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In the Netherlands, hepatitis C virus (HCV) transmission occurs predominantly among men who have sex with men (MSM) with HIV or those eligible for HIV pre-exposure prophylaxis (PrEP).1 Early testing, diagnosis and rapid treatment initiation are key to preventing onward transmission, but they may be insufficient in settings where HCV-related behaviours persist. PrEP and the adoption of undetectable equals untransmittable (U=U) for HIV prevention have likely coincided with changes in these behaviours, particularly in MSM.2 Meanwhile, the broad availability of direct acting antivirals (DAAs) has substantially reduced HCV incidence,3 potentially lowering HCV risk perception and weakening emphasis on primary prevention strategies. Individuals who continue to engage in HCV-related behaviours may acquire the virus and, if they remain untested, could contribute to its ongoing transmission. This analysis aimed to assess changes in HCV-related sexual and drug use behaviours between 2021 and 2024 among MSM in the Netherlands who could be considered potentially at risk of acquiring HCV.