The analysis of HIV infection risk perception bias among men who have sex with men in Qingdao City, China.

Misalignment between self-perceived and objectively measured risk may contribute to ongoing engagement in high-risk behaviors and impede the uptake of HIV prevention services. We aimed to investigate the concordance between self-perceived and objectively measured HIV risk and to identify factors associated with risk underestimation among MSM in Qingdao, China. A cross-sectional study design was used, with snowball sampling to recruit MSM from April 2023 to July 2024. Face-to-face interviews were used to collect demographic and behavioral information, self-perceived HIV risk, and utilization of HIV prevention services. Objectively measured HIV risk was calculated using an HIV risk assessment tool, and self-perceived risk was collected through self-reporting. The Kappa consistency test was used to compare the differences between objectively measured risk and self-perceived HIV risk. Logistic regression analysis was performed to identify the factors associated with risk underestimation. A total of 653 participants were included in the study. A profound mismatch was observed: 78.3% of participants were classified with high objective measured risk, yet 87.6% perceived their risk as only moderate, resulting in poor agreement between the two measures. Multivariate analysis showed that lower monthly income, seeking sexual partners via Internet, engagement in commercial sex, condomless anal intercourse (CAI), and group sex were associated with risk underestimation. Although not statistically significant in multivariate models, univariate analysis suggested lower prevention service uptake among those who underestimated risk, such as HIV self-testing, pre-exposure prophylaxis (PrEP), and post-exposure prophylaxis (PEP). HIV risk underestimation was highly prevalent among MSM in Qingdao, China. Future efforts should focus on enhancing health education for MSM and developing behavioral intervention programs aimed at reshaping risk perception to foster accurate risk awareness and improve cognitive accuracy.