Introduction: Surveillance for recent HIV infections was implemented at Dutch sexual health centres (SHCs) for planning and evaluation of HIV prevention initiatives. The study objective is twofold: (1) to explore trends in recent HIV infections and associated socio-demographic and behavioural risk factors among men who have sex with men (MSM )attending SHCs, to gain insight into subgroups at risk for acquiring HIV and(2) to illustrate how comparison with different reference groups affect associations with these risk factors. Methods: Residual plasma or serum samples from MSM newly HIV diagnosed at SHCs in 2014–2017 were tested with an avidity assay. Multinomial regression was used to analyse risk factors for recent HIV infections among MSM with established HIV infections among MSM and with HIV-negative MSM as reference groups. Results: Of newly diagnosed MSM, 33% were classified as recent HIV infection with avidity testing. Combining HIV-negative test results with avidity outcomes resulted in 54% recent ...