Unprotected anal intercourse, particularly evident among men who have sex with men (MSM), poses a higher risk of HIV transmission than unprotected vaginal sex. This study investigated HIV risk behaviours and awareness among MSM taking pre-exposure prophylaxis (PrEP) in Belhar, South Africa.

The findings revealed prevalent risky behaviours, with only half of the participants consistently using condoms. Many participants perceived condomless sex as more satisfying, leading to frequent unprotected anal intercourse, often with undisclosed partner HIV statuses or PrEP usage. Group sex practices further increased HIV susceptibility among MSM.

Inadequate healthcare access exacerbated HIV risks, particularly among people of colour. The study highlighted deficiencies in Belhar’s healthcare system, necessitating MSM to seek PrEP advice from friends and acquire PrEP informally. Limited healthcare availability, compounded by weekend closures, posed challenges for accessing essential services.

To mitigate HIV risks, the study advocated for local clinics to foster trust among MSM through an inclusive approach. By addressing these gaps, healthcare providers can enhance PrEP adherence and reduce HIV transmission among MSM communities.