Risky Sexual Behavior Affects Nearly Four in Ten Young Tanzanian Women, Survey Finds

Nearly four in ten sexually active adolescent girls and young women in Tanzania report risky sexual behavior, according to a secondary analysis of the 2022–2023 Tanzania HIV Impact Survey (THIS) published by researchers led by Magreth Thadei Mwakilasa. The study, which examined 3,669 sexually active respondents aged 15 to 24 years who answered PrEP-related questions, found a survey-weighted prevalence of risky sexual behaviors of 38.29 percent. The burden was sharply concentrated among the youngest participants: 61.57 percent of those aged 15 to 17 years reported risky behavior, compared with 35.63 percent of those aged 18 to 24 years.

The analysis used nationally representative survey data, applying survey-weighted descriptive statistics, chi-square tests, and multivariable logistic regression. Adjusted odds ratios with 95 percent confidence intervals were reported, with statistical significance set at p < 0.05. Risky sexual behavior contributes to HIV acquisition among adolescent girls and young women in Sub-Saharan Africa, including Tanzania, yet nationally representative evidence on its prevalence and associated factors had remained limited. The study was framed in the context of expanding provision of pre-exposure prophylaxis (PrEP), a biomedical HIV prevention intervention.

Not being in a union emerged as the strongest correlate in both age groups. Among participants aged 15 to 17 years, those not in a union had adjusted odds of risky sexual behavior of 8.72 (95 percent CI: 4.33–17.55; p < 0.001), while among those aged 18 to 24 years the adjusted odds ratio was 15.13 (95 percent CI: 11.40–20.08; p < 0.001). Alcohol use was also associated with increased odds in both groups: an adjusted odds ratio of 13.38 (95 percent CI: 1.53–116.64; p = 0.019) among 15- to 17-year-olds, and 2.47 (95 percent CI: 1.57–3.89; p < 0.001) among 18- to 24-year-olds. The very wide confidence interval for the youngest group reflects limited precision in that estimate.

Among young women aged 18 to 24 years, the pattern of associated factors was more differentiated. Health facility attendance, family planning use, and willingness to use PrEP were associated with higher odds of risky sexual behavior, whereas secondary or higher education, parent or guardian communication about sex or HIV, and prior HIV testing were associated with lower odds. The authors note that these associations suggest that young women in contact with health services may be those who recognize their own risk, while education, family communication, and prior testing appear protective in the statistical sense.

The researchers conclude that risky sexual behavior remains common among Tanzanian adolescent girls and young women, particularly those aged 15 to 17 years. They recommend age-responsive prevention programmes that integrate behavioral and biomedical interventions, prioritizing AGYW who are not in a union and who use alcohol or have limited access to PrEP. As a cross-sectional secondary analysis, the study identifies associations rather than causal effects, and the findings are limited to sexually active survey respondents who answered the PrEP-related questions. The authors report no efficacy claims for PrEP itself; the survey measured willingness to use PrEP as one of several factors associated with reported behavior.

Subject of Research: Prevalence and associated factors of risky sexual behavior among adolescent girls and young women aged 15–24 in Tanzania, analyzed from the 2022–2023 Tanzania HIV Impact Survey in the context of PrEP provision.

Article Title: Risky sexual behaviors and associated factors among adolescent girls and young women in the context of HIV prevention pre-exposure prophylaxis in Tanzania: Analysis of the Tanzania HIV Impact Survey 2022–2023

Article References: Mwakilasa, M. T., Kakoko, D., Gilmore, J., & Gilmore, B. (2026). Risky sexual behaviors and associated factors among adolescent girls and young women in the context of HIV prevention pre-exposure prophylaxis in Tanzania: Analysis of the Tanzania HIV Impact Survey 2022–2023. PLOS Global Public Health, 6(10), e0007311. https://doi.org/10.1371/journal.pgph.0007311

Image Credits: AI Generated

DOI: 10.1371/journal.pgph.0007311

Keywords: Tanzania, HIV, PrEP, adolescent girls and young women, risky sexual behavior, Tanzania HIV Impact Survey, THIS 2022-2023, Sub-Saharan Africa, alcohol use, HIV prevention, logistic regression, survey analysis