Unawareness of HIV-Positive Status among Men in Seven Sub-Saharan African Countries: Age, Behavioral, and Structural Determinants.

Men in sub-Saharan Africa lag behind women in HIV testing and awareness. We pooled 2019-2023 Population-based HIV Impact Assessments from seven countries (Eswatini, Lesotho, Malawi, Mozambique, Tanzania, Uganda, Zimbabwe). Among 59,293 men, HIV prevalence was 5.9% (95% CI 5.7-6.2). Of 5,394 HIV-positive men, 22.1% (95% CI 20.0-24.3) were unaware of their status (8.4% in Eswatini; 31.5% in Mozambique), declining with age (41.0% at 15-29 vs. 11.5% at ≥ 50). Survey-weighted Poisson regression identified independent correlates: condom-free last sex (aPR 2.5), hazardous drinking (aPR 1.3), infrequent/no prior testing (aPR 1.9), and higher wealth (lower 60% vs. upper 40%: aPR 0.8). Age amplified behavioral gaps in condom use. Among men classified as aware, 5.4% were identified solely through ARV biomarker detection despite self-reported unawareness. Youth-centered, behavior-tailored retesting strategies are essential to close the awareness gap.