Factors associated with having one or more risky sexual behaviors among adolescent girls and young women in Rwanda: population-based survey using 2018/2019 RPHIA data

Abstract

Background Adolescent girls and young women (AGYW) aged 15 to 24 years present disproportionately higher risk of HIV acquisition and unintended pregnancies (Ups) across the globe. The risks mainly due to risky sexual behaviors (RSBs) like sex for money or favor and sex without condom among others. Methods This study was conducted to assess factors associated having one or more RSBs among AGYW. Using STATA version 15, we analyzed Rwanda population-based HIV impact Assessment (RPHIA) survey data. Data were analyzed at univariable, bivariable, and multiple logistic regression analysis levels. Statistical significance was set at p value less than 0.05. Settings: Population based survey conducted in Rwanda, Eastern Africa. Results Of the 6,753 AGYW enrolled in RPHIA, 19.4% had one or more risky sexual behavior(s) including sex without a reliable method of contraception (11.0%), extra- marital sex without a condom (5.9%), sex before age of 15 (5.1%), sex for gifts/favor/money (4.4%), having multiple sexual partners (4.0%), transgenerational sex (0.7%), and anal sex (0.3%). Factors determining having one or more RSBs among AGYW include ever been pregnant [aOR: 19.2 with 95% C.I:15.8–23.4], pregnant by the time of interview [aOR: 10.5 with 95% C.I:7.5–14.6], sex before age of 15 [aOR: 2.1 with 95% C.I: 1.5–2.8], being married [aOR: 1.6 with 95% C.I:1.1–2.2], and cohabiting [aOR: 1.4 with 95% C.I:1.1–1.8]. Conclusion Overall RSBs remain a major public health threat in Rwanda. Thus, the need for sexual and reproductive health services (SRHS) appropriate to AGYW focusing condom use, delaying age of sexual debut, and contraception use to prevent their risks to HIV and unintended pregnancies.