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

doi:10.21203/rs.3.rs-4918509/v1

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Research Article

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

https://doi.org/10.21203/rs.3.rs-4918509/v1

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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.

Risky sexual behaviors (RSBs) are behaviors that can lead to unplanned pregnancies (UPs) and/or sexually transmitted infections (STIs) including HIV/AIDS and other STIs. These behaviors include sex before marriage, having multiple sex partners, sex without condom, using unreliable methods of birth control, attending nightclub, having sex due to alcohol influence, and receiving or paying money for sex (1–3). Adolescent Girls and Young Women (AGYW) are more likely to engage in these behaviors as compared to boys with same age and adult women (4). RSBs constitute a global challenge in today’s society and they are associated with numerous risk factors.

Various factors including poverty, lack of education and employment opportunities are associated with RSBs especially in Low- and Middle-Income countries (LMICs). These factors are intense in LMICs where larger proportion of women still depend on men’s financial income. Similarly, Women in these countries engage in transactional sex for basic needs, luxury life, or as a means to express love to men(5). These make women more exposed to STIs than their male counterparts, especially among AGYW.

Globally, young people (15–35 years of age) are the most susceptible groups for RSB and account for an estimated 45% of new HIV infections(6). RSBs are exacerbated by low income, job insecurity, lack of awareness about sexual and reproductive health issues and harmful traditional practices(7).

Several studies reported risky sexual behaviors among youths in sub-Saharan Africa as most common despite well-known cultural norms. Youths in this region frequently engage in prenuptial sex, have multiple sexual partners, and sex without condom that result in unwanted pregnancies, STIs and HIV infections. RSB prevalence var An Ethiopian study (43.1%)(8). Similarly, a Tanzanian study reported that about 21.6% of school children had started sexual intercourse before age of 15 and bout 80% of the study participants started sex at the age of 18 years, in 2015 (9).

About 5.7% of the 6,050 AGYW had started sexual intercourse before the age 15. About 83.7% of the 448 AGs aged 15–19 years reported having sex with non-marital and non-cohabiting partner in the last 12 months with only 42.6 them using a condom while about 48.4% of 1,554 Young women aged 20–24 years reported reporting having extramarital sex in the last 12 months with 34.0% of them using condom(10). Sex before the age of 15 years, about 19% % at Moshi secondary school in Tanzania(11). About 47.7% of AGYW had multiple sexual partners at Moshi SS in Tanzania, more than 45% in Ethiopia(8).

An Ethiopian study reported a RSB prevalence of 43.1% (226) with Youth center attendants less likely to engage in RSB 101 (38.5%) as compared to non users of Youth center clinics 125 (47.7%), p-value = 0.04(8). Of the 524 study participants; 36.5% had started sex before of 18, 107 (%) had 2 and above sexual partners, 119 (%) had not used condom in the previous 12 months, 28 (%) had sex with a Commercial sex worker, 226 (%) had one or more RSB (8). Similarly, another Ethiopian study found that about 58% of the high school students aged between.

In Kenya, findings from Determined Resilient Empowered AIDS-free Mentored and Safe (DREAMS) project, revealed that of the 578 AGYW who reported to have done sex in the last 12 months, 74% had not used condom and all girls aged 15 years and below (n = 9) had not used condom. Factors associated with high RSB were being aged between 19–23 years old, cohabiting, out of school, and living alone with a friend as compared to living with parents(12).

PHIA projects have elucidated risky sexual behaviors at population level in various countries. Sex before the age of 15 was about 9.5% in Zambia(13), 6% in Rwanda (10), Lesotho, Ethiopia, Zimbabwe, and Kenya. Sex without condom in the recent extramarital sex was at 61.2% in Zambia (13), 51.7% in Rwanda(10), Lesotho, Ethiopia, Zimbabwe, and Kenya. Having multiple sexual partners (2+) among AGYW was at 10.0% in Rwanda (10).

Overall, RSBs explains why globally; about 42% of all new HIV infections are among AGYW with about 80% of them living in SSA, and 38% of all global pregnancies are unintended (8). Therefore, accurate knowledge of these behaviors in AGYW can help to use available health resources effectively and efficiently responding to HIV epidemic and UPs among this vulnerable population. This study aimed to identify RSBs and factors associated with them among AGYW in Rwanda using 2028/2019 Rwanda population-based HIV impact assessment data.

The study was a cross-sectional retrospective study, analyzing data from the Rwanda PHIA survey which collected data from Oct 2018 to March 2019.

Population Based HIV Impact Assessment (PHIA project) started in 2014 with the overall aim to establish national status of the HIV epidemic. PHIA projects are conducted under the funding of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Centers for Disease Control and Prevention (CDC) with technical support from ICAP at Columbia University and MGIC at University of Maryland Baltimore. They collect population-based information on HIV epidemic and characteristics of the study participants including their demography, health, reproductive and behavioral information (14). The following graph shows participation flow in the Rwanda PHIA survey 2018–2018.

This study analyzed PHIA data among 6,122 Adolescent girls and young women aged between 15 to 24 years.

Inclusion and exclusion criteria

Inclusion criteria

All females aged between 15 to 24 years old

Exclusion criteria

All females aged 24 years and above

Data Analysis

Data analysis plan was developed to guide data analysis to answer current research questions. The variables include those collecting demographic characteristics, health cover used, sexual and reproductive history and behaviors, and HIV status (Appendix A). Data were analyzed at univariable level to describe participants’ characteristics and the prevalence of risky sexual behaviors among study participants. Bivariable analysis was done by cross-tabulating participants’ characteristics with identified RSBs with HIV status and history of unintended pregnancies among AGYW. Last but least, logistic regression analysis with odd ratios was done for variables statistically associated with RSBs at bivariable level. Similarly, logistic regression analysis was performed to find out to which RSBs associated with HIV infections and UPs uniquely contribute to the prevalence of HIV and UPs.

Presentation of the current study findings covers demographic characteristics of the study participants, risky sexual behaviors (RSBs) and associated factors among AGYW who participated in the 2018/2019 Rwanda PHIA.

4.1. Demographic characteristics of the study participants

This study analyzed data of 6,753 adolescent girls and young women (AGYW) aged 15 to 24 years with mean age of 19 years. Of them, more than a half (55%) aged 15 to 19 years, 72.9% were from rural areas, majority were single (84.6%) with only 3.4% married and 9.5% cohabiting, more than a half (54.4%) had primary education, only 26.2% received payment from their occupation, and 85% were in a household with a health insurance. Table 1 provides details of the study participants characteristics.

Table 1

Characteristics of the study participants
Variable	Frequency (n)	Percent (%)
Age, Mean [Min-Max]	19 [15–24]
15–19 years	3,713	55.0
20–24 years	3,040	45.0
Province
Kigali city	1313	19.4
South	1216	18.0
West	1746	25.9
North	1365	20.2
East	1113	16.5
Rural/urban
Urban	1827	27.1
Rural	4926	72.9
Marital status
Married	230	3.4
Living together	639	9.5
Divorced/Separated/widowed	168	2.5
Single	5,716	84.6
Ever married
Yes	1,038	15.4
No	5,715	84.6
Economic category
I-Lowest	1,126	16.7
II-Second	1,204	17.8
III-Middle	1,240	18.4
IV-Fourth	1,259	18.6
V-Highest	1,924	28.4
Education
No education	118	1.8
Primary	3,670	54.4
Secondary	2,839	42.0
More than Secondary	126	1.9
Received cash from my occ in 12 months
Yes	1,766	26.2
No	4,987	73.9
Household head gender
Male	4350	64.4
Female	2403	35.6
Household have health insurance
Yes	5,738	85.0
No	1,015	15.0
Total	6753	100.0

4.2. Sexual behaviors of the study participants

About 44.1% of the AGYW had ever had sexual intercourse, only 15.4% who had ever been married or lived with someone (cohabitation). 62.1% did not disclose having experienced sexual intercourse, 22.2% had ever been pregnant, 15.2% had ever given birth while 88.5% of those ever been pregnant had one child. Moreover, about 5.1% (n = 343) had started sexual intercourse before the age of 15 years.

Table 2

Risky sexual behaviors of the study participants, Rwanda PHIA 2018–2019
Variable	Frequency (n)	Percent (%)
Age at first sex
NA/Not known	4,191	62.1
Below 15	343	5.1
15–17	733	10.9
18–24	1,486	22.0
Sex before 15 years
Yes	343	5.1
No	6,410	94.9
Self-report on ever done sex
No	3,773	55.9
Yes	2,980	44.1
Had sex with someone she lives with
No	2,164	72.6
Yes	816	27.4
Age of the male sexual partner
14 to 30	1,708	85.7
31 to 40	246	12.4
41–50	38	1.9
Frequency of pregnancy
Never/unknown	5,251	77.8
Once	1,074	15.9
2 and more times	428	6.3
Are you pregnant now
Yes	292	4.3
No	6,461	95.7
Ever given birth
Yes	1268	84.8
No	228	15.2
Number of Children
None	139	11.0
1 Child	1122	88.5
2 to 4	7	0.6
Total	6753	100

4.3. Prevalence of risky sexual behaviors among AGYW

Current study shows that the prevalence of RSBs was 19% among general AGYW population. However, the prevalence was relatively higher among AGYW ever done sex at 44% (n = 1,673). Figure 1 shows the prevalence of having one or more risky sexual behaviors among AGYW among sexually active and general population of AGYW.

4.4. Types of risky sexual behaviors identified among AGYW

Various RSBs identified among the general population of AGYW ever done sex without a reliable method of contraception (11.0%), sex without a condom (5.9%), sex before the age of 15 (5.1%), sex for favor/gifts/money (4.4%) and having multiple sexual partners (4.4%). Relatively rare RSBs include transgenerational sex (0.7%) and anal sex (0.3%). The prevalence rates of RSBs among AGYW ever done sex was relatively higher and they include ever done sex without a reliable method of contraception (24.6%), sex without a condom (13.5%), sex before the age of 15 (11.5%), sex for favor/gifts/money (9.9%) and having multiple sexual partners (9.1%). Relatively rare Similarly, transgenerational sex (0.7%) and anal sex (0.3%) were relatively rare RSBs.

Table 3

Types of risky sexual behaviors identified among AGYW in general vs. those ever-done sex, 2018/2019 Rwanda PHIA
	RSBs among all AGYW		RSBs among AGYW ever done sex
Variable	Frequency (n)	Percent (%)	Frequency (n)	Percent (%)
Sex for gifts/favor/money
Yes	296	4.4	296	9.9
No	6,457	95.6	2,684	90.1
Anal sex
Yes	17	0.3	17	0.8
No	6,736	99.7	1,979	99.2
Sex without condom use in the last 12 months
Yes	402	5.9	402	13.5
No	6,351	94.1	2,578	86.5
Sex without a reliable MC method*
No	6,013	89	2,240	75.2
Yes	740	11	740	24.8
Having multiple sexual partners in last 12 months
No	6,482	96	2,701	90.9
Yes	271	4	271	9.1
Transgenerational sex**
Yes	50	0.7	50	1.7
No	6,703	99.3	2,930	98.3
Sex before the age of 15
Yes	343	5.1	343	11.5
No	6,410	94.9	2,637	88.5
Total	6,703	100	2,980	100
Sex while not using a modern contraception method *Had Sex with s.o aged 10 years + than her

4.5. Factors associated with having one or more risky sexual behaviors

This part presents the association between RSBs and participants’ characteristics including demographic, sexual, obstetric, and household characteristics. Higher prevalence rates of having one are more RSBs were among AGYW aged 20–24 years (33.3%), AGYW in Kigali (24.5%) and Eastern province (22.3%), separated (divorced/widowed) (56.6%), ever married (55.2%), with no education (28.0%), who did their first sex at age between 15–17 years, ever been pregnant (58.4%), were not pregnant by the time of interview (46.8%), and those ever-given birth (64.8%). Table 4.5 shows odd ratios of factors associated with having one or more RSBs among AGYW in a logistic regression analysis. The table 4.4 shows participants’ characteristics associated with having one or more risky sexual behaviors among AGYW aged 15 to 24 years old.

Table 4

Factors associated with having one or more risky sexual behaviors among AGYW
Participants' characteristics	No RSB	One or more RSBs	N	P Value*
Age 15–19 years	3418(92.1)	295(7.9)	3,713	< 0.001
20–24 years	2027(66.7)	1013(33.3)	3,040
Province
Kigali city	991(75.5)	322(24.5)	1,313	< 0.001
South	1017(83.6)	199(16.4)	1,216
West	1472(84.3)	274(15.7)	1,746
North	1100(80.6)	265(19.4)	1,365
East	865(77.7)	248(22.3)	1,113
Rural/Urban
Urban	1401(76.7)	426(23.3)	1,827	< 0.001
Rural	4044(82.1)	882(17.9)	4,926
Marital status
Married	103(45.8)	127(55.2)	230	< 0.001
Living together	288(45.1)	351(54.9)	639
Divorced/Separated/widowed	73(43.4)	95(56.6)	168
Single/Not applicable	4981(87.1)	735(12.9)	5,716
Ever married
Yes	465(44.8)	573(55.2)	1,038	< 0.001
No	4980(87.1)	735(12.9)	5,715
Economic category
I-Lowest	936(83.1)	190(16.9)	1,126	0.03
II-Second	962(79.9)	242(20.1)	1,204
III-Middle	1010(81.5)	230(18.5)	1,240
IV-Fourth	1024(81.3)	235(18.7)	1,259
V-Highest	1513(78.6)	411(21.4)	1,924
Education
No education	85(72.0)	33(28.0)	118	0.014
Primary	2931(80.0)	739(20.0)	3,670
Secondary	2329(82.0)	510(18.0)	2,839
More than Secondary	100(79.4)	26(20.6)	126
Occupation/Received cash from my occ in 12 months
Yes	1271(72.0)	495(28.0)	1,766	< 0.001
No/Not known	4174(84.7)	813(16.3)	4,987
Having any health cover
Yes	4662(81.3)	1076(18.7)	5,738	0.002
No	783(77.1)	232(22.9)	1,015
Household head gender
Male	3513(81.0)	837(19.2)	4,350	0.721
Female	1932(80.4)	471(19.6)	2,403
Household characteristics
Household have a radio
Yes	2828(80.4)	691(19.6)	3519	0.562
No	2617(80.9)	617(19.1)	3234
Household have a TV
Yes	1165(81.6)	263(18.4)	1428	0.305
No	4280(80.4)	1045(19.6)	5325
Sexual and obstetric characteristics of the study participants
Age at first sex
NA/Not known	4187(99.9)		4(0.1)	4191	< 0.001
Below 15	243(70.9)		100(29.1)	343
15–17	295(40.3)		438(59.8)	733
18–24	720(48.5)		766(51.5)	1486
Sex before 15 years
Yes	243(70.9)		100(29.1)	343	< 0.001
No	5202(81.2)		1208(18.9)	6,410
Self-report on ever done sex
No	3772(100.0)		1(0.0)	3773	< 0.001
Yes	1673(56.1)		1307(43.9)	2980
Had sex with someone she lives with
No	1296(59.9)		868(40.1)	2164	< 0.001
Yes	377(46.2)		439(53.8)	816
Ever pregnant
No	1048(70.9)		431(29.1)	1479	< 0.001
Yes	625(41.6)		876(58.4)	1501
Are you pregnant now
Yes	240(83.0)		49(17.0)	289	< 0.001
No	1433(53.3)		1258(46.8)	2691
Ever given birth
Yes	446(35.2)		822(64.8)	1268	< 0.001
No or pregnant now	190(76.0)		60(24.0)	250
Number of Children
None	61(43.9)		78(56.1)	139	0.071
1 Child	383(34.1)		739(65.9)	1122
2 to 4	2(28.6)		5(71.4)	7
* p value (Fisher exact test)

All variables in Table 4 with a p value below in one logistic regression model and only those with statistical significance at p value less 0.05 were maintained in the model. The findings show that AGYW who had ever been pregnant were 19.2 [aOR: 19.2 with 95% C.I: 15.8–23.4] times more likely to present one or more RSBs than those who were not. Similarly, AGYW who were not pregnant by the time of interview were 10.5 times more likely to present a RSB [aOR: 10.5 with 95% C.I: 7.5–14.6] while those who were married, and cohabiting were 1.6 and 1.4 folds (respectively) to have a RSB than those who were not. Moreover, AGYW who started sex before the age 15 were 2.1 times [aOR: 2.1 with 95% C.I: 1.5–2.8] more likely to present a RSB than those who were not.

Table 5

Logistic regression of factors associated with having one or more RSBs among AGYW
Factors	aOR*	Lower	Upper	X2p value
Sex before 15 years
Yes	2.1	1.5	2.8	< 0.001
No	1
Current marital status
Married	1.6	1.1	2.2	0.012
Living	1.4	1.1	1.8	0.005
Divorced/widowed/Separated	1.2	0.8	1.8	0.331
Single	1
Ever pregnant
Yes	19.2	15.8	23.4	< 0.001
No	1
Currently pregnant
No	10.5	7.5	14.6	< 0.001
Yes	1
*Adjusted odd ratio (predicted probabilities are of membership of having one or more RSB(s)

This section discusses the findings against recommended practices and findings of similar studies done globally, regionally, and nationally. The comparison is done against the studies conducted on types of risky sexual behaviors, factors associated with them and well their association with HIV infections and unplanned pregnancies.

4.1. The prevalence risky sexual behaviors among AGYW

This revealed that of the 6,753 AGYW enrolled in the Rwanda population-based HIV Impact assessment survey (RPHIA), 19.4% of the general AGYW population had one or more risky sexual behavior(s) while 44.0% of sexually active AGYW had one or more RSB. This prevalence is slightly higher than that reported in other countries; 43.1% (8) and 53.9%(15) in Ethiopia and 41% in Rwanda (16) but lower than 53.9% in Ethiopia (15), 69.5% in Thailand(17), and 71.1% in Zambia among female adolescent (18). Differences can be attributed to methodological approaches and geographic distributions of the study participants.

4.2. Types of risky sexual behaviors identified among AGYW

The findings show that most common RSBs among AGYW include multiple sexual partners (90.9%), non-condom use (86.5%) during an extra-marital sex in the last 12 months, and sex without a reliable method of contraception (75.2%).

This study shows that 44.1% of the study participants had ever done sex and about most of them had it with multiple sexual partners (90.9%) and about 5.1% before the age 15. These findings differ from the findings in other studies like a Ugandan study. The Ugandan study reported relatively higher rates of AGYW ever done sex (54.5%) and sex before age 15 (19.1%) but current study reported much higher prevalence of AGYW who have multiple sexual partners (90.9%) versus 24.2% in Uganda (19). Several other studies reported lower rates of having 2 and more partners like 66.2% in Colombia(20), 59.4% in Mozambique(21), 47% reported Moshi SS in Tanzania, 45% in Ethiopia(8), and 20.4% in Ethiopia (8). Variations can be attributed to disparities in methodological approaches in the surveys.

Sex without a condom was also very common among AGYW ever done sex in Rwanda (86.5%). The findings are comparable to those reported in other countries including Uganda of 79.6% (19), 74% in Kenya(12), and 61.2% in Zambia (13). However, the rate is much higher than 73% in Colombia(20), 22.7 reported in Ethiopia (8) and South Africa (40.6%)(22). Differences can be due to study populations enrolled in these studies, and community sensitization on use of youth friendly sexual and reproductive health services in these countries.

Majority of AGYW who reported to ever had sex were not using any method of contraception (75.2%). This prevalence is disproportionately higher than that reported in Kenya of 37.4% (23), and South Africa of 47.7% (1% sterilized, 9.6% pill users, 2.3% intrauterine device, and 34.8% on injectables) (22), and 42.0% in Mozambique(21). Moreover, a Kenyan study revealed that AGYW in Universities are mostly worried about getting pregnant other than contracting sexually transmitted infections including HIV. However, instead of using long-acting contraception, they merely rely on emergency contraception methods(24). This calls for action to increase AGYW awareness to equally consider STI prevention along with pregnancy planning.

Although sex for gifts/favor/money (9.9%), transgenerational sex (1.7%) and anal sex (0.8%) were relatively uncommon among AGYW aged 15 to 24 years in Rwanda, several other studies reported higher rates of these RSBs in South Africa(25), 14% of transactional sex in South Africa(26) along with many others(23, 26)

4.3. Factors associated with having one or more risky sexual behaviors

Regarding factors associated with risky sexual behaviors; AGYW ever been pregnant (aOR: 19.2), pregnant by the time of interview [aOR: 10.3], sex before age of 15 [aOR: 2.1], being married [aOR: 1.5], and cohabiting [aOR: 1.4] as main predictors of having at least one RSB. Similar results have been reported in other countries (27) and in Ghana(28), among others. Other factors were also reported including history of alcohol taking and smoking, having a colleague that is sexually active in Ethiopia (29), being not in good term with a mother(30), domestique violence, living away from biological children in Rwanda (16), being raised by single or grandparent, and using dating applications in China(31), age between 20 to 23 years and inadequate knowledge about HIV/AIDS in Ethiopia(32).

In conclusion, this study reveals that about one in four (19.0%) AGYW aged 15 to 24 years old present at least one RSB while nearly one in two (44%) of those ever-experienced sex does. Identified RSBs in general AGYW population include sex without a reliable method of contraception (11.0%), sex without a condom (5.9%), sex before the age of 15 (5.1%), sex for favor/gifts/money (4.4%), having multiple sexual partners (4.0%), transgenerational sex (0.7%), and anal sex (0.3%). These behaviors are predicted by history of pregnancy or pregnant by the time of interview, and sex before the age of 15 among other factors. Therefore, SRH services should focus on delaying age of sexual debut and use contraception and condom among AGYW.

Although current study yielded into important findings on factors associated with RSBs among AGYW, the study did not establish causal relationship between the variables. Moreover, as a retrospective study, this study relied on information available in the dataset

Supplementary Information

The online version contains available supplementary materials

Acknowledgements

The authors are grateful to James Lind Institute in Switzerland the Master of public health management offered to Ange Joselyne Iradukunda. Moreover, they are also thankful to the ICAP at Columbia university and Rwanda Ministry of Health for the effort to avail Rwanda population Based HIV Impact Assessment data available to the public.

Authors’ contributions

A.J.I conceptualized and drafted the proposal. Z.N reviewed the proposal and data analysis plan. Z.N and A.J.I analyzed data and drafted the manuscript. B.I critically reviewed the manuscript. All Authors contributed in the final version of the manuscript.

Funding

We declare that this research did not receive any funding to mention.

Data Availability

Raw data and other processed data can be obtained from the corresponding author upon request.

Ethics approval and consent to participate in the study

This study used public dataset officially obtained from ICAP at Columbia university upon request. Data analysis of RPHIA data was done for research purposes only and with an overall goal to inform targeted services to prevent HIV new infection and unintended pregnancies in Rwanda, especially among AGYW.

Consent for publication

Not applicable

Competing interests

The authors declare no competing interests

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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

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Abstract

Background

Methods

Settings:

Results

Conclusion

Figures

1. Background

2. Study methods

3. Results

4.1. Demographic characteristics of the study participants

4.2. Sexual behaviors of the study participants

4.3. Prevalence of risky sexual behaviors among AGYW

4.4. Types of risky sexual behaviors identified among AGYW

4.5. Factors associated with having one or more risky sexual behaviors

4. Discussion

4.1. The prevalence risky sexual behaviors among AGYW

4.2. Types of risky sexual behaviors identified among AGYW

4.3. Factors associated with having one or more risky sexual behaviors

5. Conclusion

6. Limitations of the study

Declarations

References

Additional Declarations

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Version 1