ArticleBMC public health2025
Prevalence and associated factors of condomless sex among adolescents and young adults in Liberia: a multilevel analysis using data from the 2019-2020 Demographic and Health Survey.
Article in BMC public health, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
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6 authors.
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Abstract
backgroundCondom use is an essential component of strategies to improve the sexual and reproductive health of adolescents and young adults (AYA). However, it remains a challenge for many Sub-Saharan African countries, including Liberia. This study aimed to examine the effects of individual and contextual factors on condomless sex within the past 12 months among AYA in Liberia.
methodsA secondary analysis was conducted using data from the 2019-2020 Liberia Demographic and Health Survey (2019-20 LDHS). Sexually active AYA were included in the study. A simultaneous assessment of the effects of individual and community characteristics on unprotected sex was conducted using a multilevel mixed-effects logistic regression model. The adjusted odds ratios (aORs) and their 95% confidence intervals (CIs) for condomless sex were estimated.
resultsOf the 2,260 AYA included in the analysis, 68.3% were female, and 40.0% were living in poor households. Their mean age (± SD) was 19.3 (±2.6) years. Only 31.6% reported a history of HIV testing. The prevalence of condomless sex was 83.1%. Individual and contextual factors explained 71.4% of the variation in condomless sex among AYA. In the multivariable analysis, condomless sex was less likely among males (aOR = 0.36 [0.27-0.47]), those with moderate (aOR = 0.67 [0.48-0.94]) or high (aOR = 0.46 [0.31-0.67]) media exposure, and those with occasional partners (aOR = 0.61 [0.39-0.96]). Having a professional activity was associated with higher odds (aOR = 1.52 [1.17-1.97]). Contextual factors associated with lower odds included high community-level education (aOR = 0.65 [0.43-0.98]), urban residence (aOR = 0.54 [0.37-0.78]), and living in South-Eastern B region (aOR = 0.52 [0.3-0.93]; reference = North-Western).
conclusionThe study shows a high prevalence of condomless sex in Liberia. Condom promotion strategies must take into account individual and contextual factors such as gender and regional inequalities.
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