Comparison of sexual risk behaviors among Zambian adolescent girls and young women living with and without HIV.

Background: We sought to identify commonalities and variations in sexual risk behaviors between adolescent girls and young women living with and without human immunodeficiency virus (HIV) in Zambia. Our goal was to understand the specific needs of these populations to inform the design of interventions to support the sexual health by age group and HIV status.

Methods: As a part of baseline survey Data collected for a cluster-randomized controlled, we surveyed a sample of 650 women aged 16-22 residing in Lusaka, Zambia between May and September 2021. We used bivariate statistical methods to determine whether sexual behavior and contraceptive use differed among participants living with and without HIV, by age group. Statistical significance was defined at P ≤ 0.10.

Results: We found that among the younger participants (aged 16-18), those living with HIV were less likely to have ever had sex or be currently sexually active, and reported fewer casual and serious sexual partners in the last three months compared to those living without HIV. Among participants aged 19-22, we did not see a difference in sexual debut or number of casual sexual partners by HIV status. However, those living with HIV reported fewer recent serious sexual partners and were less likely to be currently having sex in this older age group. There was also evidence that those living with HIV in this older age group were more likely to be using condoms with sexual partners than their counterparts without HIV.

Conclusions: Future HIV interventions should be tailored by age group and HIV status. For example, those living with HIV may require support to confidently engage in safe sexual relationships.

Trial registration: This study was approved by both U.S. and Zambian Institutional Review Boards (RTI Institutional Review Board and RES Converge Zambia, respectively) and is registered on clinicaltrials.gov (NCT03995953).