Prevalence of risky sexual behaviour and its association with alcohol use among unmarried adolescents and young adults in Eswatini: Evidence from a population-based survey

Abstract HIV remains a major public health concern in sub-Saharan Africa (SSA), with adolescents and young adults (AYA) facing heightened vulnerability due to risky sexual behaviours (RSBs). In Eswatini, despite efforts to expand sexual and reproductive health (SRH) services, HIV prevalence and teenage pregnancy remain high. Alcohol use is a known driver of risky sexual behaviours, yet evidence on its association with risky sexual behaviour among AYA in Eswatini is limited. Therefore, this study aimed to examine the association between risky sexual behaviour and alcohol use among unmarried AYA in Eswatini. We conducted a cross-sectional analysis of the Swaziland HIV Incidence Measurement Survey 3 (SHIMS 3) data, using a weighted sample of 1,392 sexually active unmarried adolescents and young adults aged 15–24 years. We fitted logistic regression models to determine the association between risky sexual behaviour and alcohol use among unmarried adolescent and young adults in Eswatini with their 95% confidence interval (CI) at p -value < 0.05 statistical significance. The prevalence of risky sexual behaviour among AYA was 52.7% (95% CI: 50.1 – 55.3), while the prevalence of alcohol use was 31.3% (95% CI: 28.9 – 33.7). The study found a significant association between risky sexual behaviour and alcohol use (aOR = 2.35, 95% CI: 1.78 – 3.11). After controlling for covariates, residing in the Shiselweni region (aOR = 2.11, 95% CI: 1.55 – 2.86), and PrEP awareness (aOR = 1.60, 95% CI: 1.26 – 2.04) were associated with higher odds of engaging in risky sexual behaviour. This study found a significant association between risky sexual behaviour and alcohol use among unmarried adolescent and young adults in Eswatini. Addressing both substance use and sexual health through tailored, youth-friendly interventions is essential to reduce HIV transmission and improve SRH outcomes among adolescents and young adults.