Prevalence and factors associated with low perceived risk of hypertension among adults living with HIV in Eastern Uganda

Persons living with HIV (PLHIV) face an increased risk of hypertension due to chronic inflammation, long-term antiretroviral therapy, and ageing. Adoption of preventive behaviours partly depends on individuals’ awareness and perception of their susceptibility to hypertension. However, evidence on the prevalence and determinants of low perceived risk of hypertension among PLHIV remains limited in Uganda and similar sub-Saharan African settings. This study assessed the prevalence of low perceived risk of hypertension and its associated factors among adult PLHIV in Eastern Uganda. We conducted a facility-based cross-sectional study among adult PLHIV attending public health facilities in Eastern Uganda. Participants who self-reported a prior diagnosis of hypertension (n = 30) were excluded from the analytic sample because the study focused on perceived risk of developing hypertension among those without known hypertension. Perceived risk was assessed using absolute, conditional, and comparative risk questions on a 4-point Likert scale. Scores were categorized into low and high perceived risk of hypertension using the overall median score. Modified Poisson regression was used to identify factors associated with low perceived risk of hypertension. Overall, 29% of participants had low perceived risk of hypertension. Urban residence (APR = 0.55; 95% CI: 0.40–0.76), tertiary education (APR = 0.72; 95% CI: 0.52–0.99), and higher hypertension knowledge (APR = 0.98; 95% CI: 0.97–0.99) were associated with a lower likelihood of low perceived risk of hypertension. Conversely, absence of NCD comorbidities (APR = 1.38; 95% CI: 1.00–1.89) and lack of a family history of hypertension (APR = 1.42; 95% CI: 1.20–1.68) were associated with a higher likelihood of low perceived risk of hypertension. More than one-quarter of PLHIV had low perceived risk of hypertension, indicating a potential gap in perceived susceptibility within a high-risk population. Tailored, community-informed hypertension risk communication integrated into routine HIV care may improve perceived susceptibility and support preventive behaviours.