Accelerating HIV Prevention in Cameroon: Factors Associated with Sexual Risk Behaviours and Increased HIV Exposure Among 15-19-Year-Old Adolescent Girls.

Adolescent girls in Cameroon face substantial sexual and reproductive health vulnerabilities that heighten their risk of HIV exposure. Using data from 2,586 adolescent girls aged 15-19 years from the 2017-18 Cameroon Population-based HIV Impact Assessment, we examined factors associated with multiple sexual partnerships, age-disparate sex, inconsistent condom use, transactional sex, and a composite measure of high-risk sex. Overall, 4.31% reported multiple partners, 25.18% engaged in age-disparate sex, 27.06% reported inconsistent condom use, 3.91% engaged in transactional sex, and 19.61% exhibited high-risk sexual behaviours. In multivariable analyses, marriage or cohabitation was strongly associated with age-disparate sex (aOR = 8.57, 95% CI = 5.84-12.56; p < 0.001) and inconsistent condom use (aOR = 10.07, 95% CI = 6.98-14.53; p < 0.001). Adolescent motherhood was associated with high-risk sex (aOR = 1.71, 95% CI = 1.14-2.55; p = 0.011). School non-enrolment was associated with inconsistent condom use (aOR = 1.76, 95% CI = 1.31-2.37; p = 0.001). Predicted probabilities showed that unmarried, non-mothers who initiated sex later had the lowest probability of high-risk sex (8%), whereas married adolescent mothers with early sexual debut had the highest (72%). These findings underscore the need for combination HIV prevention programming that prioritises married adolescents, adolescent mothers, out-of-school girls, and those initiating sex early. Delaying sexual debut, preventing adolescent motherhood and child marriage, and strengthening age-appropriate, context-specific interventions may substantially reduce HIV exposure among adolescent girls in Cameroon.