A Meta-Analysis on Higher-Risk Sexual Behavior of Women in 28 Third World Countries

Background: Previous reports on sexual behaviours and risks of HIV infection in relation to socioeconomic status of women were contradictory. The purpose of this study was to determine the consistency of risky sexual behaviour among women with regard to their age, residence, educational level and wealth index. Methods: Subgroup and pooled meta-analysis was done on risky sexual behaviour and HIV prevalence of women aged 15 - 49 years using the recent Demographic and Health Surveys data (DHS 2003-2009) from 28 countries in and outside Africa. Pooled and individual countries odds ratios were calculated using Mantel-Haenszel (M-H) statistical method. Random effect analytic model was applied since there was significant heterogeneity among surveys (I2 > 50%). Sensitivity analysis was also done to examine the effect of outliers. Results: Out of 207,776 women reported to have sex within 12 months prior to the respective surveys, 36,530 (17.6%) were practicing higher-risk sex. Risky sexual behavior was found to have statistically significant association with women living in urban areas, attained secondary and above education and owned middle to highest wealth index. Sensitivity analysis demonstrated the stability of the pooled odds ratios for outliers. Better education attainment, high wealth index and being employed were also associated with high HIV prevalence. Conclusion: This analysis has shown the high prevalence of higher-risk sexual behaviour and high HIV infection among wealthier and better educated women regardless of geographic location of the selected low to middle income countries. Further study is required to establish how and why being good in socioeconomic status associated with risky sexual behaviour.