Mismatch Between Perceived and Objective HIV Risk Among Individuals Discontinuing PrEP in Homa Bay and Kisii Counties, Kenya

Pre-exposure prophylaxis (PrEP) is highly effective HIV prevention strategy, yet discontinuation may leave individuals vulnerable. Guided by the Health Belief Model, this study examined whether perceived reductions in HIV susceptibility among PrEP discontinuers aligned with objectively assessed epidemiological risk in Homa Bay and Kisii Counties. A cross-sectional analytical study was conducted among 293 clients, of whom 175 reported a decreased perceived risk. Participants were selected using proportionate stratified random sampling across population groups. HIV risk was objectively evaluated using NASCOP-Risk Assessment Screening Tool (RAST). Descriptive statistics, chi-square and Fisher’s exact tests, and logistic regression were applied to examine alignment between perceived and actual risk and identify predictors of high-risk status. Marked discrepancies were observed between perceived and objective HIV risk. 91.4% of participants who perceived reduced HIV risk were classified as high or substantial risk by RAST. County-underestimation was 94.7% in Homa Bay and 72.0% in Kisii (p < 0.01). Despite reporting reduced perceived risk, many continued to engage in high-risk behaviors, including multiple sexual partnerships (48.4%), condomless sex (28.6%), prior sexually transmitted infections (18.7%), and low consistent condom use (22.5%). County of residence was the only significant predictor of objective high risk (aOR = 0.15; 95% CI: 0.04–0.58); Age, sex, marital status, education, and income were not independently associated. Substantial mismatch between perceived and actual HIV risk exists among PrEP discontinuers, particularly in high-prevalence settings. Strengthened risk assessment, tailored counseling, psychosocial support, and county-specific interventions are critical to prevent premature discontinuation and maintain HIV prevention gains.