Risks and predictors of HIV infection among adolescents in conflict regions of Nigeria

Abstract Objectives HIV remains highly prevalent in sub-Saharan Africa, home to approximately 66 % of all people living with HIV and 85 % of children and adolescents living with HIV globally. The region also experiences the highest levels of armed conflict, resulting in a dual burden of violence and infectious diseases like HIV. Despite these challenges, few studies have explored the impact of war and armed conflict on HIV transmission among adolescents in sub-Saharan Africa. To address this gap in the literature, our study examines HIV risk behaviors among adolescents in both conflict and non-conflict zones of Nigeria. Methods This was a cross-sectional study of adolescents aged 15–19 years, identified through the Nigeria HIV/AIDS Indicator and Impact Survey (NAIIS). We assessed the prevalence of HIV risk behaviors across the entire country, stratified by conflict zone status. Bivariate associations between risk behaviors and conflict status were evaluated using the chi-square test. To identify factors associated with HIV infection among adolescents, we employed survey-weighted logistic regression models, reporting adjusted odds ratios (AOR) and 95 % confidence intervals (CI). Results We analyzed 20,518,667 weighted records of adolescents aged 15–19 years, from both conflict (11 %) and non-conflict zones (89 %) of Nigeria. Despite the majority of adolescents residing in non-conflict zones, we found that high-risk behaviors for HIV, such as the non-use of condoms, were more prevalent in conflict zones. However, transactional sex and having two or more sexual partners were significantly higher among adolescents in non-conflict areas. Notably, the risk of HIV infection was over three times higher among adolescents who did not use condoms during sexual intercourse (AOR: 3.22, CI: 1.13, 9.19; p 0.029). Additional risk factors included younger age, educational status, engagement in transactional sex, and having multiple sexual partners. Conclusions This study reports the risk behaviors that contribute to HIV infection among adolescents, particularly within conflict settings. Our findings highlight the link between conflict and heightened HIV risk behaviors among Nigerian adolescents. By identifying these factors and understanding the unique challenges faced by adolescents in conflict zones, more effective, youth-friendly reproductive health programs can be developed for regions impacted by war and conflict.