)? A mixed-method study exploring reasons for PrEP discontinuation and potential re-initiation among gay and bisexual men. AIDS Behav. 2018;22(11):3566-75.  https://doi.org/10.1007/s10461-018-2045-1  PMID: 29404756 
  29. Wijstma ES, Jongen VW, Boyd A, De Vries HJC, Van Der Loeff MFS, Prins M, et al. Subpopulations with frequent healthcare barriers have increased risk of sexually transmitted infections and dropping out from HIV preexposure prophylaxis care. AIDS. 2025;39(11):1610-20.  https://doi.org/10.1097/QAD.0000000000004224  PMID: 40590756 
  30. Koole JCD, Bedert MRD, de la Court F, Bais I, Wit F, Stalenhoef J, et al. Barriers and missed opportunities in PrEP uptake, use and care among men who have sex with men with recent HIV infection in the Netherlands. PLoS One. 2025;20(1):e0310621.  https://doi.org/10.1371/journal.pone.0310621  PMID: 39761269 
  31. Evers YJ, Goense CJD, Hoebe CJPA, Dukers-Muijrers NHTM. Newly diagnosed HIV and use of HIV-PrEP among non-western born MSM attending STI clinics in the Netherlands: a large retrospective cohort study. Front Public Health. 2023;11:1196958.  https://doi.org/10.3389/fpubh.2023.1196958  PMID: 37404283 
  32. Central Committee on Research Involving Human Subjects (CCMO). Dossieronderzoek [File research]. The Hague. CCMO. n.d. Available from: https://www.ccmo.nl/onderzoekers/aanvullende-informatie-over-bepaalde-soorten-onderzoek/niet-wmo-onderzoek/dossieronderzoek
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