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HIV post-exposure prophylaxis (PEP) uptake is low among men who have sex with men (MSM), even among those aware of it. We examined factors associated with not seeking PEP among MSM in the ANRS-PREVENIR cohort who were PrEP-naive at enrollment, aware of PEP, and reported a potential need for it in the previous 12 months. Among 3,193 participants, 632 (19.8%) met these criteria, and 424 (67.1%) did not seek PEP. The most cited reasons were low perceived HIV risk, fear of judgment or stigmatization, and reluctance to seek hospital-based care. In multivariable analyses, living alone, perceived sexual risk, awareness of a partner's HIV status, high alcohol consumption, and engagement in 'hardcore sexual' practices were associated with higher odds of not seeking PEP, whereas frequent HIV testing and prior mental health consultation were associated with lower odds. These findings highlight the need to address individual and structural barriers to PEP uptake.