Risky Sexual Behavior and HIV Infection Among Ghanaians Aged 15–49: Evidence From the Ghana Demographic Health Survey 2003 and 2014

Objective: The study assessed the dominant risk factors associated with risky sexual behavior (RSB) and further quantify its influence on HIV infection among Ghanaians aged 15–49 years using the Ghana demographic and Health Survey (GDHS). Methods: A cross-sectional study using two rounds of the GDHS (2003 = 7448 and 2014 = 10169). RSB and HIV infection were the study outcomes. The study employed dominant analysis to rank the important risk factors associated with RSB. Meta-analysis was conducted to obtain heterogeneity in the prevalence of HIV infection by RSB. The Logistic Inverse Probability Weighting (LIPW) model was employed to estimate the average treatment effect (ATE) of RSB on HIV infection. Results: The prevalence of RSB decreased from 6.0% (95%CI = 5.4–6.6) in 2003 to 5.7% (95%CI = 5.0–6.4) in 2014. The overall growth rate showed a decrease of 2.5 percentage points, although this change was not statistically significant. Generally, dominant analysis showed that over 60% impact of the factors associated with RSB was being male. HIV prevalence ranged from 1.98% (95%CI = 1.6–2.3) in 2003 to 1.59 (95%CI = 1.21–1.98) in 2014 and the overall growth rate was decreased by 10.4%, however, statistically not significant. The overall HIV prevalence was approximately 1.8% (95%CI = 1.52–2.03) with the highest occurring among participants who engaged in RSB (a negligible Higgins’s I² value of 25.4%, p =.260). The average HIV infection, if all participants were to engage in RSB, was approximately two per 100 participants significant in both years [estimate for 2003 = 0.017 (0.013–0.021) while 2014 = 0.016 (0.012–0.019)]. Conclusion: The prevalence of RSB and HIV infection from 2003 to 2014 showed no significant decline. Even though most factors were associated with RSB, over the two rounds of GDHS, being male was the most important factor that predisposes an individual to RSB. The findings from this study recommend a community-based intervention through health promotional activity in the form of behavioral change by adopting a gender-sensitive approach. HIV program implementers should be aware that RSB is paramount among males.