Association between HIV risk perception, knowledge of biomedical prevention and sexual behaviour among sub-Saharan African immigrants living in a precarious situation in France

Objectives Sub- Saharan African immigrants are particularly affected by HIV in France, with many acquiring the infection after migration due to precarious circumstances that increase their vulnerability. This study aimed to explore the association between HIV risk perception, knowledge of biomedical HIV prevention methods and sexual behaviours among sub- Saharan African immigrants living in precarious conditions in the greater Paris area. Methods This cross- sectional study analysed data from 614 participants in the MAKASI project, conducted in the greater Paris area (2019-2020). Sociodemographic characteristics, living conditions, knowledge of biomedical HIV prevention methods (postexposure prophylaxis, treatment as prevention and pre- exposure prophylaxis (PrEP)) and sexual behaviours were described by sex using Pearson's chi(2) tests. HIV risk perception, defined as self- reported exposure to HIV comparable to or greater than the general population, was analysed by participant characteristics. A multivariable logistic regression model identified factors associated with HIV risk perception using variables with a significance threshold of 20%. Results Most participants (76.5%) were men, with a median age of 34 years (IQR: 29-41) and living in precarious conditions. Forty- one per cent of respondents reported perceiving their HIV exposure risk as comparable to or greater than the general population. Participants aware of PrEP (adjusted OR (aOR) =2.60 (1.17-5.80); p<0.020) and those who had sex with occasional partners without a condom within in the 3 months preceding the survey (aOR=1.89 (1.12-3.18); p<0.017) were more likely to report the same or greater risk of HIV exposure. Conclusions Our findings reveal that PrEP knowledge and sex with occasional partners, particularly participants who did not use condoms, are associated with increased HIV risk perception among sub- Saharan African immigrants. Further research should explore the relationship between PrEP uptake and HIV risk perception in this population. Trial registration number NCT04468724