Risky sexual behaviors and associated factors among adolescent girls and young women in the context of HIV prevention pre-exposure prophylaxis in Tanzania: Analysis of the Tanzania HIV Impact Survey 2022-2023.

Risky sexual behavior contributes to HIV acquisition among adolescent girls and young women (AGYW) in Sub-Saharan Africa (SSA), including Tanzania. However, nationally representative evidence on its prevalence and associated factors remains limited. This study examines the prevalence and associated factors of risky sexual behavior among AGYW aged 15-24 years in Tanzania, in the context of the expanding Pre-Exposure Prophylaxis (PrEP) provision. A secondary analysis of nationally representative data from the 2022-2023 Tanzania HIV Impact Survey (THIS) was conducted among 3,669 sexually active AGYW aged 15-24 who answered PrEP-related questions. Survey-weighted descriptive statistics, chi-square tests, and multivariable logistic regression were carried out. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported, and statistical significance was set at p < 0.05.The survey-weighted prevalence of risky sexual behaviors was 38.29%, higher among those aged 15-17 years than 18-24 years (61.57% versus 35.63%). Not being in a union was associated with increased odds of risky sexual behaviors among participants aged 15-17 years (AOR = 8.72, 95% CI: 4.33-17.55; p < 0.001) and 18-24 years (AOR = 15.13, 95% CI: 11.40-20.08; p < 0.001). Alcohol use was also associated with increased odds in both age groups (15-17 years: AOR = 13.38, 95% CI: 1.53-116.64; p = 0.019; 18-24 years: AOR = 2.47, 95% CI: 1.57-3.89; p < 0.001). Among young women aged 18-24 years, health facility attendance, family planning use and willingness to use PrEP were associated with higher odds, whereas secondary or higher education, parent or guardian communication about sex or HIV, and prior HIV testing were associated with lower odds. Risky sexual behavior remains common among Tanzanian AGYW, particularly those aged 15-17 years. Age-responsive prevention programmes need to integrate behavioral and biomedical interventions, prioritizing AGYW who are not in a union and who use alcohol or have limited access to PrEP.