Perceived HIV knowledge in the context of novel psychoactive substance use: evidence from a multi-city survey in Kazakhstan

Background and aim This study aims to investigate perceived HIV knowledge among NPS users in Kazakhstan and evaluate patient characteristics associated with higher perceived HIV knowledge. Methods We conducted an applied, cross-sectional survey of NPS users in Kazakhstan between March and October 2024. The dependent variable, perceived HIV knowledge, was modeled as an ordinal outcome using proportional-odds ordinal logistic regression. All analyses were conducted in R using RStudio. Results Substantial heterogeneity in perceived HIV knowledge was observed across regions, behaviors, and substance-use patterns. Participants from Petropavl (AOR = 3.24) and Shymkent (AOR = 1.61) were significantly more likely to demonstrate higher perceived HIV knowledge compared to those from Astana. Sexual behavior characteristics showed mixed associations: inconsistent condom use during paid sex was linked to lower knowledge (never vs. every time: AOR = 0.49; sometimes vs. every time: AOR = 0.35), whereas reporting loss of control during sex (AOR = 1.07) and engaging in anal sex with non-regular partners in the past 3 months (AOR = 2.12) were positively associated with perceived HIV knowledge. Substance-use patterns also showed significant associations: polydrug injection increased the likelihood of higher perceived HIV knowledge (AOR = 2.27). At the same time, both recent and non-recent syringe sharing were inversely associated (AOR = 0.14 and 0.15, respectively). Conclusion Our findings emphasize that perceived HIV knowledge is not evenly distributed and is shaped by complex interactions between geography, sexual behavior, and substance use. Therefore, effective interventions for this population must be comprehensive—combining access to substance use treatment, sexual health education, harm reduction programming, psychological support, and stigma reduction.