In 2021, there were an estimated 860,000 new HIV infections in sub-Saharan Africa (SSA). HIV prevalence in the region is reported to be five times higher among men who have sex with men (MSM) than the general population. Despite the availability of targeted interventions, access to and utilisation of HIV services by MSM in the region are still limited. Structural and individual-level factors such as laws criminalising same-sex relationships, targeted HIV policies, and Internalised Homonegativity (IH) has been reported to increase HIV-risk behaviours in MSM. However, there is still little known about the associations of these factors in the SSA region. In this thesis, I conducted secondary analyses of data from the 2019 Global LGBTI Internet Survey collected online from May to December 2019 without geographical restrictions in 32 languages, 7 of which were official languages in SSA. The survey collected data from all 46 SSA countries, of which this secondary analysis included data from 3,191 adult MSM in 44 SSA countries. Elements from Krieger’s ecosocial theory of disease distribution and Meyer’s minority stress model were used to frame the study methods. This thesis assessed the associations of laws criminalising same-sex relationships, the presence or absence of targeted HIV policy for MSM and IH with HIV testing and risk behaviour outcomes of MSM in 44 SSA countries. Paper 1 assessed the associations of legal climate and targeted HIV policy with MSM reporting being ever and recently tested (past 6 months) using linear ecological and logistic multilevel analyses. The findings showed strong evidence that countries with legalised same-sex relationships and targeted national HIV policies for MSM were more likely to report higher testing prevalence across SSA. Individual MSM in these countries also report increased odds of testing. We also highlighted heterogeneity between South Africa and other SSA countries. Paper 2 used multilevel analysis to explore the associations of IH with HIV testing and HIV-risk behaviours of MSM in SSA and whether these associations differed by the legal climate. There were high levels of IH across SSA MSM and evidence of its association with HIV testing and HIV-risk behaviours. Increasing IH levels resulted in increased odds of ever testing and recently testing in the past 6 months by MSM across SSA. The legal climate modified the associations of IH with transactional sex. With increasing IH levels, MSM in countries where same-sex relationships are legal reported reduced odds of paying for sex, whilst MSM in countries where consensual same-sex relationships are criminalised reported increased odds of paying for sex. There was suggestive evidence that MSM in countries with legalised same-sex relationships reported increased odds of ever testing. We found no associations of IH with unprotected anal sex in the population surveyed. These findings support existing evidence that discriminatory laws and policies exacerbate SSA MSM's vulnerabilities to HIV. At the structural level, these factors seem to shape the ability of MSM to initially engage with testing services in SSA. At the individual level, the internalisation of negative societal experiences of MSM in settings that criminalise same-sex relationships leads to additional disadvantages compared to their counterparts with the same level of IH. With very few countries in the region on track to meet the 2030 UNAIDS target, the reformation of these laws and policies is an important enabling first step to increasing HIV status awareness of MSM living in SSA countries and in protecting their human rights.