Food Insecurity and High-Risk Sexual Behaviour among Women of Reproductive Age in Zambia: A Socio-Ecological Model

Abstract

Abstract High-risk sexual behaviour has been shown to be influenced by interpersonal, social, and economic factors in different situations and been linked to food insecurity. This study therefore investigated the individual, household and community factors associated with high-risk sexual behaviour among women age 18-49 in Zambia, paying particular attention to food insecurity status. It was anchored on the Socio-Ecological Model and used a cross-sectional non-intervention study design. We fitted survey weighted logistic regression models based on 1784 weighted cases to examine the association between food insecurity and high-risk sexual behaviour and determine the predictors of high-risk sexual behaviour. The results show that 44 percent of the women engaged in of high-risk sexual. We found that 53.9 (±6.3) percent of the women age 18-49 experienced moderate to severe food insecurity while 21.2 (±2.9) percent experienced severe food insecurity. Food insecurity is associated with high-risk sexual behaviour before controlling for other covariates. Our results show that women with higher education [aOR= 0.471 95%CI 0.254,0.872], women who were married [aOR= 0.123 95%CI 0.065, 0.231], women whose most recent pregnancy was intended [aOR= 0.482 95%CI 0.328, 0.709], women in the rich wealth tertile [aOR= 0.372 95%CI 0.188, 0.736] and women in rural areas[aOR= 0.425 95%CI 0.239, 0.758] had lower odds of engaging in high-risk sexual behaviour. Our findings confirm that high-risk sexual behaviour is influenced by factors beyond the individual level. Thus, HIV prevention response should be holistic in nature. Greater attention should be paid to adolescent girls to reduce high-risk sexual behaviour and avert possible consequences. Improving the social-economic status of women through education and economic empowerment among other interventions, will advertently reduce vulnerability to HIV infection, unintended pregnancy, improve the health and well-being of women and ensure that women are not left behind.