Assessing Discordance Between Self-Perceived HIV Risk and Laboratory-Confirmed HIV Status in South Africa: Insights from the 2022 National Population-Based Survey

Background: The discordance between individuals’ self-perceived risk of HIV infection and laboratory-confirmed risk has a significant impact on behaviours related to HIV prevention and timely initiation of treatment. Methods: Data was obtained from the sixth South African National HIV Prevalence, Incidence, and Behaviour Survey. Descriptive statistics were used to summarise the sample characteristics and provide the prevalence of discordance. A multivariable multinomial logistic regression was employed to investigate factors associated with discordant results. Results: Of 34,528 participants, 4.1% (95% Confidence Interval (CI): 3.7–4.5) were classified as HIV-positive with low perceived risk, while 11.5% (95% CI: 10.4–12.6) were classified as HIV-negative with high perceived risk and 1.0% (95% CI: 0.8–1.1) as self-misdiagnosed. Being HIV-positive with low perceived risk was significant among older ages (25–54 years) and lower among other races than Black Africans and those residing in rural informal areas. In contrast, being HIV-negative with high perceived risk of HIV risk was more common among participants aged 25–44 years, as well as those living in rural informal and rural formal areas, but lower among other races than Black Africans. The factor associated with self-misdiagnosis was being female. However, participants aged 15–24 years who were never married were less likely to self-misdiagnose. Conclusion: These findings highlight a significant discrepancy between perceived and laboratory-confirmed HIV risk, underscoring the importance of targeted interventions to improve risk perception accuracy. Enhancing individuals’ understanding of their true risk may lead to better engagement in preventive measures and the timely initiation of treatment.