An investigation of socio-economic determinants of risky sexual behaviour in Zambia in relation to HIV/AIDS vulnerability : using the 2013/14 Zambia Demographic and Health Survey.

Abstract

Risky sexual behaviours such as using condoms inconsistently with multiple sexual partners have been highlighted as among the main drivers of HIV transmission. In light of public education campaigns, this paper investigated the demographic and socioeconomic factors associated with this risky sexual behaviour. Data for this analysis were derived from a sample of 14,773 men aged between 15 and 59 years who took part in the Demographic and Health Survey conducted in 2013-14 in Zambia. Risky sexual behaviour was defined as not using condoms consistently with all partners when the man had multiple partners in the last 12 months. All variables came from the men’s questionnaire. HIV infection was determined using dried blood spots obtained from a finger prick. Weighted unadjusted and adjusted logistic regression models were used to analyse the relationship between socio-demographic and risky sexual behaviour in relation to HIV vulnerability. The study revealed that one in four men who were interviewed in the 2013-14 ZDHS reported engaging in risky sexual behaviour. Men who were married or living with partners (Adjusted Odds Ratio (aOR) 1.81, 95% Confidence Interval (CI) 1.45-2.25), reside in rural areas (aOR, 1.60, 95% CI 1.33-1.92), were away from their home for less than one month (aOR 1.46, 95% CI 1.28 -1.66) or more than one month (aOR 1.82, 95% CI 1.54 - 2.15), men in middle (aOR 1.27, 95% CI 1.05 - 1.55) or richer wealth quintiles (aOR 1.39, 95% CI 1.09 - 1.77), were more likely to engage in risky sexual behaviour. Furthermore, men with any type of occupation, men who use alcohol (aOR 3.05, 95% CI 2.55 - 3.66) and have been tested for HIV (aOR 1.16, 95% CI 0.99 - 1.35) were more likely to be HIV infected. The analysis in the study also highlighted that men with risky sexual behaviour, that is, had multiple partners and were inconsistent condom users, were less likely to be HIV infected (aOR 0.55, 95% CI 0.40 - 0.77). Risky sexual behaviour such as inconsistent condom use when the man had multiple partners is an important determinant of HIV infection. HIV/AIDS prevention programs in Zambia need to focus on educational strategies that can be used to reduce risky sexual behaviour among vulnerable men in order to prevent HIV acquisition.