Lifetime HIV Non-Testing in Brazilian MSM: Sociodemographic, Psychosocial, and Behavioral Correlates

Lifetime HIV non-testing remains common among men who have sex with men (MSM) in Brazil, and its sociodemographic, psychosocial, and behavioral correlates have rarely been examined together. In a 2025 online survey of 1210 Brazilian cisgender and transgender MSM aged 18 or older, we examined lifetime non-testing with bivariate tests, modified Poisson regression (prevalence ratios, PR), and conditional inference trees. Overall, 9.5% (95% CI [8.0, 11.3]) had never been tested. Bivariately, never-tested men were younger, less educated, and lower income, more often students, single, living with family, and without a formal religion; they reported lower self-esteem, extraversion, and conscientiousness and greater loneliness, depressive symptoms, and internalized homonegativity; and they less often attended religious services or reported drug use during sex (erectogenic drugs or chemsex). Trees partitioned the sample only by education and age (38.9% [30.5, 48.2] among less educated men aged 24 or younger), by self-esteem (higher with low self-esteem), and by drug use during sex combined with religious attendance and alcohol use (highest, 18.4% [14.2, 23.4], among men reporting no drug use during sex, no religious attendance, and infrequent alcohol use; lowest among men reporting erectogenic drugs or chemsex). The domains appear complementary; the profiles may inform complementary testing strategies.