HIV surveillance in homosexual men is poor in most countries, as this risk
group is difficult to sample. The aim of this study is to test the feasibil
ity of reaching homosexual men for national HIV surveillance using gay comm
unity media. In 1989, a questionnaire on general gay issues, with a section
on AIDS, was included in a widely sold gay magazine in the Netherlands. Am
ong 17,700 sold copies, 1134 responses were obtained from males (6%). Of th
ese, 669 men (59%) gave their address, of which in turn 84% responded to a
questionnaire on risk behaviour in 1990. In 1991/1992, the 669 men were ask
ed to participate in an HIV serosurvey, in which eventually 308 participate
d with a blood test (46%) and 147 without (total 68%). Participation in the
serosurvey with blood test was associated with reporting multiple partners
in 1989. Twenty participants were infected (6.5%). In logistic regression
analysis, risk factors for infection were recent unprotected receptive anal
intercourse with multiple partners (odds ratio (OR):10.7; 95% confidence i
nterval (CI): (2.18-52.2); one partner 1.17 (0.31-4.48); none 1) and living
in Amsterdam (OR: 3.92; 95% CI: (0.99-15.5); urbanised western Netherlands
2.15 (0.57-8.03); elsewhere 1), while a high educational level was protect
ive (OR: 0.29 (0.08-0.96); middle 0.41 (0.11-1.54); low 1). Among those who
participated in 1991/1992, risk behaviour increased between 1989 and 1991/
1992 (reporting multiple casual partners rose from 55% to 64%; reporting in
consistent condom use with receptive anal sex from 58% to 71%). Using a pre
dictive model which included self-reported serostatus in 1989, the HIV prev
alence rate in 1991/1992 among all male responders to the 1989 questionnair
e was estimated to be 5.3% (95% CI: 3.1-7.7%). In conclusion, unless initia
l response is improved, recruitment through a gay magazine may not allow re
liable estimates of HIV prevalence in homosexual men. However, it can be us
eful at the national level for monitoring changes in prevalence and risk be
haviour over time, geographical differences and risk factors for infection.