Predictors of Human Immunodeficiency Virus High-Risk Sexual Behaviors among Unmarried Women

Rationale: Human immunodeficiency virus (HIV) incidence in Ivory Coast is the highest in West Africa, yet factors associated with high-risk sexual behaviors are not well understood. In this study, we report predictors that are dependently and independently associated with high-risk sexual behaviors among Ivory Coast unmarried women aged 15-49 using Demographic and Health Survey (DHS) data. Methods: This study used DHS data conducted in 2012 in Ivory Coast. Univariate and multivariable logistic regression models were used to determine factors associated with high-risk sexual behaviors among unmarried women. High-risk sexual behaviors examined were non-use of condoms during sexual intercourse and having multiple sexual partners. Results: A total of 10,060 women aged 15-49 participated in the survey. Of these, 3607 (36%) were single women. Among factors independently associated with non-use of a condom during sexual intercourse were: the use of contraceptives aOR=2.95, 95% CI (2.35-3.70, p<0.0001, living in a poor household aOR=1.71, 95% CI (1.09-2.69, p=0.019), and older age groups: 25-34, aOR=1.44, 95% CI (1.12-1.86, p=0.005), and 35-49, aOR=1.96, 95% CI (1.37-2.81, p<0.0001) compared to the 15-24 age group. Conversely, secondary and higher education aOR=0.65, 95% CI (0.48-0.90, p=0.008) and being exposed to the radio aOR=0.68, 95% CI (0.52-0.90, p=0.008), were independent protective determinants. In addition, independent risk factors contributing to having multiple sexual partners included: animist religion aOR=1.88, 95% CI (1.04-3.36, p=0.034), TV exposure aOR=2.31, 95% CI (1.17-4.55, p=0.015), geographical location: Abidjan aOR=2.02, 95% CI (1.16-3.56, p=0.014), South aOR=2.54, 95% CI (1.41-4.61, p=0.002), West aOR=2.19, 95% CI (1.19-1.02, p=0.011) and a higher education level aOR=2.26, 95% CI (1.25-4.06, p=0.007). Conclusion: Social, regional, economic and institutional factors influence the highrisk sexual behaviors among unmarried women in Ivory Coast. Health education programs should develop a holistic outreach programs that target the social ecological model of determinants of sexual health in Ivory Coast.