Never tested for HIV? Characteristics of first-time testers among MSM in Chongqing and Chengdu, China

Background: Men who have sex with men (MSM) are disproportionately affected by HIV, and initial HIV testing is a critical entry point for early diagnosis and treatment. However, factors associated with first-time HIV testing among MSM in the Chengdu-Chongqing region remain unclear. This study aims to assess HIV testing coverage and identify factors associated with first-time HIV testing among MSM in this region, thereby providing scientific evidence to help achieve the UNAIDS 95-95-95 targets, which include diagnosing 95% of people living with HIV by 2030. Methods: This cross-sectional study was conducted through community-based organizations in Chengdu and Chongqing from August to December 2024. Data on socio-demographics, sexual behaviors, sexually transmitted infection (STI) history, new psychoactive substance (NPS) use, and HIV testing history were collected using a structured questionnaire. Chi-square tests and multivariable logistic regression were employed to identify factors associated with first-time HIV testing. Results: Of the 514 MSM included, 156 (30.4%) were identified as first-time testers. Multivariable logistic regression revealed that the absence of group sex in the past month was associated with an increased likelihood of first-time testing (aOR = 3.22, 95% CI: 1.08-9.56). In contrast, MSM with a college degree or higher (aOR = 0.46, 95% CI: 0.23-0.93) and a history of STI in the past year (aOR = 0.13, 95% CI: 0.02-0.99) were associated with a decreased likelihood of first-time testing. Conclusion: Approximately one-third of MSM in Chengdu and Chongqing have never been tested for HIV. We recommend enhanced, targeted interventions for lower-educated MSM, along with integrated HIV and STI testing services, to increase HIV testing uptake among MSM and achieve the goal of diagnosing 95% of individuals infected with HIV by 2030.