Prevalence and factors associated with risky sexual behaviors among adolescent girls and young women in Rwanda: evidence from a national population-based cross-sectional HIV impact assessment, 2018-2019.

INTRODUCTION: globally, adolescent girls and young women (AGYW) aged 15 to 24 face higher risks of acquiring HIV and unintended pregnancies, primarily due to risky sexual behaviors (RSBs) such as engaging in sex for money and having sex without a condom. This study assessed factors associated with RSBs among AGYW in Rwanda. METHODS: this study analysed weighted data from the 2019 Rwanda Population-based HIV Impact Assessment (RPHIA), a cross-sectional study that collected data from October 2018 to March 2019. The analysis used the Jackknife method in survey logistic regression. Statistical significance was assumed for a p-value less than 0.05. RESULTS: among 6,753 adolescent girls and young women aged 15-24 years (mean age: 20.9 years), 44.1% reported ever having sex, corresponding to 2,980 participants. Among sexually active AGYW, the weighted prevalence of risky sexual behaviors was 43.9%. The most common RSBs include sex without a reliable method of contraception (24.8%), extramarital sex without a condom (13.5%), sex before the age of 15 (11.5%), sex for gifts/favors/money (9.9%), having multiple sexual partners (9.1%), transgenerational sex (1.7%), and anal sex (0.8%). Factors determining RSBs among the AGYW who reported ever having sex include having ever been pregnant (aOR: 4.3 with 95% C.I: 1.4-13.4), being pregnant at the time of the interview (aOR: 9.5 with 95% C.I: 6.8-13.4), having sex before the age of 15 (aOR: 1.8 with 95% C.I: 1.1-2.9), age at first sex ranging between 15-17 years (aOR: 1.3 with 95% C.I: 1.0-1.7), and living in a household with one or more children aged below 15 years (aORs ranging from 1.6 to 1.9). CONCLUSION: overall, RSBs remain a public health threat among young females in Rwanda, putting them at an elevated risk of HIV infection and unintended pregnancies. Thus, there is a need for sexual and reproductive health services appropriate for AGYW, focusing on delaying the age of sexual debut, promoting condom use, abstinence, and modern contraception among sexually active young females.