Introduction HIV in Peru is concentrated among men who have sex with men (MSM) and transgender women (TW). Over 70% of HIV+ MSM/TW ignore their status, as HIV testing frequency is low, delaying diagnosis and treatment. We aimed to assess the relationship between HIV testing frequency and perceived HIV risk among MSM/TW.

Methods This analysis included baseline data from MSM/TW who reported a negative or unknown HIV status from a STI clinic cohort of MSM/TW at high risk in Lima. The behavioural survey assessed HIV risk perception (high, moderate, low) and prior testing frequency (testing was defined as frequent if it had occurred at least biannually). For HIV diagnosis, we used a 3^rd generation rapid test, a 4^th generation EIA, and Western Blot confirmation. Chi-square tests and multivariable regression were used to estimate adjusted prevalence ratios (aPRs).

Results Among eligible subjects (243 MSM and 67 TW), 122 (39%) reported frequent prior HIV testing, while HIV risk was perceived as high, moderate and low by 72 (23%), 148 (48%) and, 90 (29%) participants, respectively. Frequent HIV testing was more prevalent among participants reporting low/no HIV risk (aPR: 1.62; CI: 1.20–2.20) and among those reporting previous syphilis infection (aPR: 1.58; CI: 1.22–2.04); but was less prevalent among participants reporting recent condomless anal intercourse (aPR: 0.67; CI: 0.51–0.90). Baseline HIV status and HIV risk perception were not associated: HIV prevalence was 11%, 13% and 10% among those reporting high, moderate and low/no HIV risk (chi-square p-value >0.1).

Conclusion Frequent HIV testing was more prevalent among MSM/TW reporting low/no HIV risk. Risk perception did not correlate with HIV status among previously undiagnosed subjects. WHO-recommended biannual HIV testing should be promoted, and factors potentially affecting risk perception and testing frequency (e.g. access, stigma) should be identified and addressed by HIV programming for MSM/TW in Peru.