HIV Risk Perception Among Key Populations in Nigeria: Evidence From the 2020 Integrated Biological and Behavioral Surveillance Survey

Background Risk perception influences the uptake of HIV prevention interventions among key populations (KPs). Despite the disproportionately high burden of HIV among KPs in Nigeria, data on their HIV risk perception remain limited. This study aimed to assess (i) self‐perceived HIV risk and its associated factors and (ii) the discordance between self‐perceived HIV risk and HIV serostatus among KPs in Nigeria. Methods This study was a secondary analysis of the 2020 Integrated Behavioral and Biological Surveillance Survey conducted among female sex workers (FSW), men who have sex with men (MSM), people who inject drugs (PWID), and transgender (TG) people in Nigeria. The analysis was restricted to 14,649 KPs (4348 FSW, 3617 MSM, 3444 PWID, and 3240 TG). Risk perception was based on responses to the question, ‘Do you feel at risk of HIV infection?’ Discordance was defined as reporting no risk of HIV infection while testing HIV positive. Weighted descriptive statistics and univariate and multivariable logistic regression analyses were conducted. Results Approximately 37% of KPs perceived themselves to be at risk of HIV. Compared with FSW, MSM had higher odds of perceived risk (aOR = 1.5, 95% CI: 1.30–1.66), while TG people had lower odds (aOR = 0.8, 95% CI: 0.74–0.96). Older age (≥ 25 years) (aOR = 1.4, 95% CI: 1.29–1.54), unemployment (aOR = 1.2, 95% CI: 1.07–1.29), residence in the North East zone (vs South South) (aOR = 1.6, 95% CI: 1.29–2.08), exposure to HIV information (aOR = 2.1, 95% CI: 1.96–2.32), and comprehensive HIV knowledge (aOR = 1.2, 95% CI: 1.14–1.34) were associated with higher odds of perceived HIV risk. Conversely, being currently married (aOR = 0.5, 95% CI: 0.43–0.58) or formerly married (aOR = 0.9, 95% CI: 0.76–0.98), residence in the South West (aOR = 0.6, 95% CI: 0.55–0.69), North Central (aOR = 0.9, 95% CI: 0.77–0.98), or North West zones (aOR = 0.7, 95% CI: 0.59–0.80), and consistent condom use (aOR = 0.8, 95% CI: 0.69–0.82) were associated with lower odds of perceived HIV risk. Overall, 13.5% of participants who perceived themselves not at risk of HIV tested positive, with the highest discordance observed among TG people (20.7%) and MSM (14.2%). Conclusion The majority of KPs in Nigeria did not perceive themselves to be at risk of HIV, with notable variation across the typologies. These findings highlight the need for targeted education and counseling strategies to improve HIV risk awareness among KPs in Nigeria.