Background: Populations with current HIV risk (CHR) may not report high perceived HIV risk (PHR). Factors associated with CHR and PHR among men who have sex with men (MSM) are poorly understood. This analysis aims to explore these factors among MSM from Brazil, Mexico, and Peru.
Methods: MSM were recruited to respond to an online survey advertised on gay social-network apps and social media (May-June, 2018). PHR was established with the question: Considering your sexual practices, in your opinion, what would be your risk of getting HIV during the next 12 months? CHR was defined using CDC´s MSM Risk Index. Both outcomes were dichotomized (low vs. high). Multivariable regression models were used to estimate associations with PHR and CHR.
Results: A total of 19,457 MSM were included in the analysis; median age was 28 years old (IQR: 24-34), most respondents were Brazilian (58%), and had completed high school or higher (68%). More than half had CHR, 10,165 (52%), but only 6,654 (35%) reported high PHR. Among those with CHR, 68% (4,530/10,165), also reported high PHR. After adjusting by country, the factors associated with both CHR and high PHR were non-gay identified MSM, reported anticipated risk compensation if using PrEP, daily use of apps for sex, transactional sex, and STI diagnosis in the previous six months. Low education was only associated with PHR. Young MSM, PrEP awareness, and having a steady partner were only associated with CHR.

 Perceived HIV risk
OR (95% CI)
Perceived HIV risk
aOR (95% CI)
Current HIV risk
OR (95% CI)
Current HIV risk
aOR (95% CI)
(18-24 vs. ≥35 years)
0.99 (0.92-1.07)Not significant1.67 (1.56-1.80)1.83 (1.69-1.99)
(<High school vs. ≥High school)
0.95 (0.89-1.02)1.15 (1.07-1.24)1.07 (1.01-1.14)Not significant
Sexual orientation
(other vs. gay)
1.28 (1.16-1.42)1.29 (1.66-1.44)1.83 (1.67-2.01)1.95 (1.72-2.16)
Steady partner
(yes vs. no)
0.89 (0.83-0.95)Not significant1.15 (1.08-1.22)1.38 (1.29-1.49)
Anticipated risk compensation if using PrEP
(yes vs. no)
2.26 (2.10-2.42)2.09 (1.94-2.25)1.97 (1.83-2.11)2.05 (1.82-2.31)
PrEP awareness
(yes vs. no)
1.01 (0.95-1.07)Not significant1.20 (1.12-1.28)1.38 (1.29-1.49)
Use of apps for sex
(daily vs. never)
3.86 (3.37-4.44)4.30 (3.72-4.98)2.03 (1.82-2.25)2.05 (1.82-2.31)
Transactional sex, previous 6 months
(yes vs. no)
2.20 (1.94- 2.50)1.97 (1.73-2.13)3.01 (2.61-3.48)2.51 (2.14-2.95)
STI diagnosis, previous 6 months
(yes vs. no)
2.26 (2.06-2.48)1.92 (1.73-2.13)1.93 (1.75-2.13)1.67 (1.50-1.85)
[Factors associated with high perceived and current HIV risk among MSM in Brazil, Mexico, and Peru]

Conclusions: A high proportion of MSM from Brazil, Mexico, and Peru who had CHR also had high PHR. Many factors associated with PHR were also associated with CHR. Nevertheless, these results highlight that young MSM with daily use of apps for sex, and low education could be a target group for online campaigns focusing on PHR awareness and PrEP demand creation.

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