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Background Despite representing a substantial proportion of new HIV diagnoses globally, cisgender women remain underrepresented in PrEP programs. Low PrEP uptake in this population may reflect perceived low HIV risk, yet the alignment between perceived protection and reported behaviors is unclear. We assessed self-reported reasons for declining PrEP and their concordance with self-reported HIV-related risk behaviors in a community-based setting.Materials and Methods We conducted a cross-sectional study among cisgender women reporting no interest in PrEP at a community-based HIV/STI testing center (April–December 2025). Data were collected during peer-led counseling using the COBATEST platform and an additional ad-hoc survey. Reasons for PrEP were grouped into three non-mutually exclusive domains: (i) perceived adequate risk control, (ii) gendered/misinformation-based beliefs, and (iii) medical/pharmaceutical concerns. Possible HIV exposure was quantified as the number (0–8) of related risk factors reported in the previous 12 months (prior STIs, ≥2 sexual partners, group sex, recreational drug use, irregular STI testing, inconsistent condom use, sex work, cisgender male sexual partners). Higher vulnerability was defined as ≥3 concurrent factors. Concordance between perceived protection and reported exposure was assessed descriptively, and associations were tested using chi-square.Results Among 194 women not interested in PrEP, perceived adequate risk control was the most commonly reported group (75.8%), followed by gendered/misinformation beliefs (35.1%) and medical/pharmaceutical concerns (21.6%). Overall, 72.2% demonstrated ≥3 cumulative risk indicators, suggesting clustering of multiple behavioral exposures. Higher vulnerability was similarly prevalent among women endorsing perceived protection and those who did not (72.5% vs 71.1%; p=0.857). Substantial discordance was commonly observed. Among women citing condom use as a reason for declining PrEP (13.9%), 40.7% reported a condomless last intercourse and/or inconsistent condom use. Among those reporting ‘only one partner’ (22.2%), 62.8% reported ≥2 partners or non-monogamy in the previous year. Overall, 55.7% of participants reported no interest in PrEP due to self-perceived low HIV risk, while demonstrating a higher behavioral vulnerability ( table 1).Conclusions Despite substantial cumulative HIV risk indicators, most women who declined PrEP reported low self-perceived HIV risk. This misalignment between the perceived protection and reported behaviors suggests that inaccurate or incomplete risk appraisal may limit PrEP uptake, highlighting the importance of accessible, evidence-based information on risks and prevention, and targeted strategies to enhance PrEP engagement among cisgender women.Abstract P188 Table 1PrEP refusal rationale, behavioral vulnerability and discordance among cisgender women not interested in PrEP (N=194)