DEMOGRAPHIC

AND

HEALTH

SURVEYS

DHS WORKING PAPERS

2014 No. 105

Etienne Rugigana 

Francine Birungi 

Manassé Nzayirambaho 

September 2014

This document was produced for review by the United States Agency for 

International Development.

HIV Knowledge and Risky Sexual Behavior 

among Men in Rwanda

HIV Knowledge and Risky Sexual Behavior among Men in Rwanda 

Etienne Rugigana 1

Francine Birungi 1

Manassé Nzayirambaho 1

ICF International 

Rockville, Maryland, USA 

September 2014 

1 School of Public Health, University of Rwanda 

Corresponding author: Manassé Nzayirambaho, School of Public Health, University of Rwanda, Kigali, Rwanda; 

Email: mnzayira@nursph.org 
ACKNOWLEDGMENTS 

This working paper was funded by USAID through the DHS Fellows program 

implemented by ICF International. The authors are very grateful for comments, reviews, and 

suggestions made by Sarah Staveteig and Wang Wenjuan. Particularly, we are grateful to Sarah 

Staveteig and to Dana Thomson for the constant technical support and advice they provided to 

us. Special thanks to Joy Fishel for reviewing our paper and providing invaluable comments. 

Also we would like to extend our sincere appreciation to all the 2014 DHS Fellows and cofacilitators for their support throughout the Fellows Program. We are also very grateful to Bryant 

Robey for editing, Shireen Assaf for assistance checking numbers in the document and Yuan 

Cheng for formatting. 

The DHS Working Papers series is an unreviewed prepublication series of papers reporting on research in 

progress that is based on Demographic and Health Surveys (DHS) data. This research is carried out with 

support provided by the United States Agency for International Development (USAID) through The DHS 

Program (#AID-OAA-C-13-00095). The views expressed are those of the authors and do not necessarily 

reflect the views of USAID or the United States Government. 

The DHS Program assists countries worldwide in the collection and use of data to monitor and evaluate 

population, health, and nutrition programs. For additional information about the DHS Program contact: 

DHS Program, ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA. Phone: +1 

301-407-6500; Fax: +1 301-407-6501; Email: reports@dhsprogram.com; Internet: 

www.dhsprogram.com. 
ABSTRACT 

Introduction: In many countries different interventions have been implemented to 

prevent new infections of the Human Immunodeficiency Virus (HIV). Rwanda has developed 

and implemented many strategies at the national level to reduce the incidence of HIV in the 

general population. One of the main objectives of such interventions is to improve the general 

level of knowledge of HIV, with the hypothesis that increasing HIV knowledge will reduce risky 

sexual behavior. However, there has been a concern that HIV knowledge may not necessarily 

reduce risky sexual behavior. Only a limited number of population-based studies describe the 

results of these interventions in terms of how HIV knowledge affects risky sexual behavior. 

Therefore, the aim of this paper is to fill in this gap, by exploring HIV knowledge and its effect 

on risky sexual behavior among men in Rwanda. 

Methods: The study used data from the 2005 and 2010 Rwanda Demographic and Health 

Surveys to analyze the association between HIV risk factors and two types of risky sexual 

behavior—having two or more partners in the past 12 months; and among those with two or 

more partners, not using a condom at last sex)—and the association between HIV knowledge and 

those risky behaviors. In addition to descriptive and bivariate analyses, multivariate logistic 

regression on pooled data from 2005 and 2010 was used to determine predictors of risky sexual 

behavior. 

Results: Among men in the study sample, 5% in 2005 and 7% in 2010 reported having 

two or more sexual partners in the last 12 months preceding the survey. Among these men, 93% 

in 2005 and 74% in 2010 did not use a condom at the last sex. Knowledge of the protective effect 

of having just one uninfected faithful partner decreased from 90% to 82% between 2005 and 

2010, and basic knowledge of HIV decreased from 71% in 2005 to 68% in 2010. Knowledge of 

the protective effect of using condoms increased from 90% in 2005 to 94% in 2010. In adjusted 

multivariate analysis, HIV knowledge was not associated with either type of risky sexual 

behavior. 

Conclusion: The findings suggest that, while knowledge of the protective effect of using 

condoms has increased, knowledge of the protective effect of one uninfected faithful partner has 

been decreasing in Rwanda. This should draw attention to the need to take corrective measures. 

The study did not find strong evidence of a significant association between HIV knowledge and 
risky sexual behavior among men in Rwanda. In setting up policies and strategies related to HIV 

prevention, policymakers should consider that focusing on HIV knowledge is not sufficient in 

itself. 

Keywords: HIV knowledge, men, risky sexual behavior, Rwanda 
1

INTRODUCTION 

In Rwanda as in many other countries, different interventions have been implemented to 

fight against new infections of the Human Immunodeficiency Virus (HIV). Generally, one of the 

main objectives of such interventions is to improve general knowledge of HIV. Around the 

world, local and international efforts have led to successful HIV prevention programs in terms of 

improving HIV knowledge and awareness. However, HIV transmission is not decreasing as 

rapidly as desired, especially when considering the large amount of money and many other 

efforts spent on its prevention (UNAIDS 2008). 

It is therefore important to understand the relationship between HIV knowledge and risky 

sexual behavior (RSB), and the different components of HIV knowledge that are positively 

associated with the reduction of RSB. 

Since 1987, the government of Rwanda has been making substantial efforts in the fight 

against HIV/AIDS. Activities related to HIV/AIDS prevention and treatment have been carried 

out through different structures such as the National Program for the Fight against AIDS 

(PNLS), the National AIDS Commission (CNLS), the Treatment and Research AIDS Centre 

Plus (TRAC Plus), and the district AIDS committees (CDLS). Different strategies used in the 

fight against AIDS are also found in the Rwandan National AIDS strategic Plan. These include 

Information, Education, and Communication (IEC) strategies, which target mainly sexually 

active men age 15-59 and women age 15-49 (MOH [Rwanda] and RBC 2009; Hong et al. 2013). 

These efforts have resulted in the achievement of two objectives: first, increased 

awareness of the existence of HIV as well as its transmission. Data indicate that the proportion of 

men who have heard of HIV/AIDS was virtually universal, both in 2005 and 2010 (NISR et al. 

2012). The second objective is increased awareness of ways to prevent HIV infection. Under this 

objective, information related to the “ABC” strategy (abstinence, being faithful, using a condom) 

has been widely disseminated. Condoms have also been distributed free of charge in different 

strategic places or sold at very low cost, from the cities to the last small shop in villages. 

Despite a satisfactory situation in terms of knowledge of HIV prevention and availability 

of condoms, many people still engage in RSB. 
2

Background 

RSB can be defined in different ways. The U.S. Centers for Disease Control and 

Prevention (CDC) defines RSB as behavior that increases one’s risk of contracting sexually 

transmitted infections and experiencing unintended pregnancies. Risky behaviors are measured 

through a number of elements that include having sex at an early age, having multiple sexual 

partners, having sex while under the influence of alcohol or drugs, and having unprotected sex 

(CDC 2010). Many authors include in their definitions of RSB two main elements: 1) having 

sexual intercourse with a casual acquaintance without using a condom; 2) having multiple sexual 

partners (Booysen 2004). 

This study is about HIV-related RSB. We focus on two types of RSB among men that 

have been identified by international experts as indicators of risky behavior: multiple sexual 

partners (having two or more sexual partners in the past 12 months) and unprotected sex (not 

using a condom at the last sex for someone who had two or more sexual partners in the past 12 

months). These two indicators—P8.11.N and P8.12.N, respectively, in the President’s 

Emergency Plan for AIDS Relief (PEPFAR)1

—are useful measures of risk behavior in the 

population (PEPFAR 2013). 

Different studies have reported low levels of condom use regardless of the infection risks 

(de Walque and Kline 2009; Biraro et al. 2009; Ahmed et al. 2001), while some others did not 

find significantly higher levels of condom use among populations with higher prevalence of HIV 

(Lagarde et al. 2001). A study conducted in Ethiopia among factory workers with a high HIV 

prevalence also showed low condom use despite widespread of knowledge of condoms (Sahlu et 

al. 1999). Similarly, an increase of some types of RSB was observed in Uganda over the period 

of 2001-2005, where a higher percentage of males age 15–49 in 2005 reported having multiple 

sexual partners and having sex with non-spousal partners compared with 2001 (25% versus 29% 

and 28% versus 37%, respectively) (Opio et al. 2008). Such a trend in RSB is notable given the 

high level of HIV prevention knowledge and known reduced risk of contracting HIV in the case 

of consistent condom use (Weller and Davis 2002; Pinkerton and Abramson 1997). This is why 

the question arises about the effect of HIV knowledge on RSB. 

 

1

 PEPFAR defines P8.11.N and P8.12.N among women and men age 15-49; this report uses men age 15-59. 
3

The literature gives mixed results about the effect of HIV knowledge on RSB. For 

example, studies in Zambia, Uganda, and Kenya show a positive effect of knowledge of HIV 

prevention methods on protective sexual behavior (MacIntyre et al. 2001; Magnani et al. 2002). 

However, other studies reveal little impact on condom use of having good knowledge of its 

protective benefits (Essien et al. 2002; Williams et al. 2003). Empirical theories about the link 

between behavior and knowledge suggest that self-perceived vulnerability to HIV is probably the 

main factor underlying RSB, more so than knowledge (McKusic and Coates 1985). The basis of 

HIV perceived vulnerability is people’s beliefs about their own behavior as well as the 

possibility of getting HIV from this behavior (Gillespie 1997). Perceived vulnerability is an 

important component of the Health Belief Model. Specifically for HIV, it has been proposed that 

in the general population there is a negative association between RSB and HIV self-perceived 

vulnerability (McKusic and Coates 1985). That is, when people perceive that they are less 

vulnerable to HIV, they would be more likely to engage in RSB, independent of their knowledge 

about HIV. 

In addition to HIV knowledge, some studies have also explored other factors correlated 

with RSB. According to the literature of developed countries, associations between RSB and 

socio-demographic factors are fairly robust (Kumari and Nair 2012). In other studies, some 

individual characteristics such as age, religion, caste, wealth status, education, occupation, and 

knowledge about sexually transmitted infections and HIV were associated with increased RSB 

(Kimuna and Djamba 2005; Li et al. 2009; Gras et al. 2001; Seidman et al. 1994). Other factors 

associated with higher RSB are smoking and alcohol (Opio et al. 2008; Weller and Davis 2002; 

Pinkerton and Abramson 1997), as well as witnessing violence among parents (Pinkerton and 

Abramson 1997). Recent studies also have reported an association between male circumcision 

and RSB (Kibira et al. 2014; Cassell et al. 2006; Eaton and Kalichman 2009). 

To sum up, many strategies aiming at reducing RSB assume that increasing HIV 

knowledge and making condoms available will increase safer sexual behavior. However, it is not 

always the case. The present study assesses this relationship between HIV knowledge and RSB 

in the context of Rwanda, where programmatic efforts in HIV prevention measures have been 

scaled up between 2005 and 2010. 
4

Research Questions 

In Rwanda, HIV new infections are estimated to be 6,000 per year (MOH [Rwanda] and 

RBC 2014). HIV prevalence is 3% in the general population, and 2.2% in men versus 3.7% in 

women. This prevalence is highest among women in urban areas, at 8.7%. It was also found that 

HIV prevalence is highest among those who are widowed, divorced, or separated, and those who 

are in polygamous unions (MOH [Rwanda] and RBC 2014). 

Even though men’s HIV prevalence in Rwanda is relatively low compared with some 

other African countries, Rwanda ranks 13th among 27 sub-Saharan African countries (ICF 

International 2012), unchanged since 2005. Thus HIV still constitutes a big burden on the 

Rwanda Health System. Many strategies have been developed and implemented at the national 

level to reduce the incidence of HIV in the general population of Rwanda. These strategies 

include mass media communication, community events and outreach, and campaigns. Young 

people have been reached through school-based sexual health and AIDS education, anti-AIDS 

clubs, and outreach work for out-of-school youth. One of the main objectives has been to provide 

the entire population with comprehensive knowledge of HIV/AIDS (MOH [Rwanda] and RBC 

2009). 

However, very few population-based studies describe the results of these interventions in 

terms of status of HIV knowledge and its effect on RSB. Thus, the aim of this study is to fill in 

this gap, exploring HIV knowledge and its effect on RSB among men, based on data from the 

2005 and 2010 Rwanda Demographic and Health Surveys (RDHS). Specifically, this study tries 

to answer the following questions: 

• Are there differences in HIV knowledge between the 2005 and 2010 surveys? 

• What are the differences in RSB between the 2005 and 2010 surveys? 

• What is the association between HIV knowledge and RSB of men in 2005 and 2010? 

The answer to these questions can help to design more focused and strategic 

interventions. This is particularly necessary not only for Rwanda but also for other comparable 

countries where governments and partners continue to implement and scale up HIV prevention 

interventions. It is important to implement HIV prevention programs based on strong evidence. 

This implies better understanding of the HIV dynamics and determinants that drive the 
5

transmission of new infections, and thus selecting and focusing on only those interventions that 

effectively and efficiently contribute to preventing new infections. 

Figure 1 shows the assumed factors in predicting engagement of men in RSB. 

Background characteristics (age, occupation, education, marital status, religion, residence, and 

wealth) constitute the risk factors of engaging in RSB [having two or more sexual partners in the 

past 12 months, or not using a condom at the last sex for someone who had two or more sexual 

partners in the past 12 months]. The framework postulates also that knowledge of HIV can 

modify the effect of risk factors on RSB, which means that men who have the above-mentioned 

risk factors should engage in fewer risky behaviors if at the same time they have knowledge of 

HIV. 

Figure 1. Factors model for predicting risky sexual behavior among men 

 Risk Factors Knowledge of HIV Risky Sexual Behavior

• Age 

• Occupation 

• Education 

• Marital status 

• Religion 

• Residence 

• Wealth 

• Knowledge of protective 

effect of using condoms 

• Knowledge of protective 

effect of one uninfected 

faithful partner 

• Basic Knowledge of HIV 

• Having 2+ sexual 

partners in the 

past 12 months 

• Not using a 

condom at the 

last sex for 

someone who 

had 2+ sexual 

partners in the 

past 12 months 
6

DATA AND METHODS 

Data 

Data from the 2005 and 2010 Rwanda Demographic and Health Surveys (RDHS) (NISR 

et al. 2006; NISR et al. 2012) have been used to analyze, on one hand, the association between 

risk factors and RSB, and on the other hand, the association between knowledge of HIV and 

RSB. The National Institute of Statistics of Rwanda and the Ministry of Health implemented the 

two RDHS surveys. ICF International provided technical assistance for the surveys through the 

USAID-funded MEASURE DHS program. The two RDHS samples were nationally 

representative, household-based surveys, designed to provide population and health indicator 

estimates at the national, urban-rural, and district levels. 

The sampling method used was stratified two-stage cluster sampling. The first stage 

consisted of selecting clusters (enumeration areas) from each stratum (district). The second stage 

was a systematic sampling of households from each cluster selected. Then selected households 

were visited and interviewed. The eligible men’s response rate was 97.2 % and 98.7% in 2005 

and 2010 respectively. Eligible men age 15-59 were interviewed in half of the households. 

However, during analysis, only men who said that they had sexual intercourse during the last 12 

months were considered, and this led our study population to 2 773 men in 2005 and 3 772 men 

in 2010 (figure 2). The two surveys were conducted from February to July (2005 RDH) and from 

September 2010 to March 2011 (NISR et al. 2012). 

Key Variables and Measurements 

During the interview, the following information on RSB was collected in the Men’s 

Questionnaire: sexual activities in the 12 months preceding the survey, the number of sexual 

partners in the past 12 months (and the relationship with each partner for up to three partners), 

and condom use in the last sexual intercourse with each partner (for up to three partners). 

 
7

Figure 2. Derivation of sample 

In total, 4,820 men in 2005 and 6,329 men in 2010 were interviewed. Among them, 2,773 

men in 2005 and 3,772 men in 2010 had sexual intercourse during the last 12 months. Among 

those who had sexual intercourse, 138 men in 2005 and 262 in 2010 had two or more sexual 

partners (Figure 2). 

In this study, RSB was defined as having two or more sexual partners in the past 12 

months, or not using condom at the last sex among individuals who had two or more sexual 

partners in the past 12 months. In fact, this is a metric of inconsistent condom use. The issue is 

that when a man has multiple partners and does not use condom consistently, he puts both 

partners at the risk of HIV infection, even if the most recent partner is a faithful spouse. 

HIV knowledge was defined as knowing that consistent use of condom during sexual 

intercourse and having just one uninfected faithful partner can reduce the chance of getting the 

AIDS virus, as well as having “basic knowledge” about HIV (knowing that a healthy-looking 

person can have the AIDS virus, and rejecting the two following most common local 

misconceptions about AIDS transmission or prevention: HIV transmission by mosquito bites and 

sharing food). 

2005 RDHS 2010 RDHS 

All men age 15-59 interviewed (4,820) 

Had sex last 12 months (2,773) 

Had 2+ sexual partners (138) 

All men age 15-59 interviewed (6,329) 

Had sex last 12 months (3,772) 

Had 2+ sexual partners (262) 
8

Statistical Analysis 

Analysis was performed using Stata 11 (Stata Corporation, College Station, Texas) to 

find the prevalence of RSB according to background characteristics (age, occupation, education, 

marital status, religion, residence, and wealth). Bivariate analysis was carried out and t-test was 

used to assess any significant change during the five-year study period. Also, logistic regression 

was done to determine predictors of RSB. Two binary outcomes variables were: “having two or 

more sexual partners in the past 12 months” and “not using condom at the last sex for someone 

who had two or more sexual partners in the past 12 months”. The following variables were tested 

in the model: knowledge of HIV and background characteristics. Chi-square test at the level of 

5% was used to determine the statistical significance while associations were measured using 

odds ratios (OR) with 95% confidence intervals (CI). To account for the survey design and nonresponse, all analyses applied complex sampling weights. 
9

RESULTS 

A total of 2,773 men in 2005 and 3,772 men in 2010 reported that they had sex during the 

last 12 months preceding the survey. Among them, 138 in 2005 and 262 in 2010 declared that 

they had two or more sexual partners. 

Sample Characteristics 

As Table 1 shows, the age composition of sexually active men remained fairly stable 

between 2005 and 2010, with men age 15-24 comprising the largest share of that group in both 

years (43% and 41%, respectively). Among sexually active men, however, those with two or 

more partners tended to be age 25 or older, with 32% and 40% being in the 25-34 age group in 

2005 and 2010, respectively. The majority of men who had two or more sexual partners had 

primary education level (75% in 2005 and 69% in 2010), were located in rural areas, and were 

married (83% in 2005 and 73% in 2010). 

Among sexually active men, wealth index status remained stable between 2005 and 2010, 

with the middle, richer, and richest quintiles comprising the largest share. However, among 

sexually active men, those who had two or more partners tended to be in poorer (29%) and 

middle (24%) quintiles in 2005, compared with middle (25%) and richest (26%) in 2010. 

The occupation profile of sexually active men varied from 2005 to 2010. Men who 

reported not working decreased substantially, from 36% in 2005 to just 1% in 2010, while jobs 

related to professionals/clerical/sales/services increased from 8% in 2005 to 43% in 2010. These 

changes are associated with the governance between the two surveys, especially the “Economic 

Development and Poverty Reduction Strategy” (EDPRS I) established in 2008. The EDPRS 

focused on job creation and the reduction of underemployment by making micro loans through 

microfinance cooperatives across the country. 

Table 1 also shows that the majority of men with two or more sexual partners have the 

following main background characteristics: married, age 25-34, agriculture occupation, and rural 

location. 
10

Table 1. Sample characteristics 

 

Among men who had sex 

last year 

Among men who had 2+ partners 

last year 

 2005 (n=2,773) 2010 (n=3,772) 2005 (n=138) 2010 (n= 262) 

Age (years) 

15-24 42.5 41.2 11.0 16.6 

25-34 23.7 27.6 32.0 40.2 

35-44 17.5 14.5 28.2 18.5 

45-54 13.2 12.6 24.4 18.5 

55-59 3.1 4.1 4.4 6.2 

Education level 

No education 22.9 16.6 16.0 13.0 

Primary 64.8 68.8 74.7 69.4 

Secondary 12.3 14.6 9.3 17.6 

Current marital status 

Not married 10.8 13.5 17.3 26.9 

Currently married 89.2 86.5 82.7 73.1 

Occupation 

Not working 35.5 1.1 27.7 0.2 

Prof/cleric/sales/serv 8.4 43.3 10.3 15.7 

Agriculture 42.1 66.7 43.3 58.0 

Manual 14.0 20.7 18.7 26.1 

Religion 

Catholic 51.5 47.8 42.2 46.2 

Protestant 31.8 35.0 35.4 35.3 

Adventist 12.1 12.6 14.6 12.8 

Other 4.6 4.6 7.8 5.7 

Type of place of residence 

Urban 16.2 15.9 15.7 21.3 

Rural 83.8 84.1 84.3 78.7 

Wealth 

Poorest 19.0 15.4 12.1 12.7 

Poorer 19.1 17.8 29.0 16.6 

Middle 20.7 21.5 24.4 25.1 

Richer 21.3 21.8 16.7 19.8 

Richest 20.0 23.5 17.8 25.8 

Circumcision 

No 89.8 86.3 87.7 81.9 

Yes 10.2 13.7 12.3 18.1 

 
11

Trends in HIV Knowledge among Men 

 From 2005 to 2010, among all men who had sex in the year preceding the survey, basic 

knowledge of HIV appeared to decrease, while among men who had two or more partners in the 

year preceding the survey, it appeared to increase. However, neither change was statistically 

significant. The trends in the two other types of knowledge are similar among all men who had 

recent sex and among men with two or more partners. In both groups, knowledge of the 

protective effect of having only one uninfected faithful partner decreased, while knowledge of 

the protective effect of using condoms increased. The decrease in knowledge of the protective 

effect of one uninfected faithful partner and the increase in the knowledge of the protective effect 

of using condoms were only statistically significant among all men who had sex in the year 

preceding the survey. (Table 2) 

Table 2. HIV-Related knowledge among study population 

 

Among those who had sex 

last year 

Among those who had 2+ partners 

last year 

 2005 (n=2,773) 2010 (n=3,772) 2005 (n=138) 2010 (n=262) 

 % 95% CI % 95% CI % 95% CI % 95% CI 

Basic knowledge of HIV 71.0 68.9-73.0 67.7 65.8-69.5 65.3 56.6-73.1 68.2 61.7-74.1 

Knowledge of protective 

effect of one uninfected 

faithful partner 

89.8 88.1-91.4 82.0 80.2-83.6 89.2 82.2-93.7 83.9 78.7-88.1 

Knowledge of protective 

effect of using condoms 

89.8 88.2-91.2 94.0 93.1-94.6 

 

92.3 86.6-95.7 96.9 92.3-98.8 
12

Risky Sexual Behavior by HIV Knowledge 

In 2010, more men reported that they had two or more sexual partners compared with 

2005 (7% versus 5%). However, among those who had two or more sexual partners, the 

percentage using a condom at last sex was higher in 2010 than 2005, at 93% versus 75%. The 

association is statistically significant (Figure 3). 

Figure 3. Percent of men who had two types of risky sexual behavior 

 

5.0%

93.3%

6.9%

74.5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

2+ partners among those who had sex last year did not use condom use at last sex, among

those with 2+ partners

2005

2010

Note: Bars indicate 95% confidence intervals. Difference between years is statistically significant on both outcomes.
13

Table 3 shows that, among men with basic knowledge of HIV, knowledge of protective 

effect of one uninfected faithful partner, and knowledge of the protective effect of using 

condoms, a significantly higher proportion had two or more partners in 2010 compared with 

2005. 

In 2010, among all knowledge groups, a statistically significantly lower proportion of 

men with two or more partners reported not using a condom at the last sex than in 2005, meaning 

that risky sexual behavior declined between the two surveys (Table 3). 

Table 3. Risky sexual behavior by knowledge of HIV, 2005 and 2010 

 

Men who had 2+ sexual partners 

last year 

Men who did not use a condom 

at the last sex among those 

who had 2+ sexual partners 

 2005 (n=2,773) 2010 (n=3,772) 2005 (n=138) 2010 (n=262) 

 % 95% CI % 95% CI % 95% CI % 95% CI 

Basic knowledge of HIV 4.6 3.7-5.7 7.0 6.0-8.1 95.1 88.5-98.0 71.3 64.5-77.2 

Knowledge of protective 

effect of one uninfected 

faithful partner 

4.9 4.1-6.0 7.1 6.2-8.1 93.8 87.6-97.0 75.1 69.0-80.4 

Knowledge of protective 

effect of using condoms 

5.1 4.2-6.2 7.2 6.3-8.1 

 

92.7 86.8-96.1 74.0 68.4-78.9 
14

Association between HIV Knowledge and Risky Sexual Behavior 

The study explored the association between HIV knowledge and risky sexual behavior 

using bivariate analysis and logistic regression. The model used is a pooled model of association 

between HIV knowledge and risky behavior. 

Each type of HIV knowledge (basic knowledge, knowledge of the protective effect of one 

uninfected faithful partner, and knowledge of the protective effect of using condoms) was 

regressed separately with each risky sexual behavior (having two or more sexual partners; not 

using a condom at the last high risk sex) in the unadjusted models. Then, HIV knowledge 

variables and background variables were regressed together with a set of control factors in the 

adjusted models. 

In unadjusted models, the only HIV knowledge variable associated with any risky sexual 

behavior outcome was knowledge of the protective effect of using condoms. Men who had this 

knowledge had higher odds of having two or more partners in the past year; interestingly, this 

knowledge was not significantly associated with condom use. 

The year of the survey was not statistically significant in the adjusted model of having 

two or more partners, but it was statistically significant in the adjusted model of condom use, 

indicating that men with two or more partners in 2010 were significantly less likely to report not 

using a condom at last sex than men in 2005, even after adjusting for knowledge and 

characteristics. 

The odds of having two or more sexual partners are greater among men in the poorer and 

middle wealth quintiles, while married men are less likely to have two or more sexual partners 

compared with unmarried men. However, even after adjusting for other factors, married men 

have 37 times the odds of not using a condom compared with unmarried men, when they have 

two or more sexual partners. 

Professional occupations and manual workers have increased odds of having multiple 

sexual partners compared with men who are not working, but among those with more than two 

partners, men who work in professional occupations and manual labor have significantly lower 

odds of not using a condom. Rural-urban residence is unrelated to either type of risky behavior in 

the adjusted models. 
Table 4. Pooled multivariate association between background factors, knowledge, and risky sexual behaviors 2005 and 2010 

Had 2+ sexual partners 

among those who had sex 

Not using condom at last sex, 

among those with 2+ sexual partners 

Unadjusted 

OR CI 

Adjusted 

OR CI 

Unadjusted 

OR CI 

Adjusted 

OR CI 

HIV Knowledge Basic knowledge of HIV 0.9 0.7-1.2 0.8 0.7-1.1 0.7 0.4-1.3 0.9 0.4-2.0 

Knowledge of protective effect of one uninfected faithful partner 1.0 0.7-1.4 1.1 0.8-1.5 1.4 0.7-2.9 1.3 0.6-3.0 

Knowledge of protective effect of using condoms 1.8 ** 1.0-3.1 1.7 1.0-2.9 0.2 0.03-1.6 0.2 0.02-1.6 Year of survey 2005 (ref.) 2010 1.4 ** 1.1-1.8 1.2 0.9-1.5 0.2 *** 0.1-0.4 0.2 *** 0.1-0.4 

Age 15-24 years (ref.) 25-34 years 0.9 0.7-1.3 1.4 ** 1.0-2.0 3.7 *** 2.0-7.1 1.2 0.5-2.9 35-44 years 0.7 0.5-1.0 1.4 1.0-2.1 6.5 *** 2.9-14.4 0.6 0.2-2.0 

45-54 years 0.9 0.6-1.3 1.7 *** 1.1-2.7 10.7 *** 4.3-26.5 0.6 0.2-2.5 

55-59 years 0.9 0.5-1.4 1.7 * 1.0-2.9 6.4 ** 1.7-23.4 0.2 * 0.05-1.2 

Occupation Not working (ref.) Prof/Cleric/Sales/Serv 2.3 *** 1.4-3.7 2.1 *** 1.3-3.5 0.05 *** 0.01-0.2 0.2 0.03-1.8 

Agriculture 1.5 * 1.0-2.4 1.3 0.9-2.1 0.5 0.1-2.0 0.9 0.1-6.4 

Manual 2.2 *** 1.4-3.5 1.8 ** 1.2-2.9 0.01 ** 0.03-0.5 0.5 0.1-3.7 

Education level No education (ref.) Primary 1.5 ** 1.1-2.0 1.5 ** 1.1-2.0 0.5 0.2-1.4 0.5 0.1-2.6 Secondary 1.5 * 1.0-2.2 1.3 0.8-2.0 0.2 * 0.07-0.6 2.0 0.3-13.4 

(Continued...)

15 
Table 4. – Continued

Had 2+ sexual partners 

among those who had sex 

Not using condom at last sex, 

among those with 2+ sexual partners 

Unadjusted 

OR CI 

Adjusted 

OR CI 

Unadjusted 

OR CI 

Adjusted 

OR CI 

Marital status Not married (ref.) Currently married 0.4 *** 0.3-0.5 0.4 *** 0.3-0.5 24.3 *** 13.2-44.8 37.1 *** 13.3-103.2 

Religion Catholic (ref.) Protestant 1.2 0.9-1.5 1.2 0.9-1.5 1.2 0.7-2.1 0.8 0.4-1.9 

Adventist 1.2 0.9-1.7 1.3 0.9-1.8 2.3 0.9-6.2 2.0 0.4-9.4 

Other 1.6 * 1.0-2.5 1.5 * 1.0-2.4 0.6 0.2-1.3 0.7 0.2-2.9 

Type of place of residence Urban (ref.) Rural 0.9 0.6-1.0 0.9 0.6 - 1.2 4.7 *** 2.7-8.3 1.5 0.6-3.8 

Wealth index Poorest (ref.) Poorer 1.6 * 1.1-2.3 1.6 ** 1.1 - 2.3 4.6 * 1.3-16.4 0.9 0.2-4.1 

Middle 1.6 ** 1.1-2.4 1.5 ** 1.0 - 2.2 1.3 0.5-3.3 1.0 0.3-3.9 

Richer 1.2 0.8-1.8 1.1 0.7 - 1.6 1.5 0.6-4.1 0.7 0.2-3.0 Richest 1.4 1.0-2.1 0.9 0.6 - 1.4 0.4 0.2-0.8 0.5 0.1-2.1 

Note: *= p<0.05; **=p<0.01; ***=p<0.001 

16 
17

DISCUSSION AND CONCLUSIONS 

This study explores HIV knowledge and risky sexual behavior. Using the 2005 and 2010 

RDHS, we found a number of important results. First, among sexually active men, the findings 

show that knowledge of the protective effect of using condoms has significantly increased, 

comparing 2010 with 2005, and this is a very encouraging result. However, basic knowledge of 

HIV (knowing that a healthy-looking person can have the AIDS virus, knowing that HIV is not 

transmitted by mosquito bites or sharing food) has not significantly changed, and knowledge of 

the protective effect of having one uninfected faithful partner has decreased between 2005 and 

2010, both among men who had sex in last year preceding the survey and men who had multiple 

partners. This result suggests the need for more HIV education particularly on the issues 

discussed above. Unfortunately, for the moment it is not possible to explain this decrease of HIV 

knowledge through HIV programmatic activities. In fact, it seems that there is no significant 

change in the implementation of HIV prevention activities since 2005 that could explain this 

decrease. 

Our findings also show that in 2010 the percentage of men who used a condom at last sex 

significantly increased compared with 2005. In their study on HIV-related knowledge and 

behaviors in Rwanda, Rathavuth Hong and colleagues also found a considerable increase in 

condom use during last sex and during last non-spousal sex (Hong et al. 2013). This result is 

encouraging, and it may be the positive effect of HIV/AIDS prevention interventions that 

Rwanda has been implementing. For example, the observed increase in condom use could be 

linked to the significant increase of knowledge of the protective effect of using condoms (from 

90% in 2005 to 94% in 2010). 

In an unadjusted logistic regression model, sexually active men with knowledge of the 

protective effect of using condoms had 1.8 times higher odds of having two or more partners in 

the past year, a finding which may suggest some degree of reverse causation: men who engage in 

risky behaviors are more knowledgeable about the means of risk reduction. Otherwise the 

logistic regression analysis did not find any relationship between HIV knowledge and the two 

types of risky sexual behavior studied. Although a bit surprising, this finding corroborates the 

results of other studies (Essien et al. 2002; Williams et al. 2003). In their study on HIV/AIDS 

information and risky behavior in Botswana, Dinkelman et al. (2006) also concluded, “it may be 
18

overly optimistic to hope for reductions in risky behavior through the channel of HIVinformation provision alone.” 

Therefore, this is a very important subject, particularly for policymakers who decide on 

strategies, interventions, and activities for HIV prevention. It is necessary not to focus only on 

AIDS knowledge as a means to reduce HIV transmission. Further studies could provide more 

information on other elements that probably influence safer sexual behavior and that therefore 

could be a focus for designing HIV prevention programs. 

Our study has some limitations that should be considered when interpreting its results. 

Few men reported having two or more sexual partners (only 5% in 2005 and 7% in 2010). On 

one hand, this could be an under-reporting of sexual behavior. In fact, when men are interviewed 

in close quarters with other family members, they may not be willing to disclose their sexual 

behavior. On the other hand, the small sample size of men who had two or more sexual partners 

could be a reason for lack of significant association found between HIV knowledge and condom 

use. It is also possible to have recall bias in condom use among men who have not recently had 

sex. 

In conclusion, the findings suggest that, while knowledge of the protective effect of 

condoms has increased, basic HIV knowledge has declined slightly among Rwandan men, and 

this should draw attention and lead to take appropriate measures. However, while setting up 

policies and strategies related to HIV prevention, policymakers should consider that HIV 

knowledge alone does not appear to be sufficient. Further research may help to identify other 

factors that are essential to consider. 
19

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