Toward 90-90-90: identifying those who have never been tested for HIV and differences by sex in Lesotho.

To reach HIV epidemic control it is important to ensure that those who have never been tested access HIV testing and counseling (HTC) particularly in the context of a generalized HIV epidemic. Using data from the 2014 Lesotho Demographic Health Survey bivariate and multivariate logistic regressions were conducted to determine the associations between never tested for HIV and key socio-cognitive characteristics by sex. Marginal probabilities at the means were calculated for the socio-cognitive variables for men and women to ascertain the magnitude of the differences in the likelihood of never being tested by sex. We stratified by gender and controlled for age, education, religion, marital status, place of residence, and years circumcised (for men only). Results indicate that more men than women have never been tested (χ= 461.16, p < 0.001); and, among men, acceptance of gender based violence (Odds ratio [OR]: 1.44, p < 0.001), holding discriminatory attitudes (OR: 1.50, p < 0.001), and not having basic HIV prevention knowledge (OR: 1.53, p < 0.001) were significantly associated with never being tested. The likelihood of never being tested among those who had these three socio-cognitive characteristics was much higher among men (0.56, p < 0.001) than women (0.20, p < 0.001). Given the strong sex differential, there is an urgent need for strategies specifically targeting men in order to effectively promote HTC uptake among them. Additionally, results suggest that those strategies should integrate strategies to address GBV acceptance, HIV prevention knowledge, and HIV discrimination or link men to programs addressing these.