Determinants of Higher-Risk Sexual Behavior in Some Selected African Countries

Abstract

Background. Although higher-risk sexual behavior (H-RSB) is a major contributor to the rapid rising rate of new HIV infections, there exists paucity of comprehensive evidence across the sub-Saharan African region. The purpose of this study was to determine the prevalence of H-RSB and its determinants across sub-Saharan Africa to inform policy. Method. Data were obtained from the Demographic and Health Survey (DHS) of ten sub-Saharan African (SSA) countries with their three most current DHS surveys from 2000 to 2016. Only participants who ever had sexual encounters in their lifetime were included in the study. Weighted adjusted Cox regression with robust variance and constant time was used to investigate disparities of H-RSB among the ten SSA countries. Relationships between sociodemographic, socioeconomic, knowledge, mass media, and H-RSB were investigated. Results. The trend and prevalence of higher-risk sexual behavior show that Lesotho experienced a decreasing trend of the prevalence of H-RSB from 8.92 in period one to 6.42 in period three. Ghana experienced a marginal increase from 6.22 in period one to 6.76 in period two and then to 6.43 in the third period. However, Malawi, Zambia, and Zimbabwe obtained a marginal increasing trend in the prevalence of H-RSB from period one to three: 2.75 to 3.74, 4.33 to 6.24, and 6.11 to 7.99, respectively. Meanwhile, the prevalence of H-RSB in Namibia and Uganda decreased in period two to 1.84 and 5.76 but increased in period three to 2.01 and 6.83, respectively. Generally, determinants of H-RSB among the countries include age, sex, religious affiliation, marital status, educational level, employment status, economic status, age at first sex, and status of circumcision. Conclusion. Trend of relatively high prevalence of H-RSB has been found across majority of the countries with key sociodemographic factors influencing H-RSB. Therefore, different targeted interventional approaches are needed in all the countries to help reduce H-RSB and the overall HIV incidence. If issues regarding sexual behavior and sexual health are not addressed adequately, H-RSB can negate all the appreciable efforts aimed at ending the HIV pandemic by 2030.

Individual and community-level determinates of risky sexual behaviors among sexually active unmarried men: A multilevel analysis of 2016 Ethiopian Demographic and Health Survey

“…Past studies reported mixed results on the association between marital status and levels of risky sexual behavior. Different studies conducted in different parts of the globe reported that being married increased the likelihood of risky sexual behavior [ 7 – 10 ]. In Ethiopia, similarly, the 2016 EDHS reported that men who are married are more likely to have more than one partner in the past 12 months than those who were never married (4% compared to 2%) [ 7 ].…”

Correlates of prevalent HIV infection among adolescents, young adults, and older adult female sex workers in Ghana: Analysis of data from the Ghana biobehavioral survey

“…Globally (2019), female sex workers have been identified among the population at the highest risk of contracting and spreading the HIV virus [5][6][7]. Additionally, studies conducted by Shava and others on HIV, confirmed the high incidence and prevalence of the disease among FSW [7][8][9][10][11][12][13][14][15][16][17]. In 2020, key populations (sex workers, gay men, men who have sex with men, transgender people, people who inject drugs, and people in prisons and others) and their sexual partners accounted for 65% of global new HIV infections, of which 8% were sex workers [17,18].…”

“…There are different predictors of HIV prevalence which depend on country and context. Some of these predictors include inconsistent condom use (people who do not use condoms always) and having multiple sexual partners [12][13][14]. According to Fauk et al, personal (lack of knowledge of HIV testing and HIV and AIDS service and lack of knowledge of the existence of HIV infection), social (fear of stigma and discrimination), and healthcare provision (lack of trust, fear of disclosure of their HIV status by health professionals and limited availability of medications) barriers associated with HIV testing among male clients contribute to the high prevalence of HIV among FSW [17].…”