We conducted a secondary analysis of SLDHS data to estimate the prevalence of HIV risk factors and their socio-demographic associates among women of reproductive age in Sierra Leone. In this study, four factors were considered as potential HIV risk factors, including; non-condom use at last sexual intercourse for unmarried women, engaging in transactional sex, having other sexually transmitted infections (STIs), and having multiple sexual partners. To our knowledge, this is the first study to focus on the burden of HIV risk factors in Sierra Leone.
The study results showed that 38% of the women had encountered any of the four risk factors, 27% had non-condom use (the unmarried), 12% had other STIs, while less than 10% had engaged in transactional sex and had multiple sex partners. Although no immediate similar study to compare our results with, the overall burden of such risk factors is of significant impact in a low-income country with a high burden of other infectious diseases coupled with a weak health system . With yet no effective cure nor vaccine against HIV, preventive measures aimed at reducing new infections mainly through risk-reduction are paramount in the fight against the HIV epidemic. The observed high burden of HIV risk factors, therefore, reflects a gap in the HIV/AIDS prevention and control strategies implemented in Sierra Leone, implying a need to strengthen health promotion and sexual behaviour educational programs among reproductive-aged women in the country. However, the reported prevalence, specifically, of non-condom use in this study is less than that reported by the World Health Organisation , and that from Tanzania , Malawi , USA , and China .
Our study also explored several socio-demographics associated with the burden of HIV risk factors, where age, parity, place of residence, region, sex of household head, marital status, and working status were found to be significant.
Women of younger age were more likely to engage in/encounter HIV risk factors compared to older women in Sierra Leone. This is similar to other studies that have individually reported age to be associated with condom use [3, 28], having other STIs [18, 31], transactional sex  and multiple sex partners . Younger people are generally curious and common victims of peer influence thus can easily end up engaging in various risk behaviours for not only HIV but also other STIs [18, 31]. Moreover, parity was also significantly associated with HIV risk factors among women, whereby those who had ever produced fewer children were more likely to face HIV risk factors compared to their counterparts of more parity. The possible reason could be that women with no or fewer children are usually younger with less responsibilities and children to look after, so they can easily engage in risky behaviours [18, 32].
The current study results revealed that place of residence is associated with HIV risk factors, where urban women had more chances of encountering HIV risk factors. Due to the appealing and active nature of urban settings, with more entertainment avenues such as bars and clubs, women residing in these places are more exposed to risky behaviours . Moreover, commercialized sexual activities and drug use tend to be more concentrated in urban areas, possibly due to the increasing trends of the urban poor and slum dwellings [18, 33]. Consistently, region was also found to be associated with HIV risk factors, where women in the Northwestern part of the country were more likely to face HIV risk factors. This may be attributed to the differential social-cultural contexts and economic developments in various parts of the country. No wonder, the Northwestern part has a higher concentration of economic development and mining activities, with a generally urban or semi-urban lifestyle . Furthermore, the low employment rate of women in this region lures majority of them to engage in petty trading which exposes them to HIV risk factors during hawking from one community to another . However, our results showed that women in the Southern part were less likely to encounter HIV risk factors yet the region has several fishing communities. The finding deviates from previous studies that have labelled such fishing communities as HIV/AIDS hotspots due to various unique risky behaviours in such communities [3, 34]. Region and place of residence have been reported in other studies to be associated with multiple sex partners , condom use , STIs , and transactional sex .
Participants from female-headed households were more likely to encounter HIV risk factors compared to those from male-headed households. Consistently, unmarried women also had extremely higher chances of facing HIV risk factors compared to married women. Unmarried women from female-headed households tend to have more freedom from marital obligations and autonomy to do whatever they please, unlike their married counterparts, implying they can easily engage in risky behaviours for survival or economic reasons . Marital status of women has been, disaggregatively, shown in other studies to be associated with transactional sex , multiple sex partners , and having other STIs .
Working status also had an association with HIV risk factors, whereby working women had more chances of encountering HIV risk factors compared to non-working women. Depending on the type and nature of the employment, most informal jobs predispose women to risky behaviours, for instance, working in bars, guesthouses, and sex workers, among others [33, 36]. Furthermore, although regarded as a crucial aspect of women empowerment, employment has been shown to have other negative associates, for example, sexual violence . Working status of women has been reported in previous studies to be associated with having other STIs , transactional sex , and condom use .