Pooled prevalence, spatial variation and associated factors of risky sexual behavior among sexually active men and women aged 15–49 years in sub-Saharan Africa, 2015–2024: evidence from Demographic and Health Survey

Abstract Background Risky sexual behavior remains a significant public health challenge in Sub-Saharan Africa, contributing to the high prevalence of HIV/AIDS, sexually transmitted infections. Despite extensive research on risky sexual behavior among specific populations such as adolescents and young women, there is limited evidence on the spatial variations of risky sexual behavior and its determinants among men and women aged 15–49 years across Sub-Saharan Africa. Objectives This study aimed to assess the pooled prevalence, spatial variation, and associated factors of risky sexual behavior among sexually active men and women aged 15–49 years in sub- Saharan Africa using recent Demographic and Health Surveys data from 2015 to 2024. Methods A community-based cross-sectional study was conducted using Demographic and Health Surveys data from 27 SSA countries. A weighted sample of 428,909 sexually active adults was analyzed. Spatial analysis techniques, including Global Moran’s I, Getis-Ord Gi*, and spatial interpolation, were used to detect clustering patterns. Spatial regression models such as Ordinary Least Squares and geographically weighted regression were employed to identify associated factors and assess spatial non-stationarity. Results The pooled prevalence of risky sexual behavior in SSA was 17% (95% CI: 13%–20%), with significant variation across countries ranging from 3% in Senegal to 39% in Liberia. Spatial analyses revealed statistically significant clustering of risky sexual behavior (Global Moran’s I = 0.42, p < 0.001), in parts of Southern and Western Africa. Key predictors of risky sexual behavior included being male, not married, unemployed, media exposure, and having been tested for HIV. The influence of these predictors varied significantly across geographic regions, highlighting substantial spatial heterogeneity. Conclusion Risky sexual behavior remains a major public health concern in SSA, with notable spatial variation and locally varying determinants. Targeted, geographically tailored interventions that address local socio-cultural and structural factors are important to effectively reduce risky sexual behavior and its health consequences in the region.