Routine and event-driven HIV testing among MSM in Chongqing, China: a cross-sectional study on the moderating effect of anxiety

HIV testing is critical for prevention and treatment among men who have sex with men (MSM). This study applied an extended Information-Motivation-Behavioral Skills (IMB) framework to examine HIV testing strategies among Chinese MSM, with anxiety acting as both a direct predictor and a moderator. A cross-sectional survey was conduted among 431 MSM recruited from venues and community-based organizations in Chongqing, China, from June to September 2025. Participants completed a questionnaire assessing sociodemographics, sexual behaviors, HIV knowledge, IMB constructs, and anxiety (GAD-7). HIV testing strategies were categorized as routine testing (every 3, 6, or 12 months), event-driven testing (only when perceived necessary), and never testing. Multivariable logistic regression was used to examine factors associated with testing strategies. Overall, 67.1% reported annually testing. Personal motivation was associated with routine testing, whereas behavioral skills (self-testing) were associated with event-driven testing. Moderate anxiety directly predicted event-driven testing and modified the associated between HIV knowledge and testing stategy (P = 0.066). These findings highlight the need to integrate mental health considerations into HIV testing services and tailor interventions according to anxiety level.