Despite the availability of free HIV testing services and mass mobilization and awareness campaigns, HIV testing up-take was low among rural men in Ethiopia, where only 40.3% of rural men were ever tested for HIV. Although the service was delivered freely and is easily accessible by the people, it was far less than 90-90-90 global targets. However, this rate was higher than other sub-Saharan countries, e.g., Nigeria, South Africa, and Ghana indicated the tested amount was ranged from 14% − 22.6% (2, 12, 17). The HIV testing rate was lower than the national rate of 67% (10). The difference might be happened due to the lack of commitment of the government to close the gap by availing the service in rural areas. Ethiopian government working hard on the issue by launching a separate HIV/AIDS policy from national health policy and by providing the service on almost health facilities of the nation but, due to most health facilities concentrating in urban areas cannot it has also to minimize the gap with the national average yet.
This study showed that being a young age had higher odds of being tested for HIV. This is in line with studies conducted in Burkina Faso, Rwanda, and Cambodia (1, 12, 18). The reason for this may be due to the fact that most young and adults aged might have early sexual relationships, inconsistence, use of condoms, and multiple sexual partnerships. However, the result was not consistent with studies conducted in South Africa, Uganda, Kenya, and Malawi(8, 17). The difference may be due to the difference of policy, program, and commitment of the government, for example, integrated voluntary counseling and testing (VCT) was been implemented in Ethiopia.
This study showed that rural men who attended primary and secondary education were less likely to be tested for HIV. This finding is consistent with the findings from studies conducted in Democratic Republic of Congo, Rwanda and Congo Kinshasa(1) but not consistent with many studies conducted in 29 African countries, sub-Saharan countries, Malawi, Cambodia, Uganda and Nigeria(1–2, 22,–16, 19–20). It is expected that people with higher education would have higher use of HIV testing services, but the study results were contrary to that expectation. This difference may happen due to the perception of educated persons living in the rural area that they do not need the test because they are aware of HIV and they can deal with it.
Higher wealth status was found associated with higher odds of being tested for HIV. The result contradicted with findings from studies conducted in Burkina Faso(11), Zimbabwe and Lesotho(1), Nigeria(5), and Cambodia(16). This might be due to fear of stigma and fear of loss of their prestige by society if they were positive.
This study identified that rural men who were lived in the developed region of Ethiopia had higher odds of being tested HIV than emerging regions. This is due to developed nation health and educational infrastructures were more advanced than their counterparts. It makes the residence to have a higher service seeking behavior and easily accesses the service.
This study identified that rural men engaged in the nonagricultural economic sector were more likely than agricultural engaged counterparts to be tested HIV. The result was in line with a study conducted in Cambodia(16). This might be due to the non-agricultural sector engaged segment of the population will have better school attendance and exposure to media. Based on the finding of this study, rural men Muslim followers tested HIV higher than protestant or others. The finding was in line with a study conducted in Malawi (18) but different from the study from Nigeria(17). The discrepancy might be due to unlike other Muslim-dominated countries, here in Ethiopia, they are easily attending modern education and awareness creation which gives them freedom of choice, and they are not marginalized from any Scio-economic activities. This may be encouraged to take HIV test.
Rural men who were < 17 years old at a time of first sex debut had less intension to test HIV than those not had sex debut. This may be due to lack of awareness about the test and HIV, fear to test due to their age because sex at this age is prohibited by the community. This result was the opposite of the Malawi result. This might be due to Malawi culture does allow early sexual debut and that makes them free to decide to test.
Having comprehensive knowledge about HIV would be the key to take a testing decision, but men's knowledge did not extend from 50%(5–6). This study indicated that rural men who had comprehensive knowledge about HIV had a higher probability of being tested HIV than those had not. The result was consistent with studies conducted in Burkina Faso and Nigeria(12, 19). This might be due to every time knowledge makes everyone rational, which helps decision-makers to make better choices. Society's stigmatic attitude will protect individuals from testing HIV.
This study also shows that rural men who were perceived there are discriminatory attitudes towards HIV-positive peoples were less likely to be tested. This is might be due to a fear of societal marginalization and exclusion from participating in socio-economic activities if they have got HIV. The result was consistent with the study conducted in Nigeria, Uganda, Senegal, Burkina Faso, Kenya, Malawi, and Uganda,(3), (7–8),(20–21). This study indicated rural men who had health insurance coverage were more likely to be tested HIV than their counterparts. It was in line with Malawi's study(18). This may be because, even if HIV testing was free, having health insurance packages increases confidence or fear of medical expenses and health-seeking behavior. And mostly those have the insurance coverage attending school better and fast adopters for new services and programs.