Despite all efforts made, the prevalence of HIV testing in Eastern Africa remains low but indicates a tendency to improve . The pooled prevalence of HIV testing among men in Eastern Africa was 60.5% (95% CI: 60.2, 60.7%). The present finding was higher than the study conducted in different countries [1, 4, 7, 12, 21, 22]. However, the estimated prevalence of HIV testing in this study was lower than the findings from the survey done in Cambodia . Similarly, it is also lower than the study conducted in Uganda . The possible explanation for this difference could be the variation in lifestyle and cultural beliefs among different countries. Besides, the differences in quality and availability of HIV testing services, and knowledge about HIV/AIDS could be the possible reason for the variation in the prevalence of HIV testing across different countries .
Our findings indicated that age, marital status, residence, age at first sex, community poverty level, community illiteracy level, HIV knowledge, HIV stigma index, risky sexual behavior, and health insurance were significantly associated with the uptake of HIV testing services among men in Eastern Africa. Respondents’ age was an important factor significantly associated with HIV testing among men. Older men aged 20 years and above had higher odds of being tested for HIV than adolescent men aged 15–19 years. This finding is supported by previous studies done in Haiti , South Africa , Malawi , and Ethiopia . The low levels of HIV testing among adolescent men might be due to several factors. Firstly, adolescent men might have low knowledge about HIV/AIDS and are inaccessible to health care services. For example, in a previous report, less than 20% of adolescent men aged between 15 and 19 years in Africa know their HIV status and 90% of HIV adolescents in the world live in sub-Saharan Africa . Secondly, adolescent men aged 15-19 years may have limited sexual experiences and are not informed about sexual issues; thus perceive themselves as having a lower risk of HIV, this in turn contributes to low uptake of HIV testing in this age group. Thirdly, fear and stigmatized attitude towards HIV/AIDS can also reduce the uptake of HIV testing among adolescent men .
The findings further reveal that HIV testing among men was significantly associated with marital status. The odds of HIV testing were higher among married men compared to those with never been in a union. The result was in line with the studies conducted elsewhere [7, 12, 25, 26]. This could be due to married men may have a great sense of family responsibility than single men. Another reason for this might be couple’s discussion about HIV to protect their marriage and future children’s health.
In this study, men from rural areas had a lower chance of being tested for HIV, which is consistent with the studies conducted in Malawi  and Ethiopia [27, 28]. This could be because HIV testing services are more readily available and accessible in urban areas than in rural areas [29, 30]. Men who had started sex after 20 years of age had a lower chance of being tested for HIV compared with their counterparts, which is supported by the study carried out in Malawi  and Ethiopia . This is justified by being young age at first sexual intercourse is correlated with a higher risk of getting various sexually transmitted diseases and engaging in risky sexual practices that could lead to HIV infection, forcing them to know their HIV status .
In the present study, community illiteracy level was significantly associated with ever being tested for HIV. Men from higher community illiteracy levels had lower chances of being tested for HIV than their counterparts, and this is in agreement with the reports conducted elsewhere [33, 34]. This might be justified by educated men may be more exposed to HIV/AIDS-related knowledge, have a better understanding about the importance of HIV testing, and ability to make better decisions about HIV testing. Besides, educational attainment may contribute to greater awareness about the importance of knowing an individual’s HIV status, which could lead to increased uptake of HIV testing [35, 36]. Being from higher community poverty levels had a higher likelihood of being tested for HIV than their counterparts and this finding is contrary to a study conducted in Ethiopia . The possible explanation for this may be due to having higher socioeconomic status may be associated with a greater awareness of risks and with decreased financial barriers to HIV testing, which in turn reduced the uptake of HIV testing . The study revealed that men with higher and comprehensive knowledge about HIV had a greater likelihood of being tested for HIV compared with low knowledge. This finding is consistent with the result of previous studies [12, 28, 31, 36]. This is justified by men having comprehensive HIV knowledge that may be associated with a good understanding of the potential risks of HIV, and the need to be tested to know their status to prevent the disease and its complications. Interestingly, men with higher stigma scores had a lower chance of being tested for HIV than those with no stigma. Previous studies had also indicated participants with higher HIV stigma scores had lower odds of being tested for HIV [1, 37]. The possible explanation for this could be participants may be hesitant to test since the disclosure of a positive HIV test result can result in loss of friendship, family relationships, jobs, and housing and health care as a result of discrimination [38, 39].
In this study, men who had risky sexual behavior had higher odds of being tested for HIV compared with their counterparts. This is in agreement with another study . This might be due to participants with risky sexual behavior may have frequent fear and uncertainty about their HIV serostatus and are usually suspicious and worried that they have been infected with HIV. This motivates individuals to seek voluntary counseling and testing services regularly . Moreover, being covered by health insurance was more likely to be tested for HIV compared with their counterparts. This finding is supported by the results of other studies [7, 12, 22]. This is explained as men with health insurance are more likely to visit health care facilities to seek health services including HIV testing since the services are free.
Strength and limitations of the study
As strength, this study was based on the weighted large sample size of nationally representative data drawn in eleven East African countries. Besides, we used the multilevel analysis to adjust the hierarchical nature of the DHS data. Furthermore, because the findings were based on the national survey data, they can provide important information for program managers and policymakers to develop good interventions at the regional and national levels. This study had some limitations: Firstly, since the DHS survey was dependent on participants’ self-reports, it could lead to recall bias. Secondly, since this analysis was based on the cross-sectional nature of DHS collected data, it is impossible to indicate the temporal relationship between outcome and explanatory variables. Lastly, the use of old data sets from Madagascar may scale up of access to HIV testing service.