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Hence, a restrictive definition by the physician may result in the patient having to pay testing fees out of his own pocket.

Another possibility to test for HIV is in public health offices, which are present in all larger cities and offer anonymous and - in general - free HIV testing.

Early diagnosis of HIV and timely initiation of antiretroviral treatment (ART) are essential to prevent severe clinical consequences of HIV infection.

By reducing infectiousness of people receiving ART, early treatment also contributes to reduction of HIV transmission [].

Home test kits for self-diagnosis of HIV are not legally approved for marketing in Germany [], but may be ordered and imported illegally on the internet.

Rapid tests are only available for health care institutions.

Incorrect assumptions may result in high risk for HIV transmission.

We describe reasons for not testing and analyse factors associated with not or infrequent testing using univariable and multivariable multinomial regression.Testing for presence of HIV infection is a pre-requisite to qualify for antiretroviral treatment.A considerable proportion of German men who have sex with men (MSM) infected with HIV have a CD4 cell count below 350 cells/μl at time of diagnosis and are thus defined as “late presenters”.MSM who were younger, who did not live in large cities, and who were not out about their sexual orientation tested less frequently for HIV.Apart from strengthening protection from sexual orientation-related discrimination and empowering MSM who conceal their orientation, more opportunities to test anonymously and without revealing one’s sexual orientation should be provided.

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