Correlates of never testing for HIV among men who have sex with men in Nepal

Men who have sex with men (MSM) are disproportionately affected by HIV. Individuals who accessed sexual health clinic services for sexually transmitted infections (STIs) and pre-exposure prophylaxis (PrEP) were less likely to engage in high-risk sexual behaviors such as transactional sex and condomless sex and exhibited greater perceived importance of HIV testing. HIV testing is considered the gateway to both prevention and treatment of HIV, enabling timely intervention in HIV transmission. Therefore, this study aimed to measure and determine factors associated with never testing for HIV among MSM in Nepal. We conducted the population-based HIV bio-behavioral surveillance study between October and December 2022 using the respondent-driven sampling (RDS) method. We computed estimates for never testing HIV and conducted bivariate and multivariate analyses to explore the correlation between participant characteristics and never testing HIV. Among the 250 participants, over half of the participants (52.5%) had never tested for HIV in their lifetime, and only 11.7% had tested for HIV in the last 12 months. MSM who had not engaged in transactional sex (aOR:4.5; 95% CI: 1.2-17.3), had no daily internet access (aOR: 5.4; 95% CI: 1.4-21.3), had no prior diagnosis of sexually transmitted infection in their lifetime (aOR: 8.4; 95% CI: 2.8-25.2), had never heard of HIV self-testing (aOR:6.7; 95% CI: 2.8-16.0), and were unaware that someone taking PrEP (aOR:44.9; 95% CI: 10.5-191.6) had higher odds of never having been tested for HIV. Conversely, MSM who were single (aOR:0.3; 95% CI: 0.1-0.8) had lower odds of never being tested for HIV. This study highlights a significant gap in HIV testing among MSM in Nepal, particularly among those who were unaware of an HIV self-testing kit. The findings underscore the need for targeted interventions to address multi-level barriers to increase HIV testing rates among Nepali MSM.