Assessing discordance between self-perceived HIV risk and laboratory-confirmed HIV status in South Africa: insights from the 2022 national population-based survey

Self-perceived risk of HIV is one of the key drivers influencing whether individuals adopt behaviors that either reduce or heighten their risk of contracting sexually transmitted infections, including HIV. However, evidence continues to show that often people inaccurately assess their actual level of risk of acquiring HIV, leading to discordance between self-perceived HIV risk and their laboratory-confirmed HIV status. Subsequently, these inaccurate self-perceived risks may hinder access to care and lower protective behavioral practices, such as consistent condom use, testing for HIV, and pre-exposure prophylaxis uptake. Ultimately, the consequences of discordant practices may impede meeting the UNAIDS 95-95-95 targets by 2025. This is particularly concerning for countries such as South Africa, where, despite a decline in HIV prevalence as of 2022, over 7 million people are estimated to live with HIV, among whom a proportion remain unaware of their HIV-positive status and are virally unsuppressed. Literature shows that an individual’s self-risk perception is closely associated with their proclivity to engage in risky sexual behaviors, which are a common mode of HIV transmission in South Africa. Pringle used the Health Belief Model to argue that an individual’s health-seeking behavior is influenced by the health education available to them, thus allowing for informed decision-making regarding the use of HIV prevention interventions. This level of autonomy has been valued and respected; however, research shows that it can lead to cases of risk perception bias or discordance, whereby individuals misjudge their likelihood of contracting or transmitting HIV. This has been documented to occur in three ways: underestimation of risk, overestimation of protection and optimism bias