CR24 Cover.indd 1 
ii

MEASURE DHS assists countries worldwide in the collection and use of data to monitor and 

evaluate population, health, and nutrition programs. Additional information about the 

MEASURE DHS project can be obtained by contacting Demographic and Health Research 

Division, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-

572-0200; fax: 301-572-0999; e-mail: reports@macrointernational.com; internet: 

www.measuredhs.com). 

The main objectives of the MEASURE DHS project are: 

 to provide decisionmakers in survey countries with information useful for informed 

policy choices; 

 to expand the international population and health database; 

 to advance survey methodology; and 

 to develop in participating countries the skills and resources necessary to conduct highquality demographic and health surveys. 
i 

DHS Comparative Reports No. 24 

Changes in HIV-Related Knowledge and 

Behaviors in Sub-Saharan Africa 

Vinod Mishra1

Praween Agrawal2

Soumya Alva1

Yuan Gu1

Shanxiao Wang1

 

ICF Macro 

Calverton, Maryland, USA 

September 2009 

Corresponding author: Vinod Mishra, Demographic and Health Research Division, ICF Macro, 

11785 Beltsville Drive, Suite 300, Calverton, MD 20705; Phone: 301-572-0220; Fax: 301-572-0983; 

Email: vinod.mishra@macrointernational.com. 

1

 ICF Macro 

2

 International HIV/AIDS Alliance, India 
ii

Editor: Bryant Robey 

Document Production: Shanxiao Wang 

This study was carried out with support provided by the United States Agency for International 

Development (USAID) through the MEASURE DHS project (#GPO-C-00-03-00002-00). The 

views expressed are those of the authors and do not necessarily reflect the views of USAID or 

the United States Government. 

Recommended citation: 

Mishra, Vinod, Praween Agrawal, Soumya Alva, Yuan Gu, and Shanxiao Wang. 2009. Changes 

in HIV-Related Knowledge and Behaviors in Sub-Saharan Africa. DHS Comparative Reports 

No. 24. Calverton, Maryland, USA: ICF Macro. 
iii 

Contents 

Tables v

Figures ix

Preface xi

Acknowledgments xiii

Executive Summary xv

1 Introduction 1

1.1 Purpose 1

1.2 HIV/AIDS in Sub-Saharan Africa 1

1.3 Risk Factors of HIV 1

1.4 Organization of this Report 2

2 Data and Methods 5

2.1 DHS Surveys 5

2.2 Sample Sizes 5

2.3 Indicators Included in the Analysis 7

3 Socioeconomic and Demographic Characteristics 13

3.1 Age 13

3.2 Marital Status 14

3.3 Educational Attainment 17

3.4 Household Wealth 21

3.5 Exposure to Mass Media 24

3.6 Urban Residence 25

3.7 Number of Years Living at Current Place of Residence 25

3.8 Slept and Stayed Away from Home 27

4 Knowledge, Misconceptions, and Risk Perception 29

4.1 Knowledge of HIV Prevention Methods 29

4.2 Misconceptions about HIV/AIDS 31

4.3 Comprehensive Knowledge about HIV/AIDS 35

4.4 Knowledge about Prevention of Mother-to-Child Transmission of HIV 37

4.5 Risk Perception of Contracting HIV 39

4.6 Risk Perception of Contracting HIV, by Number of Sex Partners 41

5 Attitudes Related to HIV/AIDS 43

5.1 Accepting Attitudes toward PLHIV 43

5.2 Attitudes toward Sex Education 46

6 Sexual Behavior 49

6.1 Median Age at First Sex 49

6.2 Multiple Sexual Partnerships 50

6.3 Higher-Risk Sex 56

6.4 Extramarital Sex 60

6.5 Paid Sex among Men 60

6.6 Ever Use of Condoms and Condom Use at Last Sex 62

6.7 Consistent Condom Use 67

6.8 Condom Use at Higher-Risk Sex 67

6.9 Alcohol Use 69
iv

7 Sexual Behavior of Youth 71

7.1 Sex before Age 15 71

7.2 Primary and Secondary Abstinence 76

7.3 Condom Use at First Sex 81

7.4 Sex with an Older Partner 82

7.5 Forced Sex 83

7.6 Multiple Sexual Partnerships 83

8 Other Modes of HIV Transmission 87

8.1 Male Circumcision 87

8.2 Injections by a Health Care Professional 88

8.3 Prevalence of STI or STI Symptoms 89

9 Voluntary Counseling and Testing 93

9.1 Knowledge of HIV Testing Services 93

9.2 Knowledge of HIV Status 96

10 Gender Relations 99

10.1 Attitudes toward Negotiating Safer Sex with Husbands 99

10.2 Discussing HIV/AIDS with Sexual Partners 102

10.3 Participation in Household Decision-Making 103

11 Summary and Conclusions 107

11.1 Key Findings 107

11.2 Limitations 108

11.3 Implications 108

References 111
v 

Tables 

Table 2.1 Sample sizes of women and men age 15–49, in selected countries in sub-Saharan 

Africa, 1992–2006 6

Table 3.1 Changes in age distribution (%) of women and men age 15–49, in selected 

countries in sub-Saharan Africa, 1992–2006 13

Table 3.2 Changes in marital status of women and men age 15–49, in selected countries in 

sub-Saharan Africa, 1992–2006 15

Table 3.3 Changes in educational status of women and men age 15–49, in selected countries 

in sub-Saharan Africa, 1992–2006 17

Table 3.4 Changes in percent distribution of women and men age 15–49 by household wealth 

status, in selected countries in sub-Saharan Africa, 1992–2006 22

Table 3.5 Changes in percentage of women and men age 15–49 regularly exposed to the mass 

media, and percentage living in urban areas, in selected countries in sub-Saharan 

Africa, 1992–2006 24

Table 3.6 Changes in percent distribution of women and men age 15–49 by number of years 

living at their current place of residence, in selected countries in sub-Saharan 

Africa, 1992–2006 26

Table 3.7 Changes in percent distribution of men age 15–49 by number of times slept away 

from home and by period of time stayed away from home in last 12 months, in 

selected countries in sub-Saharan Africa, 1992–2006 28

Table 4.1 Changes in percentage of women and men age 15–49 who ever heard of HIV/AIDS 

and percentage knowing that HIV infection can be prevented by abstaining from 

sex, by limiting sex to one faithful partner, and by always using a condom when 

having sex, in selected countries in sub-Saharan Africa, 1992–2006 29

Table 4.2 Changes in percentage of women and men age 15–49, who know that a person can 

have HIV, percentage who know that HIV cannot be transmitted by mosquitoes, 

and percentage who know that HIV cannot be transmitted by sharing food, in 

selected countries in sub-Saharan Africa, 1992–2006 31

Table 4.3 Changes in percentage of women and men age 15–49 who know that HIV infection 

can be prevented by both limiting sex to one faithful partner and by always using a 

condom when having sex, and percentage with comprehensive knowledge about 

HIV/AIDS, in selected countries in sub-Saharan Africa, 1992–2006 36

Table 4.4 Changes in percentage of women and men age 15–49 who know that HIV can be 

transmitted from mother to child through breastfeeding, percentage who know that 

there is a special drug that can prevent HIV transmission from mother to child 

through breastfeeding, and percentage who know both, in selected countries in subSaharan Africa, 1992–2006 38

Table 4.5 Changes in percent distribution of women and men age 15–49 who know about 

HIV/AIDS by perceived risk of getting HIV/AIDS, in selected countries in subSaharan Africa, 1992–2006 40

Table 4.6 Changes in percentage of women and men age 15–49 who believe that they have a 

low/no risk of getting HIV and had 2+ sex partners in last 12 months, and 

percentage who believe that they have a low/no risk of getting HIV and have had 

3+ lifetime sex partners, in selected countries in sub-Saharan Africa, 1992–2006 42
vi

Table 5.1 Among women and men age 15–49 who have heard about HIV/AIDS, changes in 

percentage expressing specific attitudes toward people living with HIV, in selected 

countries in sub-Saharan Africa, 1992–2006 44

Table 5.2 Among women and men age 15–49 who have heard about HIV/AIDS, changes in 

percentage who believe that children age 12–14 should be taught to wait till 

marriage to have sexual intercourse, and percentage who believe that children age 

12–14 should be taught about condom use to prevent HIV infection, in selected 

countries in sub-Saharan Africa, 1992–2006 47

Table 6.1 Changes in median age at first sex among women and men age 20–24, in selected 

countries in sub-Saharan Africa, DHS 1992–2006 49

Table 6.2 Changes in percent distribution of women and men age 15–49 by number of 

lifetime sex partners, and change in percentage having 2+ sex partners in last 12 

months, in selected countries in sub-Saharan Africa, 1992–2006 51

Table 6.3 Changes in percentage of women and men age 15–49 who had higher-risk sex in 

last 12 months, percentage who had extramarital sex in last 12 months, and 

percentage who paid for sex in last 12 months, in selected countries in sub-Saharan 

Africa, 1992–2006 56

Table 6.4 Changes in percentage of women and men age 15–49 who ever used a condom, 

percentage who used a condom at last sex in last 12 months, percentage who used a 

condom consistently in last 12 months, and percentage who used a condom at last 

higher-risk sex in last 12 months, in selected countries in sub-Saharan Africa, 

1992–2006 63

Table 6.5 Percentage of women and men age 15–49 who used alcohol, and percentage who 

used alcohol at last sex in last 12 months, in selected countries in sub-Saharan 

Africa, 1992–2006 70

Table 7.1 Changes in percentage of women and men age 15–19 who had sex before age 15, 

percentage of women and men age 15–24 who never had sex (primary abstinence), 

and percentage of women and men age 15–24 who ever had sex but not in last 12 

months (secondary abstinence), in selected countries in sub-Saharan Africa, 1992–

2006 72

Table 7.2 Percentage of women and men age 15–24 who used a condom at first sex, 

percentage of women age 15–19 who had higher-risk sex with a partner who was 

10 or more years older, and percentage of women age 15–24 who were forced at 

first sex, and percentage of women age 15–24 who were forced at sex in last 12 

months, in selected countries in sub-Saharan Africa, 1992–2006 81

Table 7.3 Changes in percentage of women and men age 15–24 having 3+ lifetime sex 

partners, and percentage having 2+ sex partners in last 12 months, in selected 

countries in sub-Saharan Africa, 1992–2006 83

Table 8.1 Percentage of men age 15–49 who are circumcised, in selected countries in subSaharan Africa, 1992–2006 87

Table 8.2 Changes in percent distribution of women and men age 15–49 by number of 

injections in recent months by a health care professional, in selected countries in 

sub-Saharan Africa, 1992–2006 89

Table 8.3 Among women and men age 15–49 who ever had sex, changes in percentage who 

had sexually transmitted infections (STI) or symptoms of an STI in last 12 months, 

in selected countries in sub-Saharan Africa, 1992–2006 90
vii 

Table 9.1 Changes in percentage of women and men age 15–49 who know where to get 

tested for HIV, percentage ever tested for HIV and received test results, and 

percentage tested for HIV in last 12 months and received test results, in selected 

countries in sub-Saharan Africa, 1992–2006 94

Table 10.1 Changes in percentage of women and men age 15–49 who believe that a wife is 

justified in refusing to have sex with her husband if she knows that the husband has 

an STI, percentage who believe that a wife is justified in refusing to have sex with 

her husband if she knows that her husband has sex with other women, percentage 

who believe that a wife is justified to ask her husband to use a condom if he has an 

STI, and percentage who believe that a woman can negotiate safer sex, in selected 

countries in sub-Saharan Africa, 1992–2006 100

Table 10.2 Among women and men age 15–49 who are currently in union, changes in 

percentage who never discussed HIV/AIDS with any of their sexual partners, in 

selected countries in sub-Saharan Africa, 1992–2006 103

Table 10.3 Changes in percentage of women age 15–49 who participate in making various 

household decisions, in selected countries in sub-Saharan Africa, 1992–2006 104
viii 
ix

Figures 

Figure 3.1a Changes in educational level among women age 15–49, 1992–2006 19

Figure 3.1b Changes in educational level among men age 15–49, 1995–2006 20

Figure 4.1a Changes in knowledge that a healthy-looking person can have HIV among women 

age 15–49, 1995–2006 33

Figure 4.1b Changes in knowledge that a healthy-looking person can have HIV among men age 

15–49, 1995–2006 34

Figure 6.1a Changes in percentage of women age 15–49 who had 2+ sexual partners in last 12 

months, 1996–2006 54

Figure 6.1b Changes in percentage of men age 15–49 who had 2+ sexual partners in last 12 

months, 1995–2006 55

Figure 6.2a Changes in percentage of women age 15–49 who had higher-risk sex in last 12 

months, 1996–2006 58

Figure 6.2b Changes in percentage of men age 15–49 who had higher-risk sex in last 12 

months, 1995–2006 59

Figure 6.3 Changes in percentage of men age 15–49 who had paid sex in last 12 months, 

1995–2006 61

Figure 6.4a Changes in percentage of women age 15–49 who used a condom at last sex in last 

12 months, 1995–2006 65

Figure 6.4b Changes in percentage of men age 15–49 who used a condom at last sex in last 12 

months, 1995–2006 66

Figure 6.5a Changes in percentage of women age 15–49 who used a condom at last higher-risk 

sex in last 12 months, 1999–2006 68

Figure 6.5b Changes in percentage of men age 15–49 who used a condom at last higher-risk 

sex in last 12 months, 1999–2006 68

Figure 7.1a Changes in percentage of women age 15–19 who had sex before age 15, 1992–

2006 74

Figure 7.1b Changes in percentage of men age 15–19 who had sex before age 15, 1995–2006 75

Figure 7.2a Changes in percentage of women age 15–24 in primary abstinence, 1992–2006 77

Figure 7.2b Changes in percentage of men age 15–24 in primary abstinence, 1995–2006 78

Figure 7.3a Changes in percentage of women age 15–24 in secondary abstinence, 1992–2006 79

Figure 7.3b Changes in percentage of men age 15–24 in secondary abstinence, 1995–2006 80

Figure 7.4 Percentage of women age 15–19 who had higher-risk sex with a partner 10 or more 

years older in last 12 months, 2003–2006 82

Figure 7.5a Changes in percentage of women age 15–24 who had two or more sexual partners 

in last 12 months, 1996–2005 85

Figure 7.5b Changes in percentage of men age 15–24 who had two or more sexual partners in 

last 12 months, 1995–2006 86

Figure 8.1 Percentage of men age 15–49 who are circumcised, 2003–2006 88

Figure 8.2a Changes in percentage of women age 15–49 reporting STI or STI symptoms in last 

12 months, 1995–2006 91

Figure 8.2b Changes in percentage of men age 15–49 reporting STI or STI symptoms in last 12 

months, 1995–2006 92
x 

Figure 9.1a Changes in percentage of women age 15–49 with knowledge of where to get tested 

for HIV, 1998–2006 95

Figure 9.1b Changes in percentage of men age 15–49 with knowledge of where to get tested for 

HIV, 1998–2006 95

Figure 9.2a Percentage of women age 15–49 ever tested for HIV and received test results, 

2000–2006 97

Figure 9.2b Percentage of men age 15–49 ever tested for HIV and received test results, 2000–

2006 97

Figure 9.3 Changes in percentage of women and men age 15–49 ever tested for HIV and 

received test results, Uganda 2000–2006 98

Figure 10.1a Changes in percentages of women age 15–49 who believe that a wife can refuse 

sex if she knows that her husband has an STI or if he has sex with other women, 

1999–2006 101

Figure 10.1a Changes in percentages of women age 15–49 who believe that a wife can refuse 

sex if she knows that her husband has an STI or if he has sex with other women, 

1999–2006 101

Figure 10.1b Changes in percentages of men age 15–49 who believe that a wife can refuse sex if 

she knows that her husband has an STI or if he has sex with other women, 1999–

2006 101

Figure 10.2 Changes in women‘s participation in major household decisions, 1999–2006 105
xi 

Preface 

One of the most significant contributions of the MEASURE DHS program is the creation of an 

internationally comparable body of data on the demographic and health characteristics of populations in 

developing countries. The DHS Comparative Reports series examines these data across countries in a 

comparative framework. The DHS Analytical Studies series focuses on specific topics. The principal 

objectives of both series are to provide information for policy formulation at the international level and to 

examine individual country results in an international context. Whereas Comparative Reports are 

primarily descriptive, Analytical Studies have a more analytical approach. 

The Comparative Reports series covers a variable number of countries, depending on the availability of data sets. Where possible, data from previous DHS surveys are used to evaluate trends over 

time. Each report provides detailed tables and graphs organized by region. Survey-related issues such as 

questionnaire comparability, survey procedures, data quality, and methodological approaches are addressed as needed. 

The topics covered in Comparative Reports are selected by MEASURE DHS staff in conjunction 

with the U.S. Agency for International Development. Some reports are updates of previously published 

reports. 

It is anticipated that the availability of comparable information for a large number of developing 

countries will enhance the understanding of important issues in the fields of international population and 

health by analysts and policymakers. 

Ann Way 

Project Director 
xii 
xiii 

Acknowledgments 

Authors thank Avril Armstrong, Sarah Bradley, Zsuzsa Daczo, and Shane Khan for their support 

in checking the tabulations and their comments, and Bryant Robey for editing the report. 
xiv 
xv 

Executive Summary 

The purpose of this study is to provide strategic information on key HIV-related indicators for 

program managers and policymakers to monitor and evaluate prevention programs and to design new 

strategies. The report summarizes levels and recent changes in 69 indicators of HIV-related knowledge, 

attitudes, and behaviors of women and men age 15–49 in 23 countries in sub-Saharan Africa. Data come 

from the two most recent rounds of population-based, nationally representative Demographic and Health 

Surveys (DHS) conducted between 1992 and 2006. 

The results show that in most countries in the region education levels and exposure to the mass 

media have improved in recent years, yet men remain better educated than women and continue to have 

more exposure to the media. Overall, there have been improvements in women‘s participation in 

household decision-making, and women report greater ability to negotiate safer sex. Men are more likely 

than women themselves to report that women can negotiate safer sex. 

In most sub-Saharan countries knowledge about HIV prevention methods has increased. 

However, considerable proportions of men and women still lack knowledge of specific prevention 

methods: abstinence, partner faithfulness, and condom use. Comprehensive knowledge about HIV/AIDS 

has increased, but in most countries, especially in west Africa, levels of such knowledge remain 

unacceptably low. 

Although men generally are more knowledgeable than women about HIV prevention methods, 

higher percentages of women than men know that HIV can spread from mother to child through breast 

milk. Few adults know about drugs that can prevent mother-to-child HIV transmission. 

The results suggest that considerable proportions of people continue to have discriminatory 

attitudes toward people living with HIV (PLHIV). While a majority of adults indicate that they would 

care for an infected family member, fewer would want others to know if someone in their own family 

were infected. Levels of acceptance of HIV-infected female teachers or vegetable vendors are also low, 

though improving. 

An overwhelming majority of adults agree that children age 12–14 should be taught to abstain 

from sex until they get married. However, in most sub-Saharan countries only about half of women and a 

slightly higher percentage of men would want children age 12–14 to be taught about condom use. 

In all countries a large majority of people perceive themselves to be at no risk or low risk of 

becoming infected with HIV. Nonetheless, many adults, particularly men, report being at no risk or low 

risk of HIV infection, even though they have had multiple lifetime sexual partners. The proportion of 

people who consider themselves to be at high risk or who already have HIV shows no correlation to HIV 

prevalence in the country. 

A high percentage of men and women initiate sex before age 15. Median age at first sex is much 

lower among women than among men. In recent years, the median age at first sex has remained generally 

unchanged for both men and women in most countries. 

Men are much more likely than women to report having multiple sexual partners in their lifetime, 

as well as in the year before the survey. Men also are much more likely than women to report non-spousal 

sex. In most countries women have become less likely to report multiple partners, but among men there is 

no clear pattern of change. The highest levels of paid sex among men are in southern Africa, where the 

prevalence of HIV is higher than in east Africa or west Africa. 
xvi 

Among never-married youth age 15–24, no clear pattern of change appears across countries in the 

practice of primary abstinence, but secondary abstinence has increased in most countries. Over time, 

fewer youth are having multiple sex partners, comparing the two rounds of surveys. Considerable 

proportions of young women report that their first sex was forced and that they have had sex with nonspousal partners who were 10 years or older than themselves. Women in west Africa are more likely to 

have older non-spousal partners than women in east Africa or southern Africa. 

Overall, condom use has increased somewhat but remains very low in most sub-Saharan 

countries. Less than one woman in every six and one man in every three report using a condom at last sex 

in the year before the survey. Levels of consistent condom use are even lower. 

Although in east Africa and southern Africa the percentages of respondents who know where to 

get tested for HIV are substantial, the percentages of respondents who have ever been tested for HIV and 

received test results are quite low in most sub-Saharan countries, at less than 25 percent of men and 

women. For countries with data from two time points, the study finds sizeable increases among both 

women and men in knowledge of where to get tested for HIV. 

In sum, the study provides a comprehensive look at the levels and direction of many important 

HIV/AIDS-related indicators in sub-Saharan countries. Notably, the study finds evidence of 

improvements in HIV/AIDS-related knowledge and attitudes but also highlights persistent high levels of 

sexual risk-taking and very low levels of voluntary counseling and testing coverage and condom use. 

These findings make a case for strengthening prevention programs in sub-Saharan Africa with a range of 

efforts to promote safer sexual behavior. 

The study also highlights large differentials between women and men in a number of HIV-related 

indicators, and wide variations among the 23 countries studied in the levels of and recent changes in HIVrelated knowledge, attitudes, and behaviors. These differences suggest the need for HIV prevention, 

treatment, and care policies and programs to be gender and context specific. 
1 

1 Introduction 

1.1 Purpose 

The purpose of this study is to provide strategic information on key HIV-related indicators for 

program managers and policymakers to monitor and evaluate prevention programs and design new 

strategies. The report summarizes levels and recent changes in 69 indicators of HIV-related knowledge, 

attitudes, and behaviors of women and men age 15–49 in 23 countries in sub-Saharan Africa. Data come 

from the two most recent rounds of population-based, nationally representative Demographic and Health 

Surveys (DHS) conducted between 1992 and 2006. 

Over the years, as the HIV epidemic has become more widespread, numerous programs and 

policies have evolved that focus on providing education about prevention methods, reducing 

misconceptions about HIV/AIDS, and increasing protective sexual behaviors, including sexual 

abstinence, reduction in premarital sex, and condom use during risky sex. The HIV/AIDS epidemic has 

also resulted in several global initiatives, such as the U.S. President‘s Emergency Plan for AIDS Relief 

(PEPFAR) and the Global Fund to fight AIDS, TB, and malaria in developing countries. The data 

contained in this report can assist these and other efforts to combat HIV/AIDS, particularly in subSaharan Africa. 

1.2 HIV/AIDS in Sub-Saharan Africa 

Globally in 2007, an estimated 33 million [30 million–36 million] people were living with HIV 

(UNAIDS 2008). Sub-Saharan Africa is the region hardest hit by HIV/AIDS, accounting for two-thirds of 

all people living with HIV (PLHIV) and almost 90 percent of all infected children worldwide. An 

estimated 1.9 million [1.6 million–2.1 million] people were newly infected with HIV in sub-Saharan 

Africa in 2007, bringing the total number of PLHIV in sub-Saharan Africa to 22 million [20.5 million–

23.6 million]. Sub-Saharan Africa accounted for three quarters of all AIDS-related deaths in 2007 

(UNAIDS 2008). Unlike in the rest of the world, women in sub-Saharan Africa are disproportionately 

more likely than men to be infected with HIV. 

The sub-Saharan region‘s HIV/AIDS epidemics vary significantly from country to country, in 

both scale and scope (Mishra et al. 2009; UNAIDS 2008; Asamoah-Odei, Garcia-Calleja, and Boerma 

2004). In 2007, adult national HIV prevalence was below 2 percent in most countries of west Africa, was 

above 5 percent in several east African countries, but exceeded 15 percent in some southern African 

countries. Southern Africa continues to bear a disproportionate share of the global burden of HIV. For 

example, 35 percent of HIV infections and 38 percent of AIDS deaths in 2007 occurred in this sub-region. 

In recent years, some epidemics in sub-Saharan Africa appear to have stabilized at high levels, while in a 

few others there are signs of resurgence (UNAIDS 2008). 

1.3 Risk Factors of HIV 

A recent cross-country study has shown that in a majority of countries HIV prevalence increases 

with risky sexual behaviors, such as a higher number of lifetime sex partnerships, sex with non-marital or 

non-cohabitating partners, alcohol use by either or both partners, and not using condoms at last sex 

(Mishra et al. 2009). Numerous other studies have also examined sexual and other behaviors in subSaharan Africa as they relate to the spread of HIV in the general population (Hudson 1996; Ferry et al. 

2001; Lagarde et al. 2001; Morris and Kretzchmar 1997; Slaymaker and Buckner 2004; Kirungi et al. 

2006; Hallett et al. 2006).
2 

More specifically, studies have explored the role of risk factors that lead to HIV infection—

including sexual behavior, particularly higher-risk behavior by certain sections of the population such as 

commercial sex workers (Morison et al. 2001); low prevalence of condom use (Ghys et al. 2002); early 

marriage, poor gender relations, and the risk and vulnerability of women (Clark, Bruce, and Dude 2006; 

Clark 2004; Glynn et al. 2001; Kelly et al. 2003; Luke 2005; Pettifor et al. 2004); male circumcision and 

STIs (Auvert et al. 2001; Auvert et al. 2005; NIAID 2006; Johnson and Way 2006; Weiss, Quigley, and 

Hayes 2000); and transmission of HIV infection from mothers to children (Coovadia et al. 2007). Most of 

these studies focus on individual countries or particular contexts. 

Heterosexual intercourse remains the epidemic‘s main driving force in sub-Saharan Africa, 

unlike in the rest of the world where HIV disproportionately affects injecting drug users, commercial sex 

workers, and men who have sex with men (UNAIDS 2008). At the same time, an increased focus on 

understanding the causes and determinants of HIV infection has developed to respond effectively to the 

fast-growing epidemic (Boerma and Weir 2005). In recent years, the need to understand the reasons for 

stagnation in the rate of decline or reversal in HIV prevalence rates in some countries, such as Kenya and 

Uganda, has been increasingly emphasized (Opio et al. 2008; Cheluget et al. 2006; Murphy et al. 2006; 

Stoneburner and Low-Beer 2004). 

This stagnation and reversal are often accompanied by increased sexual risk-taking. In Uganda, 

for example, where HIV prevalence has risen slightly, multiple sexual partnerships among Ugandan men 

age 15–49 increased from 28 percent in 2001 to 37 percent in 2005, while condom use at last nonspousal sex declined from 65 percent to 55 percent during the same period (Opio et al. 2008; Green et al. 

2006). 

Given this context, there is need for a comprehensive look at the levels and direction of 

HIV/AIDS-related indicators in sub-Saharan Africa, to assess whether program efforts to raise levels of 

knowledge of prevention measures, reduce stigma and discrimination, promote safer sexual practices, and 

provide counseling and testing services are having their intended consequences, as well as to identify 

population groups and program areas needing greater attention. 

1.4 Organization of this Report 

In addition to this introductory chapter, the report has 10 chapters that define the study, present 

results, and suggest implications: 

 Chapter 2 provides details on survey sample sizes, indicators used, and the methodological 

approach. 

 Chapter 3 examines changes in selected socioeconimic and demographic characteristics. 

 Chapter 4 covers respondents‘ knowledge, misconceptions, and perceptions of their risk of HIV 

exposure. This includes information on whether individuals have ever heard of HIV/AIDS; their 

awareness of methods by which HIV infection can be prevented – by abstaining from sex, by 

limiting sex to one faithful partner, and by using condoms; their misconceptions regarding 

ways of transmitting HIV, such as by sharing food; and their perceived risk of HIV infection, 

also measured in relation to their sexual behaviors, including the number of sexual partners. 

 Chapter 5 presents attitudes and perceptions related to how respondents would treat PLHIV. This 

includes attitudes such as whether a respondent would care for a family member with HIV, would 

allow a teacher with HIV to continue teaching, and would buy vegetables from a person with HIV. 
3 

The chapter also covers beliefs on whether children age 12–14 should be taught about condoms 

and about abstaining from sex until marriage. 

 Chapter 6 examines changes in sexual behavior, including detailed information on riskier sexual 

behavior that could be associated with HIV infection and spread. The indicators of sexual behavior 

include age at initiation of sexual activity, number of lifetime sexual partners, sex with nonspousal partners, paid sex, condom use, and alcohol consumption during sex. 

 Chapter 7 reports data on youth, including primary and secondary abstinence, condom use, and 

risky sexual behavior. This focus reflects the fact that youth is a time of risk taking, and that HIV 

infection can occur early in a person‘s sexual life. 

 Chapter 8 presents data on number of medical injections, prevalence of circumcision among men, 

and prevalence of sexually transmitted infections (STIs) or STI symptoms among women and men. 

Although the emphasis of this report is on changes in sexual behaviors in relation to the HIV 

epidemic, other possible modes of HIV transmission may contribute to risk. 

 Chapter 9 presents selected indicators from the individual‘s perspective, including whether the 

survey respondents know where to get tested for HIV and whether they did get tested for HIV 

and received test results. 

 Chapter 10 focuses on indicators of gender relations. General indicators of gender relations 

examined in the DHS include women‘s ability to make decisions on their health care, 

household purchases, and visiting family or relatives. Other indicators more specific to sexual 

behavior include male and female perspectives on whether a woman is justified in refusing sex 

or requesting a condom under circumstances where she is aware of her husband's extra-marital 

sexual activities or of his exposure to STIs. 

 Chapter 11 concludes the report with a summary of key findings, discussion of limitations, and 

mention of implications for HIV policies and programs. 
4 
5 

2 Data and Methods 

2.1 DHS Surveys 

The DHS surveys collect data from population-based, nationally representative samples of adult 

women and men in developing countries. The surveys are designed to obtain national and sub-national 

data on key program-related indicators of fertility, family planning, reproductive and child health, and 

women‘s status, as well as knowledge, attitudes, and behaviors related to HIV/AIDS. The surveys also 

collect data on many background socioeconomic and demographic characteristics of the households and 

individual respondents. Survey data of this kind can provide program managers and policymakers with 

strategic information needed to monitor and evaluate existing programs and to design effective new 

strategies. 

Surveys select a random sample of clusters (usually villages or urban blocks) from a national 

sampling frame, usually from the most recent national population census. Within the selected clusters, a 

full listing of all households is made before the survey, and then a systematic random sample of 

households is taken. During the main fieldwork, all women age 15–49 and men age 15–59 (age cut-offs 

for men vary by survey) who are either permanent residents of the households in the sample or visitors 

present in the household on the night before the survey are eligible to be interviewed in the survey. 

Information is gathered using three questionnaires: a household questionnaire, a woman‘s questionnaire, 

and a man‘s questionnaire.

Using information from the woman‘s and man‘s questionnaires, this report analyzes data from 

the two most recent rounds of DHS surveys in 23 countries in sub-Saharan Africa. All analysis in this 

report is limited to women and men age 15–49. The surveys included in this analysis were conducted 

between 1992 and 2006. By region within sub-Saharan Africa, the countries and survey years included 

are: 

West Africa: Benin (1996 and 2001), Burkina Faso (1998/99 and 2003), Cameroon (1998 and 

2004), Chad (1996/97 and 2004), Cote d‘Ivoire (1998/99 and 20051

), Ghana (1998 and 2003), Guinea 

(1999 and 2005), Mali (1995/96 and 2001), Niger (1998 and 2005), Nigeria (1999 and 2003), and 

Senegal (1997 and 2005); 

East Africa: Eritrea (1995 and 2002), Ethiopia (2000 and 2005), Kenya (1998 and 2003), 

Rwanda (2000 and 2005), Tanzania (1999 and 2004/05), and Uganda (2000/01 and 2006); 

Southern Africa: Madagascar (1997 and 2003/04), Malawi (2000 and 2004), Mozambique (1997 

and 2003), Namibia (1992 and 2000), Zambia (1996 and 2001/02), and Zimbabwe (1999 and 2005/06). 

Details about the survey design and data collection procedures used in each survey are available 

in individual DHS country reports (available at www.measuredhs.com). 

2.2 Sample Sizes 

Table 2.1 presents total sample sizes for women and men in age groups 15–49 and 15–24, for 

each survey round in the 23 countries. Table 2.1 also presents sample sizes for women and men currently 

in union (married or cohabiting), those who have ever had sex, and those who had sex in last 12 months. 

 

1

2005 survey for Cote d‘Ivoire was an AIDS Indicator Survey.
6 

These indicators provide denominators for most of the indicators presented in this report. Sample sizes for 

women and men varied considerably across countries, depending on the objectives of each survey round. 

Table 2.1 Sample sizes of women and men age 15–49, in selected countries in sub-Saharan 

Africa, 1992–2006

Country/year

Sample sizes

Women Men

Age 

15–49

Age 

15–24

Currently 

in union1

Ever 

had 

sex

Had sex 

in last 

12 

months

Age 

15–49

Age 

15–24

Currently 

in union1

Ever 

had 

sex

Had sex 

in last 

12 

months

West Africa

Benin 1996 5,491 2,095 4,198 4,925 4,064 1,272 295 886 1,228 1,105 

Benin 2001 6,219 2,448 4,563 5,608 4,617 2,465 905 1,378 2,164 1,957 

Burkina Faso 1998/99 6,445 2,602 5,181 5,665 4,389 2,354 994 1,230 1,773 1,554 

Burkina Faso 2003 12,477 5,050 9,655 10,911 8,168 3,209 1,440 1,636 2,375 2,014 

Cameroon 1998 5,501 2,409 3,676 5,019 4,441 2,345 1,067 1,122 2,006 1,879 

Cameroon 2004 10,656 4,936 7,166 9,280 8,060 4,815 2,177 2,271 3,959 3,660 

Chad 1996/97 7,454 3,084 5,832 6,596 5,770 2,140 863 1,307 1,716 1,609 

Chad 2004 6,085 2,432 4,663 5,284 4,512 1,682 673 977 1,324 1,232 

Cote d'Ivoire 1998/99 3,040 1,353 1,863 2,743 2,320 799 338 349 691 630 

Cote d'Ivoire* 2005 5,183 2,360 3,057 4,707 4,116 4,503 1,836 2,000 3,951 3,497 

Ghana 1998 4,843 1,810 3,131 4,183 3,495 1,382 575 670 1,014 876 

Ghana 2003 5,691 2,160 3,549 4,807 3,863 4,529 1,791 2,228 3,376 2,906 

Guinea 1999 6,753 2,407 5,561 6,144 4,597 1,752 689 899 1,501 1,292 

Guinea 2005 7,954 2,800 6,292 7,213 5,345 2,709 1,146 1,419 2,315 2,014 

Mali 1995/96 9,704 3,477 8,222 9,004 8,412 2,163 727 1,343 1,800 1,694 

Mali 2001 12,849 4,904 10,723 11,810 10,84

0 

3,000 1,131 1,723 2,447 2,259 

Niger 1998 7,577 3,078 6,382 6,806 6,318 3,143 1,260 1,935 2,383 2,154 

Niger 2005 9,223 3,369 7,941 8,342 7,658 3,101 1,110 1,923 2,283 2,067 

Nigeria 1999 8,206 3,296 5,757 6,872 5,910 2,255 830 1,205 1,712 1,526 

Nigeria* 2003 7,620 3,210 5,336 6,530 5,855 2,093 880 1,006 1,535 1,373 

Senegal 1997 8,593 3,601 5,851 6,652 5,926 3,070 824 1,591 2,696 n/a

Senegal 2005 14,602 6,400 9,866 10,716 9,238 3,415 1,571 1,533 2,414 1,983 

East Africa

Eritrea 1995 5,054 1,952 3,371 4,067 3,348 964 379 537 640 591 

Eritrea 2002 8,754 3,456 5,733 6,815 5,320 n/a n/a n/a n/a n/a

Ethiopia 2000 15,367 6,570 9,789 11,860 10,007 2,320 1,008 1,179 1,558 1,419 

Ethiopia* 2005 14,070 5,813 9,066 10,748 4,354 5,464 2,399 2,890 3,450 3,121 

Kenya 1998 7,881 3,399 4,834 6,639 5,924 3,224 1,400 1,616 2,788 2,566 

Kenya* 2003 8,195 3,547 4,919 6,806 5,710 3,363 1,537 1,615 2,825 2,380 

Rwanda 2000 10,421 4,524 5,052 7,361 5,301 2,532 1,195 1,249 1,748 1,427 

Rwanda* 2005 11,321 4,938 5,510 7,816 5,887 4,413 2,048 2,126 3,053 2,399 

(Cont’d)
7 

Table 2.1 – cont’d

Country/year

Sample sizes

Women Men

Age 

15–49

Age 

15–24

Currently 

in union1

Ever 

had sex

Had 

sex in 

last 12 

months

Age 

15–49

Age 

15–24

Currently 

in union1

Ever 

had 

sex

Had sex 

in last 

12 

months

Tanzania 1999 4,029 1,720 2,653 3,533 3,209 3,171 1,330 1,722 2,75

7 

2,602 

Tanzania* 2004/05 10,329 4,252 6,950 8,979 8,038 2,635 1,130 1,401 2,22

1 

1,975 

Uganda 2000/01 7,246 3,119 4,881 6,398 5,594 1,879 762 1,108 1,56

0 

1,376 

Uganda* 2006 8,531 3,646 5,337 7,281 6,266 2,385 997 1,343 1,93

8 

1,703 

Southern Africa

Madagascar 1997 7,060 2,878 4,435 6,206 5,619 n/a n/a n/a n/a n/a

Madagascar 2003/04 7,949 2,919 5,140 7,095 6,201 2,216 832 1,331 1,915 1,851 

Malawi 2000 13,220 5,824 9,452 11,845 10,360 2,915 1,259 1,745 2,609 2,303 

Malawi 2004 11,698 5,262 8,312 10,397 9,087 3,114 1,237 1,936 2,715 2,402 

Mozambique 1997 8,779 3,499 6,530 8,181 7,140 1,975 715 1,332 1,825 1,650 

Mozambique* 2003 12,418 4,910 8,736 11,712 9,824 2,490 1,076 1,466 2,264 2,117 

Namibia 1992 5,421 2,377 2,259 4,399 3,912 n/a n/a n/a n/a n/a

Namibia* 2000 6,755 2,838 2,610 5,775 4,568 2,766 1,304 887 2,474 2,094 

Zambia 1996 8,021 3,834 4,902 7,077 6,056 1,731 863 834 1,528 1,364 

Zambia* 2001/02 7,658 3,476 4,694 6,751 5,613 1,974 804 1,087 1,772 1,568 

Zimbabwe 1999 5,907 2,741 3,609 4,685 4,132 2,505 1,219 1,152 1,866 1,711 

Zimbabwe 2005/06 8,907 4,104 5,143 7,059 5,879 6,863 3,358 3,132 5,070 4,382 

Note: Cote d'Ivoire 2005 was an AIDS Indicator Survey.

* PEPFAR focus country.

1 Currently in union is defined as married or cohabiting at the time of the survey.

n/a: not available

Sample sizes of women and men age 15–49 in the earlier survey rounds ranged from 3,040 in 

Cote d‘Ivoire to 15,367 in Ethiopia for women, and from 799 in Cote d‘Ivoire to 3,224 in Kenya for men; 

and in the later rounds from 5,183 in Cote d‘Ivoire to 14,602 in Senegal for women, and from 1,682 in 

Chad to 6,863 in Zimbabwe for men. In most countries included in the analysis, sample sizes in the later 

rounds were larger than sample sizes in the earlier rounds, for both women and men. The exceptions are 

Chad, Nigeria, Ethiopia, Malawi, and Zambia for women, and Chad, Niger, Nigeria, and Tanzania for 

men, where sample sizes decreased slightly in the later rounds. In Madagascar and Namibia, men were 

not included in the earlier survey, and in Eritrea men were not included in the later survey.

2.3 Indicators Included in the Analysis 

Socioeconomic and Demographic Characteristics: 

1. Age groups (15–24, 25–34, 35–49), among all women and men age 15–49 

2. Residence (urban, rural), among all women and men age 15–49 

3. Educational status (no education, primary or less, secondary or higher), among all women and 

men age 15–49 
8 

4. Wealth quintile (lowest, lower, middle, higher, highest)2, among all women and men age 15–49 

5. Marital status (never married, currently in union-monogamous, currently in union-polygynous, 

widowed, divorced/separated)3, among all women and men age 15–49 

6. Media exposure: Exposed to at least one of the three mass media (newspaper, radio, television) at 

least once a week (no, yes), among all women and men age 15–49 

7. Number of years living in the current place of residence (<3 years, 3–9 years, 10+ years), among 

all women and men age 15–49 

8. Number of times slept away from home in last 12 months (0, 1–2, 3–4, 5+ times), among all men 

age 15–49 

9. Period of time stayed away from home in last 12 months (never away, away less than 1 month, 

away 1 month or longer), among all men age 15–49 

Knowledge, Misconceptions, and Risk Perception: 

10. Ever heard of HIV/AIDS (no, yes), among all women and men age 15–49 

11. Knowledge that HIV infection can be prevented by abstaining from sex (no, yes), among all 

women and men age 15–49 

12. Knowledge that HIV infection can be prevented by limiting sex to one faithful partner (no, yes), 

among all women and men age 15–49 

13. Knowledge that HIV infection can be prevented by always using a condom when having sex (no, 

yes), among all women and men age 15–49 

14. Knowledge that HIV infection can be prevented by limiting sex to one faithful partner and by 

always using a condom when having sex (no, yes), among all women and men age 15–49 

15. Knowledge that a healthy-looking person can have HIV (no, yes), among all women and men age 

15–49 

16. Knowledge that HIV cannot be transmitted by mosquitoes (no, yes), among all women and men 

age 15–49 

17. Knowledge that HIV cannot be transmitted by sharing food (no, yes), among all women and men 

age 15–49 

 

2

 Household wealth is measured by means of an index based on household ownership of consumer durables (such as 

a television and a bicycle); materials used for housing construction; and the availability of amenities (such as 

electricity, source of drinking water, and type of toilet facility) that tend to be correlated with household economic 

status. The index, constructed using principal components analysis, is a composite measure of the cumulative living 

standard of a household, which places individual households on a continuous scale of relative wealth. The wealth 

index is divided into quintiles, with the lowest quintile representing the poorest 20 percent and the highest quintile 

representing the wealthiest 20 percent of households within each country (Rutstein and Johnson 2004). 

3 Currently in union includes currently married and cohabiting. For some countries, only the combined ―currently in 

union‖ category is available, without the distinction between monogamy and polygyny.
9 

18. Comprehensive knowledge about HIV/AIDS: Knows that HIV infection can be prevented by 

limiting sex to one faithful partner and by always using a condom when having sex, and knows 

that a healthy-looking person can have HIV, as well as rejects the two most common 

misconceptions (country specific) about HIV transmission (no, yes), among all women and men 

age 15–49 

19. Knowledge that HIV can be transmitted from mother to child through breastfeeding (no, yes), 

among all women and men age 15–49 

20. Knowledge that there is a special drug that can prevent HIV transmission from mother to child 

through breastfeeding (no, yes), among all women and men age 15–49 

21. Knowledge both that HIV can be transmitted from mother to child through breastfeeding and that 

there is a special drug that can prevent HIV transmission from mother to child through 

breastfeeding (no, yes), among all women and men age 15–49 

22. Perceived risk of getting HIV (no risk, small risk, moderate risk, high risk/has HIV), among all 

women and men age 15–49 

23. Believes that the respondent has a low/no risk of getting HIV and having 3+ lifetime sex partners 

(no, yes), among all women and men age 15–49 

24. Believes that the respondent has a low/no risk of getting HIV and having 2+ sex partners in last 

12 months (no, yes), among women and men age 15–49 who had sex in last 12 months 

Attitudes Related to HIV/AIDS: 

25. Would not want the HIV-positive status of a family member to remain secret (no, yes), among all 

women and men age 15–49 who have heard about HIV/AIDS 

26. Willingness to care for a family member who has HIV (no, yes), among all women and men age 

15–49 who have heard about HIV/AIDS 

27. Would allow female4 teacher with HIV to continue teaching (no, yes), among all women and men 

age 15–49 who have heard about HIV/AIDS 

28. Would buy vegetables from a vendor who has HIV (no, yes), among all women and men age 15–

49 who have heard about HIV/AIDS 

29. Having all four accepting attitudes toward people with HIV (no, yes), among all women and men 

age 15–49 who have heard about HIV/AIDS 

30. Believes that children age 12–14 should be taught to wait till marriage for sexual intercourse (no, 

yes), among all women and men age 15–49 who have heard about HIV/AIDS 

31. Believes that children age 12–14 should be taught about condom use to prevent HIV infection 

(no, yes), among all women and men age 15–49 who have heard about HIV/AIDS 

 

4

 Some surveys do not specify the gender of the teacher.
10 

Sexual Behavior: 

32. Median age at first sex, among women and men age 20–24 

33. Number of lifetime sex partners (0, 1, 2, 3+), among all women and men age 15–49 

34. Number of sex partners in last 12 months (1, 2+), among women and men age 15–49 who had sex 

in last 12 months 

35. Higher-risk sex5 in last 12 months (sex with spouse/cohabiting partner, sex with other), among 

women and men age 15–49 who had sex in last 12 months 

36. Extramarital sex in last 12 months (sex with spouse/cohabiting partner, sex with other), among 

women and men age 15–49 currently in union and who had sex in last 12 months 

37. Paid for sex in last 12 months (no, yes), among men age 15–49 who had sex in last 12 months 

38. Ever used condom (no, yes), among women and men age 15–49 who ever had sex 

39. Used condom at last sex in last 12 months (no, yes), among women and men age 15–49 who had 

sex in last 12 months 

40. Used a condom at last higher-risk sex in last 12 months (no, yes), among women and men age 

15–49 who had higher-risk sex in last 12 months 

41. Used condom consistently in last 12 months: Used condom at last sex with all sexual partners (up 

to three) in last 12 months (no, yes), among women and men age 15–49 who had sex in last 12 

months 

42. Alcohol use (never, 3+ months before the survey, in last 3 months)6, among all women and men 

age 15–49 

43. Alcohol use at last sex in last 12 months7 (neither used, either used, both used), among women 

and men age 15–49 who had sex in last 12 months 

Sexual Behavior of Youth: 

44. Had sex before age 15 (no, yes), among women and men age 15–19 

45. Primary abstinence: never had sex (no, yes), among women and men age 15–24 who never 

married 

46. Secondary abstinence: ever had sex but not in last 12 months (no, yes), among women and men 

age 15–24 who never married and ever had sex 

 

5

 Higher-risk sex is defined as sex with a non-marital, non-cohabiting partner.

6

 Some countries asked about last one month

7 The question was asked for up to three most recent sex partners in last 12 months. The responses ―respondent 

only‖ and ―partner only‖ were grouped into ―either used.‖ Some countries additionally asked about getting drunk, 

which is not analyzed here.
11 

47. Women age 15–19 who had higher-risk sex in last 12 months with a partner who was 10 or more 

years older (no, yes), among women age 15–19 who had higher-risk sex in last 12 months 

48. Condom use at first sex (no, yes), among women and men age 15–24 who never married and ever 

had sex 

49. Forced at first sex (no, yes), among women age 15–24 who ever had sex 

50. Forced sex in last 12 months, among women age 15–24 who had sex in last 12 months 

51. Having 3+ lifetime sex partners, among women and men age 15–24 who ever had sex 

52. Having 2+ sex partners in last 12 months (no, yes), among women and men age 15–24 who had 

sex in last 12 months 

Other Modes of HIV Transmission: 

53. Number of injections by a health care professional in recent months8 (0, 1–3, 4+), among all 

women and men age 15–49 

54. Circumcised (no, yes), among all men age 15–49 

55. Had STI or STI symptoms9 in last 12 months (no, yes), among women and men age 15–49 who 

ever had sex 

Program Coverage: 

56. Ever tested for HIV and received test results (no, yes), among all women and men age 15–49 

57. Tested for HIV in last 12 month and received test results (no, yes), among all women and men 

age 15–49 

58. Know where to get tested for HIV (no, yes), among all women and men age 15–49 

Gender Relations: 

59. Agrees that a wife is justified in refusing to have sex with her husband if she knows that the 

husband has an STI (no, yes), among all women and men age 15–49 

60. Agrees that a wife is justified in refusing to have sex with her husband if she knows that the 

husband has had sex with other women (no, yes), among all women and men age 15–49 

61. Agrees that a wife is justified to ask the husband to use a condom if the husband has an STI (no, 

yes), among all women and men age 15–49 

 

8

 The reference period for this question varied across surveys, from last 3 months to 12 months preceding the survey.

9

 STI or STI symptoms include having diagnosed STI, genital sore or ulcer, or bad smelling, abnormal genital 

discharge in last 12 months.
12 

62. Woman‘s ability to negotiate safer sex10 (no, yes), among all women and men age 15–49 

63. Has never discussed HIV/AIDS with any of the sexual partners (no, yes), among women and men 

age 15–49 currently in union 

64. Participates in making decision on own health care (no, yes), among all women age 15–49 

65. Participates in making decision on large household purchases (no, yes), among all women age 

15–49 

66. Participates in making decision on household purchases for daily needs (no, yes), among all 

women age 15–49 

67. Participates in making decision on visit to family or relatives (no, yes), among all women age 15–

49 

68. Participates in making 2 or more of the 4 household decisions (no, yes), among all women age 

15–49 

69. Participates in making all 4 household decisions (no, yes), among all women age 15–49 

 

10 Wife can negotiate safer sex if response was ―yes‖ to one of the two questions: 1) a woman can refuse sex if she 

knows that the husband has an STI or 2) a woman can request condom use if she knows that the husband has an STI. 
13 

3 Socioeconomic and Demographic Characteristics 

This chapter presents key socioeconomic and demographic characteristics that have been 

associated with HIV, including age, marital status, educational attainment, household wealth, exposure to 

mass media, urban/rural residence, and two indicators of mobility. 

3.1 Age 

Table 3.1 shows the percentage distribution of the samples of each country studied, by age group 

and sex for the two most recent rounds of DHS surveys. In general, the proportion of youth age 15–24 in 

the population was high in most of the sub-Saharan African countries studied. Zimbabwe, Cameroon, and 

Cote d‘Ivoire had the highest percentages of female youth (46 percent). The country with the highest 

proportion of male youth was Zimbabwe (49 percent), followed by Namibia (47 percent). 

The percentage of young women age 15–24 ranged from 36 percent in Guinea and Mali to 48 

percent in Zambia in the earlier surveys. In the later surveys, this percentage remained relatively 

unchanged in the majority of countries. However, in Niger, Madagascar, and Zambia the percentage of 

female youth decreased slightly, while in Cameroon and Mali it increased slightly. 

Table 3.1 Changes in age distribution (%) of women and men age 15–49, in selected countries in 

sub-Saharan Africa, 1992–2006

Country/year

Age group

Women Men

15–24 25–34 35–49

Number

15–24 25–34 35–49

% % % % % % Number

West Africa

Benin 1996 38.1 31.5 30.3 5,491 23.2 36.5 40.4 1,272 

Benin 2001 39.4 32.7 27.9 6,219 36.7 32.5 30.7 2,465 

Burkina Faso 1998/99 40.4 29.6 30.1 6,445 42.2 29.0 28.8 2,354 

Burkina Faso 2003 40.5 29.3 30.2 12,477 44.9 26.3 28.9 3,209 

Cameroon 1998 43.8 29.7 26.5 5,501 45.5 27.4 27.1 2,345 

Cameroon 2004 46.3 29.1 24.6 10,656 45.2 29.7 25.0 4,815 

Chad 1996/97 41.4 31.2 27.4 7,454 40.3 30.3 29.4 2,140 

Chad 2004 40.0 31.6 28.4 6,085 40.0 30.0 30.0 1,682 

Cote d'Ivoire 1998/99 44.5 30.3 25.2 3,040 42.3 31.3 26.4 799 

Cote d'Ivoire 2005 45.5 30.8 23.7 5,183 40.8 31.7 27.5 4,503 

Ghana 1998 37.4 31.4 31.3 4,843 41.6 31.0 27.4 1,382 

Ghana 2003 38.0 30.8 31.2 5,691 39.5 30.6 29.8 4,529 

Guinea 1999 35.6 32.8 31.5 6,753 39.4 27.2 33.5 1,752 

Guinea 2005 35.2 29.9 34.9 7,954 42.3 22.8 34.9 2,709 

Mali 1995/96 35.8 33.1 31.0 9,704 33.6 27.1 39.3 2,163 

Mali 2001 38.2 32.0 29.9 12,849 37.7 29.1 33.2 3,000 

Niger 1998 40.6 30.7 28.7 7,577 40.1 26.4 33.5 3,143 

Niger 2005 36.5 34.1 29.4 9,223 35.8 28.9 35.3 3,101 

Nigeria 1999 40.2 32.3 27.5 8,206 36.8 31.6 31.5 2,255 

Nigeria 2003 42.1 30.5 27.4 7,620 42.0 29.9 28.0 2,093 

Senegal 1997 41.9 30.4 27.7 8,593 26.8 35.1 38.1 3,070 

Senegal 2005 43.8 29.7 26.5 14,602 46.0 27.4 26.6 3,415 

(Cont’d)
14 

Table 3.1 – cont’d

Country/year

Age group

Women Men

15–24 25–34 35–49

Number

15–24 25–34 35–49

% % % % % % Number

East Africa

Eritrea 1995 38.6 28.1 33.3 5,054 39.3 23.8 36.9 964 

Eritrea 2002 39.5 30.3 30.2 8,754 n/a n/a n/a n/a

Ethiopia 2000 42.8 28.8 28.4 15,367 43.4 26.7 29.9 2,320 

Ethiopia 2005 41.3 30.7 28.0 14,070 43.9 27.4 28.7 5,464 

Kenya 1998 43.1 29.9 27.0 7,881 43.4 27.3 29.2 3,224 

Kenya 2003 43.3 30.1 26.6 8,195 45.7 27.5 26.8 3,363 

Rwanda 2000 43.4 27.5 29.1 10,421 47.2 24.8 28.0 2,532 

Rwanda 2005 43.6 28.3 28.1 11,321 46.4 25.8 27.8 4,413 

Tanzania 1999 42.7 30.7 26.6 4,029 42.0 28.9 29.1 3,171 

Tanzania 2004/05 41.2 33.2 25.7 10,329 42.9 30.1 27.1 2,635 

Uganda 2000/01 43.0 32.1 24.9 7,246 40.6 32.0 27.4 1,879 

Uganda 2006 42.7 30.8 26.4 8,531 41.8 29.6 28.7 2,385 

Southern Africa

Madagascar 1997 40.8 31.3 28.0 7,060 n/a n/a n/a n/a

Madagascar 2003/04 36.7 31.5 31.8 7,949 37.6 29.4 33.1 2,216 

Malawi 2000 44.1 30.0 25.9 13,220 43.2 29.8 27.0 2,915 

Malawi 2004 45.0 31.1 23.9 11,698 39.7 35.9 24.3 3,114 

Mozambique 1997 39.9 31.8 28.4 8,779 36.2 30.1 33.7 1,975 

Mozambique 2003 39.5 32.3 28.1 12,418 43.2 28.4 28.4 2,490 

Namibia 1992 43.9 29.7 26.4 5,421 n/a n/a n/a n/a

Namibia 2000 42.0 31.4 26.6 6,755 47.1 29.9 23.0 2,766 

Zambia 1996 47.8 29.5 22.7 8,021 49.9 27.7 22.4 1,731 

Zambia 2001/02 45.4 30.7 24.0 7,658 40.7 32.5 26.7 1,974 

Zimbabwe 1999 46.4 28.8 24.8 5,907 48.7 28.4 23.0 2,505 

Zimbabwe 2005/06 46.1 30.1 23.8 8,907 48.9 28.6 22.5 6,863 

The percentage of young men age 15–24 in the earlier surveys ranged from 23 percent in Benin to 

50 percent in Zambia. Over time, the percentage of young men remained relatively unchanged in eight 

countries, increased in eight others, and decreased in four (three countries do not have data on men for 

both survey rounds). 

3.2 Marital Status 

Table 3.2 presents the marital status of women and men age 15–49 in the two most recent rounds 

of DHS surveys. All countries had a greater percentage of never-married men than women, and a greater 

percentage of widowed women than men. Generally, the percentages of widowed women were higher in 

east and southern Africa than in west Africa. In the most recent surveys, Namibia had the highest 

percentage of never-married men (63 percent), and Zimbabwe had the highest percentage of widowed 

women (8 percent). In Zimbabwe the percentage of widows doubled comparing the earlier survey to the 

most recent, while in Rwanda the proportion of widows decreased from 8 percent to 4 percent. Of the 20 

countries with data available for men in both rounds of surveys, the proportion of never-married men 

increased in 6 countries, decreased in 5 others, and remained stable in the other 9.
15 

Table 3.2 Changes in marital status of women and men age 15–49, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Marital status

Women Men

Never 

married 

Currently in union*

Widowed

Divorced/

separated

Number

Never 

married

Currently in union*

Widowed

Divorced/

separated

Number

MonogamyPolygynyMonogamyPolygyny

% % % % % % % % % %

West Africa

Benin 1996 19.0 38.5 37.8 1.8 2.7 5,491 26.4 48.7 20.8 0.6 3.4 1,272 

Benin 2001 21.7 39.8 33.3 1.7 3.2 6,219 40.6 41.0 14.9 0.5 3.1 2,465 

Burkina Faso 1998/99 16.9 36.4 43.9 1.8 1.0 6,445 46.0 37.8 14.4 0.4 1.3 2,354 

Burkina Faso 2003 18.7 39.9 37.4 2.2 1.7 12,477 47.4 38.8 12.2 0.2 1.4 3,209 

Cameroon 1998 23.4 44.7 21.9 3.2 6.6 5,501 48.0 40.4 7.5 0.4 3.7 2,345 

Cameroon 2004 24.0 46.6 20.2 2.8 5.9 10,656 43.9 42.0 5.2 [9.0] 4,815 

Chad 1996/97 13.7 47.6 30.6 3.1 5.0 7,454 36.3 47.2 13.8 0.4 2.2 2,140 

Chad 2004 14.3 46.5 29.9 3.2 5.8 6,085 38.6 46.3 11.8 0.4 2.8 1,682 

Cote d'Ivoire 1998/99 30.4 39.8 21.3 2.0 6.3 3,040 52.5 38.5 5.2 [3.8] 799 

Cote d'Ivoire 2005 32.3 41.1 15.6 2.7 6.0 5,183 49.7 37.7 6.4 0.8 5.1 4,503 

Ghana 1998 23.7 50.0 14.6 1.8 9.8 4,843 45.8 43.3 5.1 0.3 5.5 1,382 

Ghana 2003 28.4 48.0 14.1 1.9 7.3 5,691 45.0 43.5 5.7 0.4 5.4 4,529 

Guinea 1999 13.9 38.1 43.9 1.4 2.2 6,753 46.6 36.6 14.7 0.1 1.9 1,752 

Guinea 2005 16.5 37.1 40.8 2.0 2.4 7,954 42.9 36.1 16.3 0.2 4.5 2,709 

Mali 1995/96 12.8 47.2 37.4 1.2 1.2 9,704 36.2 47.8 14.3 0.3 1.4 2,163 

Mali 2001 13.5 47.8 35.4 1.3 1.8 12,849 40.4 n/a n/a [2.1] 3,000 

Niger 1998 11.2 52.4 31.7 1.4 3.1 7,577 35.8 48.8 12.7 0.3 2.3 3,143 

Niger 2005 9.9 55.2 30.7 1.5 2.5 9,223 35.8 49.7 12.3 0.5 1.8 3,101 

Nigeria 1999 26.0 45.1 22.9 1.6 2.3 8,206 43.8 41.5 9.0 0.4 2.4 2,255 

Nigeria 2003 25.3 44.5 25.1 1.8 2.9 7,620 50.1 38.2 9.7 0.3 1.6 2,093 

Senegal 1997 26.9 35.0 31.3 1.0 4.1 8,593 45.7 40.4 11.3 0.1 2.3 3,070 

Senegal 2005 27.0 40.7 25.8 1.2 4.3 14,602 51.4 36.0 8.9 0.1 3.6 3,415 

(Cont’d)

15
16 

Table 3.2 – cont’d

Country/year

Marital status

Women Men

Never 

married 

Currently in union*

Widowed

Divorced/

separated

Number

Never 

married

Currently in union*

Widowed

Divorced/

separated

Number

MonogamyPolygynyMonogamyPolygyny

% % % % % % % % % %

East Africa

Eritrea 1995 20.0 62.0 4.6 4.8 8.6 5,054 40.2 53.1 2.6 1.2 2.9 964 

Eritrea 2002 23.3 59.3 5.9 3.7 7.4 8,754 n/a n/a n/a n/a n/a n/a

Ethiopia 2000 24.0 55.0 8.6 3.6 8.7 15,367 44.7 46.7 4.1 0.5 3.9 2,320 

Ethiopia 2005 25.0 56.5 7.4 4.0 6.6 14,070 44.2 49.7 3.2 0.4 2.5 5,464 

Kenya 1998 30.1 51.3 9.8 3.7 4.9 7,881 46.2 45.7 4.4 0.5 3.2 3,224 

Kenya 2003 29.8 48.7 9.9 4.2 5.9 8,195 47.9 43.6 4.4 0.7 3.4 3,363 

Rwanda 2000 34.1 42.5 5.9 7.9 9.5 10,421 48.2 46.8 2.3 0.9 1.6 2,532 

Rwanda 2005 37.7 43.2 5.4 4.3 9.3 11,321 49.7 45.8 2.4 0.5 1.7 4,413 

Tanzania 1999 23.4 n/a n/a 3.2 7.6 4,029 40.6 49.9 4.4 0.6 4.5 3,171 

Tanzania 2004/05 23.0 51.2 15.4 2.6 7.2 10,329 41.7 47.3 5.9 0.4 4.7 2,635 

Uganda 2000/01 20.1 45.4 19.5 3.4 9.2 7,246 35.9 48.5 10.4 0.7 4.5 1,879 

Uganda 2006 23.8 43.4 17.6 4.3 9.4 8,531 38.5 47.2 9.2 0.6 4.6 2,385 

Southern Africa

Madagascar 1997 23.4 60.3 2.1 2.2 11.6 7,060 n/a n/a n/a n/a n/a n/a

Madagascar 2003/04 21.3 62.4 2.0 2.2 11.8 7,949 34.2 59.8 0.3 0.2 5.5 2,216 

Malawi 2000 17.0 59.2 12.2 3.5 8.0 13,220 36.8 54.9 5.0 0.6 2.8 2,915 

Malawi 2004 16.8 59.8 11.1 3.7 8.4 11,698 34.8 56.2 6.0 0.5 2.5 3,114 

Mozambique 1997 15.1 53.2 20.3 1.2 9.3 8,779 28.7 57.4 10.0 [3.8] 1,975 

Mozambique 2003 15.8 48.1 17.0 0.9 13.0 12,418 36.6 51.8 7.1 0.1 4.4 2,490 

Namibia 1992 51.3 31.1 4.8 1.4 5.5 5,421 n/a n/a n/a n/a n/a n/a

Namibia 2000 54.3 26.8 4.8 1.8 5.3 6,755 63.2 30.8 1.2 0.2 4.5 2,766 

Zambia 1996 25.3 50.6 10.1 4.1 9.5 8,021 47.0 44.4 3.7 0.9 3.9 1,731 

Zambia 2001/02 24.8 51.4 9.6 4.7 9.3 7,658 39.6 50.4 4.7 0.9 4.4 1,974 

Zimbabwe 1999 27.7 51.6 9.4 4.2 7.0 5,907 49.9 43.5 2.5 1.1 2.9 2,505 

Zimbabwe 2005/06 27.0 48.5 6.6 7.5 7.7 8,907 49.6 43.5 2.0 1.3 3.5 6,863 

* In some countries currently in union has only one category, without a distinction between monogamy and polygyny.

 [ ] Combines widowed, divorced, or separated.

16
17 

In the most recent surveys, west African countries had a higher proportion of women in 

polygynous marriages (ranging from 14 percent to 41 percent) than east African countries (5 percent to 18 

percent) and southern African countries (2 percent to 17 percent). In all three regions a greater percentage 

of women than men reported being in polygynous marriages. The proportion of women in polygynous 

unions decreased in eight countries and increased in one country. Among men, the proportion in 

polygynous marriages decreased in only six of the countries in this study. 

3.3 Educational Attainment 

Table 3.3 presents the educational attainment of women and men age 15–49 for the two survey 

rounds. The educational levels of women and men varied notably across countries. In the most recent 

surveys, the proportion of women with no education ranged from 4 percent in Zimbabwe to 80 percent in 

Burkina Faso. In 10 countries more than 50 percent of women had no education, while among men the 

same was true in only 3 countries. 

Table 3.3 Changes in educational status of women and men age 15–49, in selected countries in 

sub-Saharan Africa, 1992–2006

Country/year

Educational status

Women Men

No 

education

Primary 

or less

Secondary 

or higher

Number

No 

education

Primary 

or less

Secondary 

or higher

% % % % % % Number

West Africa

Benin 1996 70.8 19.8 9.4 5,491 43.0 33.3 23.6 1,272 

Benin 2001 64.1 22.1 13.9 6,219 37.6 32.6 29.7 2,465

Burkina Faso 1998/99 85.8 8.4 5.8 6,445 71.4 15.1 13.5 2,354 

Burkina Faso 2003 80.3 11.0 8.7 12,477 62.7 18.9 18.4 3,209 

Cameroon 1998 28.1 38.6 33.3 5,501 12.2 39.3 48.5 2,345 

Cameroon 2004 22.4 38.6 39.1 10,656 9.7 36.1 54.2 4,815 

Chad 1996/97 77.0 19.3 3.8 7,454 52.0 30.1 17.9 2,140 

Chad 2004 74.8 18.8 6.4 6,085 45.0 33.1 21.9 1,682 

Cote d'Ivoire 1998/99 55.9 28.8 15.3 3,040 37.5 25.8 36.7 799 

Cote d'Ivoire 2005 53.9 26.5 19.6 5,183 34.0 25.1 40.9 4,503 

Ghana 1998 29.1 18.0 52.8 4,843 14.7 12.6 72.6 1,382 

Ghana 2003 28.2 20.0 51.8 5,691 16.4 16.6 67.1 4,529 

Guinea 1999 80.4 10.2 9.4 6,753 51.1 21.6 27.2 1,752 

Guinea 2005 77.5 11.4 11.1 7,954 48.2 17.8 34.1 2,709 

Mali 1995/96 81.1 11.9 7.1 9,704 66.7 16.7 16.6 2,163 

Mali 2001 80.0 11.3 8.7 12,849 62.3 16.7 20.9 3,000 

Niger 1998 84.8 9.9 5.3 7,577 68.1 17.6 14.3 3,143 

Niger 2005 83.5 10.4 6.1 9,223 66.0 18.5 15.5 3,101 

Nigeria 1999 40.5 22.8 36.7 8,206 20.2 26.0 53.8 2,255 

Nigeria 2003 41.6 21.4 37.0 7,620 18.4 24.8 56.8 2,093 

Senegal 1997 66.6 20.9 12.5 8,593 49.9 23.7 26.4 3,070 

Senegal 2005 59.6 25.2 15.2 14,602 41.1 28.3 30.6 3,415 

(Cont’d)
18 

Table 3.3 – cont’d

Country/year

Educational status

Women Men

No 

education

Primary 

or less

Secondary 

or higher

Number

No 

education

Primary 

or less

Secondary 

or higher

% % % % % % Number

East Africa

Eritrea 1995 65.9 18.1 16.0 5,054 41.8 26.9 31.3 964 

Eritrea 2002 50.1 29.8 20.1 8,754 n/a n/a n/a n/a 

Ethiopia 2000 75.2 15.8 9.1 15,367 47.6 36.0 16.4 2,320 

Ethiopia 2005 65.9 22.2 11.9 14,070 39.6 39.2 21.2 5,464 

Kenya 1998 11.5 59.3 29.2 7,881 3.5 55.1 41.5 3,224 

Kenya 2003 12.7 58.0 29.3 8,195 5.7 57.0 37.3 3,363 

Rwanda 2000 29.4 59.9 10.6 10,421 21.1 64.3 14.7 2,532 

Rwanda 2005 23.4 67.1 9.6 11,321 16.3 71.0 12.7 4,413 

Tanzania 1999 27.1 67.5 5.3 4,029 12.2 80.1 7.5 3,171 

Tanzania 2004/05 24.2 67.2 8.6 10,329 11.8 76.9 11.2 2,635 

Uganda 2000/01 21.9 59.8 18.4 7,246 5.9 65.1 29.0 1,879 

Uganda 2006 19.3 59.3 21.3 8,531 4.9 65.0 30.1 2,385 

Southern Africa

Madagascar 1997 21.2 51.9 26.9 7,060 n/a n/a n/a n/a 

Madagascar 2003/04 22.4 46.8 30.8 7,949 17.2 48.3 34.5 2,216 

Malawi 2000 27.0 61.9 11.1 13,220 9.9 69.2 20.9 2,915 

Malawi 2004 22.6 61.9 15.5 11,698 10.6 62.3 27.2 3,114 

Mozambique 1997 42.9 52.7 4.4 8,779 16.2 71.8 12.0 1,975 

Mozambique 2003 41.1 51.1 7.8 12,418 13.7 68.6 17.7 2,490 

Namibia 1992 14.5 48.4 37.1 5,421 n/a n/a n/a n/a 

Namibia 2000 9.5 33.1 57.4 6,755 11.7 34.3 54.0 2,766 

Zambia 1996 13.3 58.9 27.8 8,021 6.5 50.0 43.5 1,731 

Zambia 2001/02 12.1 58.0 30.0 7,658 4.9 50.8 44.3 1,974 

Zimbabwe 1999 6.7 40.2 53.0 5,907 2.0 30.6 67.3 2,505 

Zimbabwe 2005/06 4.3 32.6 63.1 8,907 1.3 26.0 72.8 6,863 

While overall a greater percentage of women than men had no education, there were large 

regional variations. West African countries showed higher proportions of women with no education (22 

percent to 84 percent) than east African countries (13 percent to 66 percent) and southern African 

countries (4 percent to 41 percent). The percentage of women with secondary or higher education ranged 

from 6 percent in Niger and Chad to 63 percent in Zimbabwe. Although the percentage of women and 

men with secondary or higher education increased in the majority of countries, men were consistently 

more educated than women (Figures 3.1a and 3.1b). In Namibia and Zimbabwe, however, the proportion 

of women with secondary or higher education increased by 20 percentage points and 10 percentage 

points, respectively. 
19 

Figure 3.1a Changes in educational level among women age 15–49, 1992–2006 
20 

Figure 3.1b Changes in educational level among men age 15–49, 1995–2006 
21 

3.4 Household Wealth 

Table 3.4 presents the distribution of respondents by household wealth for the two most recent 

surveys. The DHS measure of household wealth is based on household ownership of durable assets. In 

most of the sub-Saharan African countries studied, a greater proportion of women and men lived in 

households in the highest wealth quintile than in households in the lowest wealth quintile. Although 

household wealth was not strictly comparable across surveys,

11 in most countries this pattern remained 

generally unchanged between the first and second survey rounds. 

 

11 Household wealth status is not strictly comparable across surveys because the composition of durable assets varies 

from survey to survey. 
22 

Table 3.4 Changes in percent distribution of women and men age 15–49 by household wealth status, in selected countries in subSaharan Africa, 1992–2006

Country/year

Wealth quintile

Women Men

Lowest Lower Middle Higher Highest

Number

Lowest Lower Middle Higher Highest

% % % % % % % % % % Number

West Africa

Benin 1996 19.4 18.5 18.5 20.9 22.8 5,491 21.3 18.3 16.6 18.7 25.1 1,272 

Benin 2001 17.8 18.3 18.5 20.9 24.6 6,219 21.4 18.3 16.1 18.3 25.9 2,465 

Burkina Faso 1998/99 20.3 21.6 17.1 19.1 21.9 6,445 15.9 18.6 18.5 17.8 29.1 2,354 

Burkina Faso 2003 17.6 18.4 23.8 16.5 23.8 12,477 14.9 19.2 21.9 15.8 28.3 3,209 

Cameroon 1998 21.8 16.4 17.9 21.1 22.8 5,501 15.0 16.4 19.0 23.4 26.2 2,345 

Cameroon 2004 18.8 16.5 19.2 21.4 24.1 10,656 13.5 16.4 18.8 23.1 28.2 4,815 

Chad 1996/97 16.8 28.6 17.1 18.3 19.2 7,454 11.4 24.2 19.4 18.3 26.6 2,140 

Chad 2004 20.0 21.5 18.1 20.5 19.9 6,085 15.3 19.3 18.3 19.7 27.4 1,682 

Cote d'Ivoire 1998/99 19.1 17.5 17.2 21.2 24.9 3,040 16.4 14.3 21.3 20.6 27.5 799 

Cote d'Ivoire 2005 17.1 18.3 18.6 21.2 24.8 5,183 16.8 18.8 20.1 20.9 23.4 4,503 

Ghana 1998 20.3 17.2 18.2 20.1 24.2 4,843 15.6 17.4 21.3 22.4 23.4 1,382 

Ghana 2003 17.0 16.7 18.8 21.9 25.6 5,691 17.1 17.7 19.4 21.4 24.3 4,529 

Guinea 1999 21.8 18.1 17.9 19.8 22.4 6,753 16.8 17.8 18.3 19.8 27.4 1,752 

Guinea 2005 20.6 19.0 19.3 20.0 21.1 7,954 16.5 16.8 17.1 19.1 30.4 2,709 

Mali 1995/96 19.3 19.6 18.8 19.5 22.9 9,704 17.9 19.7 18.3 19.8 24.4 2,163 

Mali 2001 19.0 18.6 19.1 19.8 23.4 12,849 21.6 16.5 15.7 17.1 28.6 3,000 

Niger 1998 16.1 26.9 17.8 18.2 21.1 7,577 12.9 22.0 19.1 19.7 26.2 3,143 

Niger 2005 19.0 19.3 19.0 20.7 22.0 9,223 13.3 17.8 20.8 19.9 28.2 3,101 

Nigeria 1999 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Nigeria 2003 18.6 18.9 19.9 20.0 22.7 7,620 17.3 17.2 18.7 21.6 25.2 2,093 

Senegal 1997 17.0 17.8 19.0 21.5 24.8 8,593 14.8 18.0 17.2 23.1 26.9 3,070 

Senegal 2005 16.7 17.6 19.4 21.6 24.7 14,602 15.3 14.1 17.6 22.8 30.2 3,415 

(Cont’d)

22
23 

Table 3.4 – cont’d

Country/year

Wealth quintile

Women Men

Lowest Lower Middle Higher Highest

Number

Lowest Lower Middle Higher Highest

% % % % % % % % % % Number

East Africa

Eritrea 1995 18.9 18.1 18.3 19.0 25.6 5,054 11.7 19.5 21.0 21.5 26.3 964 

Eritrea 2002 16.8 18.6 19.1 20.9 24.6 8,754 n/a n/a n/a n/a n/a n/a 

Ethiopia 2000 18.6 18.8 19.1 19.5 24.1 15,367 18.8 20.0 19.8 19.2 22.2 2,320 

Ethiopia 2005 17.3 18.8 19.4 18.8 25.7 14,070 17.9 19.3 17.9 19.9 25.0 5,464 

Kenya 1998 18.4 18.9 18.8 19.4 24.5 7,881 15.0 16.7 17.9 23.9 26.5 3,224 

Kenya 2003 16.6 18.0 18.3 20.9 26.1 8,195 15.2 17.0 18.3 22.0 27.5 3,363 

Rwanda 2000 12.6 22.6 18.9 23.4 22.4 10,421 12.0 18.1 20.7 26.0 23.1 2,532 

Rwanda 2005 21.4 20.5 18.5 18.8 20.7 11,321 18.1 18.0 20.2 20.4 23.3 4,413 

Tanzania 1999 16.9 18.0 20.9 19.6 24.6 4,029 15.9 17.7 21.1 20.2 25.1 3,171 

Tanzania 2004/05 17.8 18.8 18.8 19.4 25.1 10,329 18.4 19.1 19.6 19.6 23.3 2,635 

Uganda 2000/01 19.0 19.0 18.7 19.8 23.5 7,246 19.0 21.2 17.6 21.1 21.2 1,879 

Uganda 2006 18.1 19.2 18.9 19.0 24.8 8,531 15.8 20.8 17.7 21.2 24.5 2,385 

Southern Africa

Madagascar 1997 20.3 19.5 17.2 19.5 23.5 7,060 n/a n/a n/a n/a n/a n/a 

Madagascar 2003/04 21.4 15.2 18.4 19.3 25.7 7,949 17.3 19.7 19.8 18.8 24.4 2,216 

Malawi 2000 20.2 18.3 20.8 18.5 22.2 13,220 18.4 17.9 22.0 17.7 24.0 2,915 

Malawi 2004 17.4 19.5 20.4 20.2 22.6 11,698 12.3 19.7 21.4 21.4 25.2 3,114 

Mozambique 1997 27.6 12.0 19.9 19.0 21.5 8,779 19.6 16.6 19.5 22.1 22.1 1,975 

Mozambique 2003 22.7 17.4 18.8 18.1 23.0 12,418 21.6 16.2 17.9 17.1 27.2 2,490 

Namibia 1992 16.8 17.4 18.1 21.9 25.8 5,421 n/a n/a n/a n/a n/a n/a 

Namibia 2000 16.4 16.8 20.2 22.1 24.4 6,755 13.0 15.5 21.2 26.5 23.8 2,766 

Zambia 1996 22.5 15.0 17.5 21.5 23.4 8,021 17.2 15.8 19.5 20.9 26.6 1,731 

Zambia 2001/02 15.3 20.9 20.2 20.4 23.2 7,658 13.9 20.6 18.8 21.0 25.7 1,974 

Zimbabwe 1999 16.4 17.8 18.5 23.0 24.3 5,907 14.0 17.2 16.9 28.7 23.1 2,505 

Zimbabwe 2005/06 17.4 16.8 17.4 22.5 25.9 8,907 15.2 16.6 17.4 27.6 23.3 6,863 

23
24 

3.5 Exposure to Mass Media 

Table 3.5 presents the proportion of women and men age 15–49 regularly exposed to mass media, 

for the two survey rounds. Regular media exposure was defined as listening to radio, watching television, 

or reading a newspaper or magazine at least once a week. Media exposure of women and men varied 

considerably across countries. In the first round of surveys, the percentage of women exposed to the mass 

media ranged from 14 percent in Ethiopia to 86 percent in Namibia. Media exposure among both women 

and men increased substantially between surveys in all countries except Niger, Zambia, and Zimbabwe. 

In the most recent round of surveys, mass media exposure among women exceeded 50 percent in 17 of 

the 23 countries, and among men in 21 of the 22 countries with data. 

Table 3.5 Changes in percentage of women and men age 15–49 regularly exposed to the mass 

media, and percentage living in urban areas, in selected countries in sub-Saharan Africa, 1992–

2006

Country/year

Media exposure* Urban residence

Women Men Women Men

% Number % Number % Number % Number

West Africa

Benin 1996 21.4 5,491 52.9 1,272 39.7 5,491 41.1 1,272 

Benin 2001 66.8 6,219 87.1 2,465 40.7 6,219 42.4 2,465 

Burkina Faso 1998/99 25.1 6,445 50.3 2,354 16.9 6,445 22.9 2,354 

Burkina Faso 2003 55.7 12,477 75.8 3,209 21.6 12,477 25.2 3,209 

Cameroon 1998 44.2 5,501 70.8 2,345 35.3 5,501 38.9 2,345 

Cameroon 2004 54.9 10,656 82.0 4,815 54.8 10,656 58.4 4,815 

Chad 1996/97 24.9 7,454 45.6 2,140 23.1 7,454 30.8 2,140 

Chad 2004 23.7 6,085 58.7 1,682 21.2 6,085 27.9 1,682 

Cote d'Ivoire 1998/99 66.8 3,040 85.3 799 41.9 3,040 43.8 799 

Cote d'Ivoire 2005 66.3 5,183 85.0 4,503 47.3 5,183 47.0 4,503 

Ghana 1998 69.7 4,843 85.6 1,382 35.9 4,843 35.8 1,382 

Ghana 2003 78.8 5,691 91.8 4,529 48.4 5,691 45.2 4,529 

Guinea 1999 38.1 6,753 60.4 1,752 32.2 6,753 38.0 1,752 

Guinea 2005 48.9 7,954 78.8 2,709 31.1 7,954 40.5 2,709 

Mali 1995/96 63.6 9,704 84.5 2,164 31.7 9,704 33.5 2,164 

Mali 2001 66.4 12,849 86.4 3,000 30.1 12,849 34.5 3,000 

Niger 1998 56.5 7,577 83.7 3,143 20.4 7,577 24.5 3,143 

Niger 2005 44.7 9,223 75.8 3,101 19.7 9,223 26.3 3,101 

Nigeria 1999 58.0 8,206 83.3 2,255 31.0 8,206 31.1 2,255 

Nigeria 2003 64.7 7,620 88.9 2,093 34.5 7,620 37.8 2,093 

Senegal 1997 71.3 8,593 n/a n/a 44.2 8,593 49.8 3,070 

Senegal 2005 88.1 14,602 56.3 3,415 48.7 14,602 57.0 3,415 

East Africa

Eritrea 1995 54.5 5,054 73.4 964 32.6 5,054 32.8 964 

Eritrea 2002 73.6 8,754 n/a n/a 43.0 8,754 n/a n/a

Ethiopia 2000 13.6 15,367 29.4 2,320 18.2 15,367 15.2 2,320 

Ethiopia 2005 20.1 14,070 36.9 5,464 17.8 14,070 15.6 5,464 

Kenya 1998 69.8 7,881 90.0 3,224 23.2 7,881 26.8 3,224 

Kenya 2003 78.2 8,195 92.2 3,363 25.1 8,195 25.5 3,363 

(Cont’d)
25 

Table 3.5 – cont’d

Country/year

Media exposure* Urban residence

Women Men Women Men

% Number % Number % Number % Number

Rwanda 2000 41.2 10,421 66.1 2,532 17.2 10,421 20.0 2,532 

Rwanda 2005 56.4 11,321 81.0 4,413 17.0 11,321 17.8 4,413 

Tanzania 1999 30.4 4,029 50.6 3,171 27.9 4,029 27.2 3,171 

Tanzania 2004/05 66.6 10,329 83.5 2,635 28.4 10,329 27.2 2,635 

Uganda 2000/01 54.6 7,246 77.7 1,879 16.7 7,246 17.0 1,879 

Uganda 2006 74.9 8,531 88.7 2,385 16.9 8,531 16.9 2,385 

Southern Africa

Madagascar 1997 49.6 7,060 n/a n/a 28.1 7,060 n/a n/a

Madagascar 2003/04 62.2 7,949 68.6 2,216 24.8 7,949 23.5 2,216 

Malawi 2000 54.1 13,220 74.0 2,915 15.9 13,220 18.8 2,915 

Malawi 2004 68.6 11,698 87.2 3,114 17.8 11,698 21.2 3,114 

Mozambique 1997 32.0 8,779 50.9 1,975 23.9 8,779 30.3 1,975 

Mozambique 2003 49.6 12,418 79.2 2,490 36.6 12,418 42.9 2,490 

Namibia 1992 86.4 5,421 n/a n/a 38.3 5,421 n/a n/a

Namibia 2000 79.9 6,755 86.8 2,766 41.2 6,755 44.5 2,766 

Zambia 1996 63.3 8,021 80.5 1,731 44.9 8,021 46.7 1,731 

Zambia 2001/02 48.7 7,658 69.4 1,974 40.1 7,658 39.9 1,974 

Zimbabwe 1999 59.8 5,907 78.5 2,505 38.6 5,907 42.0 2,505 

Zimbabwe 2005/06 56.3 8,907 73.3 6,863 39.3 8,907 40.3 6,863 

* Media exposure is defined as listening to the radio, watching television, or reading a newspaper or magazine at least 

once a week.

3.6 Urban Residence 

Table 3.5 also shows the percentage of women and men age 15–49 living in urban areas in the 

two rounds of DHS surveys studied. The percentage of women and men in urban areas varied 

considerably across countries—among women in the first round of surveys, for example, from 16 percent 

in Malawi to 45 percent in Zambia, and in the recent surveys from 17 percent in Rwanda and Uganda to 

55 percent in Cameroon. Most countries witnessed an increase in the percentage of women and men 

living in urban areas from the earlier survey round to the more recent. In several countries, including 

Cameroon, Ghana, Eritrea, and Mozambique, the increases in urban residence were large. 

3.7 Number of Years Living at Current Place of Residence 

Table 3.6 presents the percent distribution of women and men age 15–49 by number of years 

living at their current place of residence, for both survey rounds. In the recent surveys the percentage of 

women living at their current place of residence for less than three years ranged from 6 percent in Niger 

to 30 percent in Zambia and Cote d‘Ivoire. For men, the range was from 4 percent in Ethiopia to 28 

percent in Cote d‘Ivoire. Among both women and men, the proportion living in their current place of 

residence for less than three years increased in some countries but decreased in others, while the overall 

pattern varied widely both within and across regions. 
26 

Table 3.6 Changes in percent distribution of women and men age 15–49 by number of years 

living at their current place of residence, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Number of years living at their current place of residence

Women Men

<3 

years

3–9 

years

10+ 

years

Number <3 

years

3–9 

years

10+ 

years

 Number

West Africa

Benin 1996 16.9 22.9 60.1 5,491 9.8 20.0 70.2 1,272 

Benin 2001 18.1 21.2 60.5 6,219 12.4 17.4 70.1 2,465 

Burkina Faso 1998/99 12.1 21.8 65.6 6,445 9.7 13.0 76.9 2,354 

Burkina Faso 2003 12.1 20.4 67.4 12,477 9.7 12.8 77.3 3,209 

Cameroon 1998 22.1 24.2 53.3 5,501 18.9 25.3 55.6 2,345 

Cameroon 2004 20.4 22.0 57.4 10,656 21.4 23.7 54.9 4,815 

Chad 1996/97 11.0 18.6 70.1 7,454 11.9 17.6 70.5 2,140 

Cote d'Ivoire 2005 29.8 24.3 45.6 5,183 27.9 26.1 45.9 4,503 

Ghana 1998 14.5 23.2 62.3 4,843 12.0 22.4 65.6 1,382 

Ghana 2003 17.4 25.5 57.0 5,691 14.2 25.1 60.6 4,529 

Guinea 2005 7.4 12.3 80.0 7,954 8.1 14.4 77.4 2,709 

Mali 1995/96 10.1 15.0 74.4 9,704 13.4 20.2 66.3 2,163 

Mali 2001 12.2 19.5 67.8 12,849 16.5 20.8 62.1 3,000 

Niger 1998 11.7 16.5 71.7 7,577 7.9 8.6 83.4 3,143 

Niger 2005 6.2 11.8 81.3 9,223 8.9 7.6 83.4 3,101 

Nigeria 1999 11.3 18.4 69.7 8,206 8.7 16.5 73.7 2,255 

Nigeria 2003 14.2 17.9 67.7 7,620 10.8 16.4 72.8 2,093 

Senegal 1997 13.4 17.4 69.0 8,593 n/a n/a n/a n/a

Senegal 2005 13.0 18.8 67.8 14,602 14.5 17.4 67.5 3,415 

East Africa

Eritrea 1995 9.7 16.3 74.0 5,054 12.1 15.9 71.7 964 

Eritrea 2002 9.5 21.9 68.5 8,754 n/a n/a n/a n/a

Ethiopia 2000 8.1 11.1 80.8 15,367 7.3 9.1 83.5 2,320 

Ethiopia 2005 7.0 13.0 80.0 14,070 4.2 6.2 89.4 5,464 

Kenya 1998 20.0 17.4 62.5 7,881 11.6 13.6 74.6 3,224 

Kenya 2003 23.0 24.1 52.8 8,195 16.0 19.5 64.4 3,363 

Rwanda 2000 17.9 22.0 59.9 10,421 11.9 11.4 76.6 2,532 

Rwanda 2005 15.2 23.9 60.7 11,321 10.6 14.2 75.1 4,413 

Tanzania 1999 14.8 18.9 66.2 4,029 9.4 15.7 74.9 3,171 

Tanzania 2004/05 19.5 19.2 61.2 10,329 15.0 17.7 67.2 2,635 

Uganda 2000/01 30.7 27.8 41.4 7,246 19.2 20.3 60.4 1,879 

Uganda 2006 28.8 27.0 44.2 8,531 17.2 22.9 59.8 2,385 

(Cont’d)
27 

Table 3.6 – cont’d

Country/year

Number of years living at their current place of residence

Women Men

<3 

years

3–9 

years

10+ 

years

Number <3 

years

3–9 

years

10+ 

years

Number

Southern Africa

Madagascar 1997 13.0 17.6 69.4 7,060 n/a n/a n/a n/a

Madagascar 2003/04 11.3 17.9 70.8 7,949 7.1 12.6 80.2 2,216 

Malawi 2000 21.2 22.1 56.7 13,220 24.0 23.0 52.9 2,915 

Malawi 2004 22.8 22.2 55.0 11,698 22.2 22.3 55.5 3,114 

Mozambique 1997 10.6 15.7 72.9 8,779 10.9 16.2 72.5 1,975 

Mozambique 2003 9.6 16.4 73.6 12,418 9.2 16.4 74.4 2,490 

Namibia 1992 15.6 11.2 72.9 5,421 n/a n/a n/a n/a

Namibia 2000 12.1 12.8 74.8 6,755 12.6 13.0 74.1 2,766 

Zambia 1996 21.1 24.1 54.6 8,021 18.3 23.0 58.4 1,731 

Zambia 2001/02 30.3 27.9 41.7 7,658 20.8 25.4 53.7 1,974 

Zimbabwe 1999 26.7 27.0 46.3 5,907 22.0 22.8 55.1 2,505 

Zimbabwe 2005/06 11.6 22.2 66.2 8,907 13.4 15.7 70.9 6,863 

3.8 Slept and Stayed Away from Home 

Table 3.7 shows changes in the percentages of men who slept away from home, both the number 

of times slept away and the period of time away. The percentage of men who slept away from home more 

than five times in last 12 months ranged from 5 percent in Rwanda to 28 percent in Nigeria in the recent 

surveys. The percentage of men who slept away for more than one month ranged from 6 percent in 

Ethiopia to 34 percent in Niger. Data were available for both rounds of DHS in only three countries 

(Rwanda, Uganda, and Malawi). 
28 

Table 3.7 Changes in percent distribution of men age 15–49 by number of times slept away from 

home and by period of time stayed away from home in last 12 months, in selected countries in 

sub-Saharan Africa, 1992–2006

Country/year

Number of times slept away from home Period of time stayed away from home

0 1–2 3–4 5+ Number Never <1 

month

≥1 

month

Number

West Africa

Burkina Faso 2003 59.8 21.3 8.4 10.2 3,209 59.8 22.7 16.7 3,209 

Cote d'Ivoire 2005 54.3 24.2 8.5 12.5 9,686 54.3 26.4 18.4 9,686 

Ghana 2003 41.0 22.3 16.1 20.1 4,529 41.0 38.2 19.6 4,529 

Guinea 2005 49.9 26.6 10.2 12.7 2,709 49.9 30.8 17.7 2,709 

Niger 2005 43.5 37.2 8.2 10.4 3,101 43.5 20.9 33.8 3,101 

Nigeria 2003 36.3 21.2 14.4 27.6 2,093 36.3 39.5 23.1 2,093 

East Africa

Ethiopia 2005 70.6 16.8 5.1 7.4 5,464 70.6 22.9 6.1 5,464 

Kenya 2003 50.6 21.7 10.0 17.2 3,363 50.6 31.7 16.8 3,363 

Rwanda 2000 90.3 5.6 2.3 1.5 2,532 90.3 0.0 9.4 2,532 

Rwanda 2005 74.3 15.0 5.4 4.8 4,413 74.3 16.7 7.8 4,413 

Tanzania 2004/05 50.2 27.0 12.0 10.7 2,635 50.2 32.9 16.7 2,635 

Uganda 2000/01 52.6 17.2 13.8 16.1 1,879 52.6 35.4 11.4 1,879 

Uganda 2006 46.5 21.1 14.4 17.6 2,385 46.5 38.7 13.6 2,385 

Southern Africa

Madagascar 2003/04 68.2 15.2 7.7 8.7 2,216 68.2 21.7 9.8 2,216 

Malawi 2000 51.5 29.6 10.0 8.7 2,915 51.5 22.5 25.6 2,915 

Malawi 2004 64.5 17.1 8.0 10.3 3,114 64.5 23.7 11.4 3,114 

Mozambique 2003 56.4 22.3 11.4 9.8 2,490 56.4 33.0 10.4 2,490 

Zambia 2001/02 46.5 28.1 12.0 12.7 1,974 46.5 35.5 17.2 1,974 

Zimbabwe 2005/06 44.6 21.2 11.2 22.6 6,863 44.6 35.6 18.9 6,863 
29 

4 Knowledge, Misconceptions, and Risk Perception

This chapter presents changes in HIV/AIDS-related knowledge, common misconceptions, and 

risk perception among women and men age 15–49, comparing the recent surveys with the earlier round. 

4.1 Knowledge of HIV Prevention Methods 

Table 4.1 presents changes in awareness of HIV/AIDS and knowledge of HIV prevention 

methods among women and men. In most countries, awareness of HIV/AIDS was generally high and was 

increasing. In some countries almost everyone surveyed had heard of HIV/AIDS, although men were 

somewhat more likely than women to have heard of HIV/AIDS. 

The surveys also asked women and men if a person could reduce the risk of HIV infection by 

abstaining from sexual intercourse, limiting sex to one faithful partner, and always using a condom when 

having sex—the so-called ―A,B,C‖ prevention methods. Knowledge of the A (abstaining), B (being 

faithful), and C (condoms) prevention methods varied considerably across countries, both among women 

and men. While levels varied widely within and across regions, knowledge was somewhat higher in east 

Africa compared with the other two regions. 

Table 4.1 Changes in percentage of women and men age 15–49 who ever heard of HIV/AIDS and 

percentage knowing that HIV infection can be prevented by abstaining from sex, by limiting sex 

to one faithful partner, and by always using a condom when having sex, in selected countries in 

sub-Saharan Africa, 1992–2006

Country/year

Heard of 

HIV/AIDS

Knowledge of prevention methods

Abstinence Being faithful Number

Using a 

condom

Women Men Women Men Women Men Women Men Women Men

West Africa

Benin 1996 81.7 96.2 n/a n/a n/a n/a n/a n/a 5,491 1,272 

Benin 2001 95.5 97.7 43.2 37.2 51.2 58.9 45.6 51.8 6,219 2,465 

Burkina Faso 1998/99 87.2 96.2 n/a n/a n/a n/a n/a n/a 6,445 2,354 

Burkina Faso 2003 95.8 96.5 n/a 50.2 62.9 75.5 48.4 65.9 12,477 3,209 

Cameroon 1998 89.7 97.7 n/a n/a n/a n/a n/a n/a 5,501 2,345 

Cameroon 2004 97.8 99.2 77.4 83.2 81.4 87.5 68.7 82.2 10,656 4,815 

Chad 1996/97 60.0 89.1 n/a n/a n/a n/a n/a n/a 7,454 2,140 

Chad 2004 79.9 89.8 54.7 73.3 55.7 81.0 27.4 60.0 6,085 1,682 

Cote d'Ivoire 1998/99 96.7 99.5 n/a n/a n/a n/a n/a n/a 3,040 799 

Cote d'Ivoire 2005 89.9 94.6 67.5 73.4 69.2 78.0 60.4 74.4 5,183 4,503 

Ghana 1998 96.7 98.9 n/a n/a n/a n/a n/a n/a 4,843 1,382 

Ghana 2003 98.4 99.3 78.8 82.6 86.1 89.9 72.9 82.1 5,691 4,529 

Guinea 1999 94.9 96.2 n/a n/a n/a n/a n/a n/a 6,753 1,752 

Guinea 2005 97.0 98.8 83.4 90.0 87.9 92.1 71.0 82.1 7,954 2,709 

Mali 1995/96 76.7 95.7 n/a n/a n/a n/a n/a n/a 9,704 2,164 

Mali 2001 90.3 98.2 33.3 46.1 41.3 56.3 38.5 56.4 12,849 3,000 

Niger 1998 54.6 89.0 n/a n/a n/a n/a n/a n/a 7,577 3,143 

Niger 2005 83.1 94.6 68.4 78.8 74.4 87.6 55.2 67.2 9,223 3,101 

(Cont’d)
30 

Table 4.1 – cont’d

Country/year

Heard of 

HIV/AIDS

Knowledge of prevention methods

Abstinence Being faithful Number

Using a 

condom

Women Men Women Men Women Men Women Men Women Men

Nigeria 1999 74.4 89.7 n/a n/a n/a n/a n/a n/a 8,206 2,255 

Nigeria 2003 86.3 97.0 47.2 66.8 59.9 80.2 44.6 63.4 7,620 2,093 

Senegal 1997 91.7 98.1 n/a n/a n/a n/a n/a n/a 8,593 3,070 

Senegal 2005 96.6 98.0 85.5 86.8 91.4 89.8 73.8 74.0 14,602 3,415 

East Africa

Eritrea 1995 72.2 89.5 n/a n/a n/a n/a n/a n/a 5,054 964 

Eritrea 2002 96.1 n/a n/a n/a 82.2 n/a 55.9 n/a 8,754 n/a

Ethiopia 2000 84.7 95.2 n/a n/a 65.4 85.6 33.5 60.3 15,367 2,320 

Ethiopia 2005 89.9 96.5 62.3 80.3 62.5 79.0 40.2 64.3 14,070 5,464 

Kenya 1998 99.0 99.3 n/a n/a n/a n/a n/a n/a 7,881 3,224 

Kenya 2003 98.5 99.4 79.2 88.9 80.5 88.8 61.0 72.0 8,195 3,363 

Rwanda 2000 99.6 99.6 81.1 84.3 75.9 80.2 64.9 80.4 10,421 2,532 

Rwanda 2005 99.9 99.9 81.8 88.1 86.8 87.0 80.0 89.7 11,321 4,413 

Tanzania 1999 97.0 99.0 n/a n/a n/a n/a n/a n/a 4,029 3,171 

Tanzania 2004/05 98.9 99.1 92.5 88.8 91.2 86.2 78.5 80.3 10,329 2,635 

Uganda 2000/01 99.7 100.

0

n/a n/a 82.8 90.1 64.7 77.4 7,246 1,879 

Uganda 2006 99.2 99.9 86.4 92.8 89.4 95.4 70.0 84.1 8,531 2,385 

Southern Africa

Madagascar 1997 68.9 n/a n/a n/a n/a n/a n/a n/a 7,060 n/a

Madagascar 2003/04 79.0 87.7 52.9 54.5 60.4 72.7 50.8 61.0 7,949 2,216 

Malawi 2000 98.9 99.7 74.5 82.7 77.2 81.3 64.0 73.0 13,220 2,915 

Malawi 2004 98.6 99.5 70.7 89.8 67.6 79.9 57.3 75.5 11,698 3,114 

Mozambique 1997 82.2 94.4 n/a n/a n/a n/a n/a n/a 8,779 1,975 

Mozambique 2003 95.7 97.8 46.2 63.3 52.7 66.5 53.3 70.3 12,418 2,490 

Namibia 2000 98.1 99.5 n/a n/a 74.2 87.7 73.1 83.7 6,755 2,766 

Zambia 1996 99.6 99.5 n/a n/a n/a n/a n/a n/a 8,021 1,731 

Zambia 2001/02 99.3 98.6 n/a n/a 81.3 85.3 68.7 71.0 7,658 1,974 

Zimbabwe 1999 96.5 99.1 n/a n/a n/a n/a n/a n/a 5,907 2,505 

Zimbabwe 2005/06 97.9 99.2 80.7 87.5 80.8 84.7 75.7 81.4 8,907 6,863 

Examining data from the few countries with data from both rounds of surveys, the following 

comparisons could be observed: knowledge levels about abstinence increased among men in Rwanda and 

Malawi, remained steady among women in Rwanda, and declined among women in Malawi. Knowledge 

of faithfulness as a prevention method declined in Ethiopia and Malawi but increased in Rwanda and 

Uganda. Knowledge of condom use to prevent infection rose in all countries with two data points except 

Malawi, where it declined slightly among women. 
31 

4.2 Misconceptions about HIV/AIDS 

Having correct beliefs about HIV/AIDS is important to avoiding infection, but surveys have 

shown that many people have misconceptions. Table 4.2 presents several of these misconceptions among 

women and men age 15–49. Misconceptions about HIV/AIDS varied notably across the countries studied. 

Among women in the recent round of surveys, knowledge that a healthy-looking person could have HIV 

ranged from 37 percent in Niger to 86 percent in Zimbabwe. Among men the range was from 48 percent 

in Madagascar to more than 90 percent in Zimbabwe, Malawi, and Rwanda. 

In the vast majority of countries, knowledge that a healthy-looking person could have HIV 

increased among women and men from the earlier survey to the more recent. Among women in Guinea, 

however, the percentage declined by 12 percentage points, and among men in Zambia declined by 9 

percentage points (Figures 4.1a and 4.1b). 

Table 4.2 Changes in percentage of women and men age 15–49, who know that a healthylooking person can have HIV, percentage who know that HIV cannot be transmitted by 

mosquitoes, and percentage who know that HIV cannot be transmitted by sharing food, in 

selected countries in sub-Saharan Africa, 1992–2006

Country/year

Misconceptions about HIV/AIDS

Number

Know that a 

healthy-looking 

person can have 

HIV

Know that HIV 

cannot be 

transmitted by 

mosquitoes

Know that HIV 

cannot be 

transmitted by 

sharing food

Women Men Women Men Women Men Women Men

West Africa

Benin 1996 41.4 62.3 n/a n/a n/a n/a 5,491 1,272 

Benin 2001 56.2 68.8 23.1 35.6 28.0 46.0 6,219 2,465 

Burkina Faso 1998/99 42.5 70.5 n/a n/a n/a n/a 6,445 2,354 

Burkina Faso 2003 54.8 69.3 26.3 42.4 39.4 62.8 12,477 3,209 

Cameroon 1998 54.5 63.6 n/a n/a n/a n/a 5,501 2,345 

Cameroon 2004 67.0 79.9 46.2 53.6 65.0 75.3 10,656 4,815 

Chad 1996/97 19.8 32.8 n/a n/a n/a n/a 7,454 2,140 

Chad 2004 39.4 48.7 39.8 49.3 52.3 61.8 6,085 1,682 

Cote d'Ivoire 1998/99 63.1 69.3 n/a n/a n/a n/a 3,040 799 

Cote d'Ivoire 2005 61.5 75.4 40.0 49.4 58.8 67.5 5,183 4,503 

Ghana 1998 72.5 81.3 n/a n/a n/a n/a 4,843 1,382 

Ghana 2003 79.9 86.3 55.2 60.2 71.8 75.5 5,691 4,529 

Guinea 1999 59.9 60.5 n/a n/a n/a n/a 6,753 1,752 

Guinea 2005 48.4 68.4 43.6 35.9 46.8 49.1 7,954 2,709 

Mali 1995/96 32.9 55.0 n/a n/a n/a n/a 9,704 2,164 

Mali 2001 43.7 63.3 22.6 33.8 35.2 54.6 12,849 3,000 

Niger 1998 20.4 42.7 n/a n/a n/a n/a 7,577 3,143 

Niger 2005 36.6 64.8 32.6 38.3 38.2 61.8 9,223 3,101 

Nigeria 1999 45.2 56.2 n/a n/a n/a n/a 8,206 2,255 

Nigeria 2003 53.4 73.2 36.9 44.6 44.9 59.0 7,620 2,093 

Senegal 1997 46.1 64.1 n/a n/a n/a n/a 8,593 3,070 

Senegal 2005 56.9 72.7 38.1 41.2 66.1 67.7 14,602 3,415 

(Cont’d)
32 

Table 4.2 – cont’d

Country/year

Misconceptions about HIV/AIDS

Number

Know that a 

healthy-looking 

person can have 

HIV

Know that HIV 

cannot be 

transmitted by 

mosquitoes

Know that HIV 

cannot be 

transmitted by 

sharing food

Women Men Women Men Women Men Women Men

East Africa

Eritrea 1995 42.3 61.3 n/a n/a n/a n/a 5,054 964 

Eritrea 2002 75.6 n/a 53.8 n/a 71.7 n/a 8,754 n/a

Ethiopia 2000 37.2 55.5 n/a n/a n/a n/a 15,367 2,320 

Ethiopia 2005 50.6 69.1 47.1 57.1 63.4 79.9 14,070 5,464 

Kenya 1998 78.3 84.7 n/a n/a n/a n/a 7,881 3,224 

Kenya 2003 84.7 89.9 61.0 74.2 71.3 80.5 8,195 3,363 

Rwanda 2000 68.1 75.6 61.1 54.4 69.7 64.9 10,421 2,532 

Rwanda 2005 83.8 91.7 81.2 77.5 89.3 91.7 11,321 4,413 

Tanzania 1999 69.2 77.2 n/a n/a n/a n/a 4,029 3,171 

Tanzania 2004/05 81.4 84.0 75.2 73.0 78.8 81.0 10,329 2,635 

Uganda 2000/01 77.2 87.6 44.6 55.5 66.7 79.7 7,246 1,879 

Uganda 2006 84.9 90.0 54.4 61.0 77.4 83.7 8,531 2,385 

Southern Africa

Madagascar 1997 34.4 n/a n/a n/a n/a n/a 7,060 n/a

Madagascar 2003/04 48.0 47.8 31.7 36.4 39.6 41.7 7,949 2,216 

Malawi 2000 84.3 91.8 67.6 67.5 78.8 84.9 13,220 2,915 

Malawi 2004 81.8 92.0 66.0 69.1 81.7 90.6 11,698 3,114 

Mozambique 1997 39.0 61.2 n/a n/a n/a n/a 8,779 1,975 

Mozambique 2003 62.5 81.9 36.5 49.2 44.7 58.7 12,418 2,490 

Namibia 2000 82.8 87.0 56.0 59.3 63.1 62.3 6,755 2,766 

Zambia 1996 81.4 87.5 n/a n/a n/a n/a 8,021 1,731 

Zambia 2001/02 77.1 79.3 52.3 63.3 65.3 76.5 7,658 1,974 

Zimbabwe 1999 75.7 85.4 n/a n/a n/a n/a 5,907 2,505 

Zimbabwe 2005/06 85.8 91.4 74.9 74.6 82.4 85.3 8,907 6,863 
33 

Figure 4.1a Changes in knowledge that a healthy-looking person can have HIV 

among women age 15–49, 1995–2006 
34 

Figure 4.1b Changes in knowledge that a healthy-looking person can have HIV 

 among men age 15–49, 1995–2006 
35 

Knowledge that HIV cannot be transmitted by mosquitoes ranged from 23 percent among women 

in Benin and Mali to 81 percent in Rwanda. Among men, knowledge levels were higher. The percentage 

of women who knew that HIV cannot be transmitted by sharing food ranged from 28 percent in Benin to 

89 percent in Rwanda, and among men from 42 percent in Madagascar to more than 90 percent in 

Rwanda and Malawi. 

Only three countries, Rwanda, Uganda, and Malawi, had data on misconceptions about HIV 

transmission risk from mosquitoes and from sharing food for two time points (Table 4.2). The percentage 

who knew that HIV cannot be transmitted by sharing food increased among both women and men in all 

three countries. The percentage who knew that HIV cannot be transmitted by mosquitoes also increased 

among both women and men in two of the three countries (Rwanda and Uganda), but there was little 

change in Malawi. 

4.3 Comprehensive Knowledge about HIV/AIDS 

Comprehensive knowledge about HIV/AIDS was defined as knowing that HIV infection can be 

prevented both by limiting sex to one faithful partner and by always using a condom when having sex, 

and knowing that a healthy-looking person can have HIV, as well as rejecting the two most common 

misconceptions (country specific) about HIV transmission (Table 4.3). Comprehensive knowledge about 

HIV/AIDS among women and men was low generally, while men were more likely than women to have 

comprehensive knowledge. Only in Rwanda did the percentage of women with comprehensive 

knowledge about HIV/AIDS exceed 50 percent, and for men, only in Rwanda and Kenya. West Africa 

had the lowest levels of comprehensive knowledge compared with east Africa and southern Africa. 
36 

Table 4.3 Changes in percentage of women and men age 15–49 who know that HIV infection can 

be prevented by both limiting sex to one faithful partner and by always using a condom when 

having sex, and percentage with comprehensive knowledge* about HIV/AIDS, in selected 

countries in sub-Saharan Africa, 1992–2006

Country

Know that HIV can be 

prevented by limiting sex to 

one partner and by always 

using a condom

Have comprehensive 

knowledge about HIV/AIDS Number

Women Men Women Men Women Men

West Africa

Benin 2001 42.1 44.8 7.7 11.3 6,219 2,465 

Burkina Faso 2003 45.0 59.8 12.3 25.4 12,477 3,209 

Cameroon 2004 62.0 74.5 22.5 32.2 10,656 4,815 

Chad 2004 22.9 56.0 7.4 20.9 6,085 1,682 

Cote d'Ivoire 2005 55.2 67.4 16.1 26.0 5,183 4,503 

Ghana 2003 68.9 77.7 21.9 32.8 5,691 4,529 

Guinea 2005 67.5 78.6 14.8 20.3 7,954 2,709 

Mali 2001 31.0 44.5 8.2 13.3 12,849 3,000 

Niger 2005 53.2 64.8 12.6 18.6 9,223 3,101 

Nigeria 2003 42.3 59.8 15.2 26.7 7,620 2,093 

Senegal 2005 72.4 70.5 20.2 25.5 14,602 3,415 

East Africa

Eritrea 2002 51.5 n/a 29.4 n/a 8,754 n/a

Ethiopia 2000 31.8 58.3 n/a n/a 15,367 2,320 

Ethiopia 2005 34.6 56.9 15.8 30.0 14,070 5,464 

Kenya 2003 57.8 69.9 36.1 51.6 8,195 3,363 

Rwanda 2000 54.1 68.6 25.8 25.2 10,421 2,532 

Rwanda 2005 72.7 79.9 53.6 57.5 11,321 4,413 

Tanzania 2004/05 74.6 72.0 47.0 43.9 10,329 2,635 

Uganda 2000/01 62.5 74.9 26.8 39.3 7,246 1,879 

Uganda 2006 66.4 82.0 31.3 42.0 8,531 2,385 

Southern Africa

Madagascar 2003/04 48.9 58.7 19.0 18.8 7,949 2,216 

Malawi 2000 55.9 62.8 33.3 38.9 13,220 2,915 

Malawi 2004 46.6 63.4 25.0 41.8 11,698 3,114 

Mozambique 2003 45.2 61.0 18.0 32.1 12,418 2,490 

Namibia 2000 64.8 79.5 29.8 36.9 6,755 2,766 

Zambia 2001/02 66.3 66.8 31.1 37.2 7,658 1,974 

Zimbabwe 2005/06 65.2 71.3 43.4 46.5 8,907 6,863 

* Individuals with a comprehensive knowledge about HIV/AIDS include those who know that HIV infection can be 

prevented both by limiting sex to one faithful partner and by always using a condom when having sex, and know that a 

healthy-looking person can have HIV, as well as reject the two most common misconceptions about HIV transmission. 

Note: the two most common misconceptions about HIV transmission are country specific.
37 

Levels of comprehensive knowledge about HIV/AIDS varied dramatically across the 23 countries 

studied. The percentage of women with comprehensive knowledge ranged from 7 percent in Chad to 54 

percent in Rwanda. Among men, the range was from 11 percent in Benin to 58 percent in Rwanda. 

Survey data on comprehensive knowledge for two time points were available only for Malawi, 

Rwanda, and Uganda. Among women In Rwanda, comprehensive knowledge increased from 26 percent 

to 54 percent, and among men from 25 percent to 58 percent. In Uganda and Malawi, comprehensive 

knowledge increased somewhat among men, and also among women in Uganda, but it decreased 

somewhat among women in Malawi. 

4.4 Knowledge about Prevention of Mother-to-Child Transmission of HIV 

Table 4.4 presents the percentages of women and men age 15–49 in the study who knew that HIV 

could be transmitted from mother to child through breastfeeding, who knew that there was a special drug 

that could prevent HIV transmission from mother to the child, and who knew both facts. 
38 

Table 4.4 Changes in percentage of women and men age 15–49 who know that HIV can be 

transmitted from mother to child through breastfeeding, percentage who know that there is a 

special drug that can prevent HIV transmission from mother to child through breastfeeding, and 

percentage who know both, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Know that HIV 

virus transmits 

through 

breastfeeding

Know of a special 

drug that prevents 

mother to child 

transmission Know both Number

Women Men Women Men Women Men Women Men

West Africa

Benin 2001 68.1 59.2 n/a n/a n/a n/a 6,219 2,465 

Burkina Faso 2003 49.8 47.0 n/a n/a n/a n/a 12,477 3,209 

Cameroon 2004 47.2 57.3 n/a n/a n/a n/a 10,656 4,815 

Chad 2004 35.7 42.0 n/a n/a n/a n/a 6,085 1,682 

Cote d'Ivoire 2005 62.1 58.0 43.7 42.5 37.2 29.6 5,183 4,503 

Ghana 1998 78.6 78.7 n/a n/a n/a n/a 4,843 1,382 

Ghana 2003 72.6 74.8 15.9 15.9 15.1 14.0 5,691 4,529 

Guinea 2005 51.6 66.3 9.7 16.0 7.9 13.1 7,954 2,709 

Mali 2001 31.6 40.7 n/a n/a n/a n/a 12,849 3,000 

Niger 2005 52.5 64.1 15.9 31.5 13.1 26.2 9,223 3,101 

Nigeria 1999 n/a n/a 8.5 6.4 n/a n/a 8,206 2,255 

Nigeria 2003 45.9 56.4 6.1 7.5 5.2 49.6 7,620 2,093 

Senegal 2005 61.2 55.0 28.1 26.3 21.5 19.1 14,602 3,415 

East Africa

Eritrea 2002 69.8 n/a n/a n/a n/a n/a 8,754 n/a

Ethiopia 2000 42.6 49.3 n/a n/a n/a n/a 15,367 2,320 

Ethiopia 2005 69.3 74.5 21.2 28.9 19.5 25.7 6,751 5,464 

Kenya 2003 71.8 68.4 32.6 37.5 28.1 30.2 8,195 3,363 

Rwanda 2000 66.5 63.0 n/a n/a n/a n/a 10,421 2,532 

Rwanda 2005 79.7 82.2 73.0 80.3 63.7 69.0 11,321 4,413 

Tanzania 2004/05 79.1 73.9 30.8 36.4 28.7 30.2 10,329 2,635 

Uganda 2000/01 46.3 43.1 n/a n/a n/a n/a 7,246 1,879 

Uganda 2006 73.3 62.5 64.8 63.6 52.2 42.9 8,531 2,385 

Southern Africa

Madagascar 2003/04 44.9 50.9 n/a n/a n/a n/a 7,949 2,216 

Malawi 2000 64.8 61.9 n/a n/a n/a n/a 13,220 2,915 

Malawi 2004 74.7 67.1 39.2 34.5 37.1 29.3 11,698 3,114 

Mozambique 2003 50.2 50.5 30.9 41.9 26.1 31.9 12,418 2,490 

Namibia 2000 70.7 63.0 n/a n/a n/a n/a 6,755 2,766 

Zambia 2001/02 70.7 64.4 n/a n/a n/a n/a 7,658 1,974 

Zimbabwe 1999 32.9 36.3 n/a n/a n/a n/a 5,907 2,505 

Zimbabwe 2005/06 79.9 79.9 57.1 45.7 51.6 38.9 8,907 6,863 

 
39 

Among women in the recent round of surveys, knowledge about HIV transmission from mother 

to child through breastfeeding ranged from 32 percent in Mali to 80 percent in Rwanda and Zimbabwe. 

Among men, it ranged from 41 percent in Mali to 82 percent in Rwanda. Among women, knowledge 

about special drugs to prevent mother to child transmission ranged from 6 percent in Nigeria to 73 percent 

in Rwanda, and among men from 8 percent in Nigeria to 80 percent in Rwanda. Among women, 

knowledge that HIV could be transmitted through breastfeeding and that special drugs could prevent 

mother-to-child transmission ranged from 5 percent in Nigeria to 64 percent in Rwanda. Among men, it 

varied from 13 percent in Guinea to 69 percent in Rwanda. 

Data on either indicator for two time points were available only for Ghana, Nigeria, Ethiopia, 

Rwanda, Uganda, Malawi, and Zimbabwe. These countries varied in the extent of change in knowledge 

about transmission from mother to child through breastfeeding, both among women and men. Zimbabwe, 

Uganda, and Ethiopia showed a substantial increase (20–40 percentage points); Rwanda and Malawi a 

moderate increase (5–20 percentage points); whereas Ghana experienced a decline (4–6 percentage 

points) in knowledge about transmission from mother to child through breastfeeding among women and 

men. 

4.5 Risk Perception of Contracting HIV 

Respondents who knew about HIV/AIDS were asked about their perception of their risk of 

contracting HIV. Table 4.5 shows that the percentage of respondents who reported themselves at high risk 

of contracting HIV or who already had HIV varied considerably across the countries studied, ranging 

among women from 2 percent in Niger and Nigeria to 24 percent in Mali and 26 percent in Zambia, and 

among men from 2-3 percent in Niger and Nigeria to 25 percent in Zambia. 
40 

Table 4.5 Changes in percent distribution of women and men age 15–49 who know about 

HIV/AIDS by perceived risk of getting HIV/AIDS, in selected countries in sub-Saharan Africa, 

1992–2006

Country/year

Perceived risk of getting HIV

Women Men

No 

risk

Low 

risk

Moderate 

risk

High 

risk/has 

HIV Number

No 

risk

Low 

risk

Moderate 

risk

High 

risk/has 

HIV Number

West Africa

Benin 1996 44.1 28.5 20.0 6.4 4,488 55.3 25.5 11.1 8.1 1,224

Burkina Faso 1998/99 35.9 44.7 7.9 9.3 5,619 21.3 57.2 13.6 7.8 2,264

Cameroon 1998 39.6 38.6 13.1 8.5 4,936 37.9 48.3 6.9 6.6 2,292

Chad 1996/97 38.3 34.9 13.4 13.3 4,470 33.3 42.8 7.3 16.6 1,906

Cote d'Ivoire 1998/99 36.0 39.8 13.0 11.1 2,938 33.7 52.1 8.1 5.8 795

Ghana 1998 53.6 22.3 4.4 5.3 4,683 58.1 22.6 4.4 5.2 1,367

Guinea 1999 34.1 39.3 10.5 16.0 6,409 64.7 26.1 4.3 4.7 1,686

Mali 1995/96 33.4 34.3 8.3 23.9 7,443 47.0 41.7 3.7 7.5 2,070

Niger 1998 72.2 18.2 7.1 2.2 4,136 74.9 18.3 4.7 2.0 2,798

Nigeria 1999 65.5 25.5 4.8 3.7 6,105 63.7 31.0 2.9 1.6 2,023

Nigeria 2003 61.3 12.7 2.9 2.0 6,577 59.9 23.7 3.9 2.9 2,031

East Africa

Eritrea 1995 87.2 5.5 5.0 2.2 3,649 91.9 7.1 0.6 0.3 863

Eritrea 2002 74.9 14.1 7.6 3.3 8,416 n/a n/a n/a n/a n/a

Kenya 1998 32.1 34.2 23.9 9.6 7,804 29.6 47.2 18.1 5.0 3,202

Kenya 2003 35.7 39.5 15.4 9.1 8,073 33.6 51.8 9.8 4.7 3,344

Tanzania 1999 37.1 16.9 13.4 13.1 3,908 40.6 22.9 15.6 7.3 3,139

Southern Africa

Madagascar 1997 48.0 7.9 4.9 8.6 4,867 n/a n/a n/a n/a n/a

Madagascar 2003/04 53.5 11.4 3.9 4.3 6,283 41.8 27.1 5.2 4.3 1,944

Mozambique 1997 9.4 22.9 8.0 7.2 7,220 24.9 47.5 14.4 10.7 1,865

Mozambique 2003 20.5 14.3 27.8 6.1 11,879 10.7 16.1 0.0 8.5 2,435

Namibia 2000 22.7 27.8 10.3 13.6 6,626 31.9 29.8 5.2 13.3 2,751

Zambia 1996 45.2 24.3 21.1 9.4 7,986 56.6 29.9 9.9 3.4 1,722

Zambia 2001/02 31.1 17.0 26.2 25.7 7,603 37.5 19.6 17.8 25.1 1,947

Zimbabwe 2005/06 34.4 27.1 17.0 8.2 8,719 41.7 29.1 15.8 8.1 6,808
41 

Table 4.5 also shows that, over time, there was little change in the percentage of people who 

perceived themselves at high risk of HIV or who already had HIV, in all countries with available data 

except for Zambia, where the percentage increased markedly among both women and men. 

Differences between women and men in the perception of being at high risk of HIV were 

negligible in the southern African countries. Within west Africa, however, in Mali, Guinea, and Cote 

d‘Ivoire women were much more likely than men to report being at a high risk of getting HIV or already 

having HIV, as was also the case in Kenya in east Africa. 

4.6 Risk Perception of Contracting HIV, by Number of Sex Partners 

Table 4.6 shows the percentage of women and men age 15–49 who believed that they had low 

risk or no risk of getting HIV and who had two or more sex partners in last 12 months, and those who 

perceived a low risk or no risk and who had three or more lifetime sexual partners. The percentage of 

respondents who believed that they had low risk or no risk of getting HIV and had two or more sex 

partners in last 12 months varied across countries. Also, higher proportions of men than women believed 

that they had a low risk or no risk of contracting HIV, even while having two or more sex partners in last 

12 months. Among women, the percentage ranged from close to 1 percent in Chad, Niger, Nigeria, 

Burkina Faso, Kenya, Namibia, Zambia, and Zimbabwe to 7 percent in Cameroon. Among men, the range 

was from 5 percent in Eritrea to 32 percent in Cameroon. 

In the four countries where data were available for two time points (Nigeria, Kenya, 

Mozambique, and Zambia), the proportion of men who believed that they had low risk or no risk of 

getting HIV and also had two or more sexual partners in last 12 months decreased substantially. Only two 

surveys, Tanzania 2004/05 and Zimbabwe 2005/06, provided information on both risk perception and 

number of lifetime sex partners. In Tanzania 18 percent of men, and in Zimbabwe 38 percent of men, 

reported a low risk or no risk of HIV infection, even though they also reported having three or more 

lifetime sexual partners. 
42 

Table 4.6 Changes in percentage of women and men age 15–49 who believe that they have a 

low/no risk of getting HIV and had 2+ sex partners in last 12 months, and percentage who believe 

that they have a low/no risk of getting HIV and have had 3+ lifetime sex partners, in selected 

countries in sub-Saharan Africa, 1992–2006

Country/year

Low/no risk with 2+ sex partners in the 

last 12 months1 Low/no risk with 3+ lifetime sex partners2

Women Men Women Men

% Number % Number % Number % Number

West Africa

Benin 1996 1.6 3,385 18.3 1,065 n/a n/a n/a n/a

Burkina Faso 1998/99 1.3 3,934 11.3 1,534 n/a n/a n/a n/a

Cameroon 1998 7.3 4,005 32.3 1,854 n/a n/a n/a n/a

Chad 1996/97 0.8 3,518 12.3 1,492 n/a n/a n/a n/a

Cote d'Ivoire 1998/99 3.2 2,260 21.6 628 n/a n/a n/a n/a

Ghana 1998 n/a n/a 12.6 872 n/a n/a n/a n/a

Guinea 1999 3.1 4,361 20.1 1,267 n/a n/a n/a n/a

Mali 1995/96 n/a n/a 7.8 1,654 n/a n/a n/a n/a

Niger 1998 0.5 3,269 8.5 1,975 n/a n/a n/a n/a

Nigeria 1999 n/a n/a 21.2 1,400 n/a n/a n/a n/a

Nigeria 2003 1.4 5,096 16.0 1,354 n/a n/a n/a n/a

East Africa

Eritrea 1995 n/a n/a 5.3 526 n/a n/a n/a n/a

Kenya 1998 1.8 5,882 15.1 2,560 n/a n/a n/a n/a

Kenya 2003 1.1 5,655 11.0 2,375 n/a n/a n/a n/a

Tanzania 2004/05 n/a n/a n/a n/a n/a n/a 18.0 2,212

Southern Africa

Madagascar 1997 3.9 3,930 n/a n/a n/a n/a n/a n/a

Madagascar 2003/04 1.7 5,008 12.0 1,656 n/a n/a n/a n/a

Mozambique 1997 n/a n/a 25.8 1,586 n/a n/a n/a n/a

Mozambique 2003 1.9 9,432 8.4 2,077 n/a n/a n/a n/a

Namibia 2000 1.4 4,512 12.1 2,092 n/a n/a n/a n/a

Zambia 1996 2.2 6,039 19.0 1,359 n/a n/a n/a n/a

Zambia 2001/02 0.9 5,584 11.1 1,557 n/a n/a n/a n/a

Zimbabwe 2005/06 0.6 5,766 7.5 4,372 5.4 6,927 37.5 5,056

1 Based on women and men age 15–49 who have heard about HIV/AIDS and who had sex in last 12 months.

2 Based on women and men age 15–49 who have heard about HIV/AIDS and who have ever had sex.
43 

5 Attitudes Related to HIV/AIDS 

This chapter presents findings about accepting attitudes toward people living with HIV (PLHIV) 

and attitudes toward sex education, among women and men age 15–49. People living with HIV often 

suffer stigma and discrimination in their communities, which can adversely affect willingness to be tested 

for HIV and adherence to antiretroviral therapy. 

5.1 Accepting Attitudes toward PLHIV 

In the DHS surveys, respondents were asked about four aspects of acceptance of people with 

HIV: whether they would want to keep it secret that a family member had HIV; whether they would be 

willing to care for a family member or relative with HIV; whether they believed that a female teacher 

(some surveys did not specify the gender of the teacher) living with HIV should be allowed to continue 

teaching; and whether they would buy fresh vegetables from a vendor who had HIV. 

Table 5.1 presents data based on responses of women and men who had heard about HIV/AIDS. 

The percentage who responded positively to all four indicators of acceptance ranged, among women, 

from 2 percent in Guinea to 46 percent in Rwanda, and among men from 6 percent in Guinea to 51 

percent in Rwanda. 

The percentage of respondents who did not want the HIV-positive status of a family member to 

remain secret varied across countries, among women from 32 percent in Senegal to 81 percent in Benin 

and Eritrea, and among men from 40 percent in Senegal to 78 percent in Madagascar (Table 5.1). 

Similarly, the percentage of respondents who would be willing to care for a family member or relative 

with HIV ranged, among women, from 40 percent in Benin to 94 percent in Rwanda and Malawi, and 

among men from 40 percent in Nigeria to 96 percent in Malawi. 

The percentage of respondents who believed that a female teacher living with HIV should be 

allowed to continue teaching also varied across countries—among women from 20 percent in Guinea to 

74 percent in Rwanda, and among men from 27 percent in Nigeria to 80 percent in Rwanda and Malawi. 

The proportion who would buy fresh vegetables from a vendor who had HIV ranged from 9 percent in 

Guinea to 69 percent in Rwanda among women, and from 18 percent in Chad to 84 percent in Malawi 

among men (Table 5.1). 

In Ghana, Ethiopia, Rwanda, Uganda, Malawi, and Zimbabwe, the countries where data were 

available for more than one time point, changes in accepting attitudes toward PLHIV were similar. 

Among both women and men there was an increase in willingness to care for a family member or relative 

with HIV. Also, the proportion who would not want the HIV-positive status of a family member to 

remain secret declined among both women and men, with the exception of women in Uganda, where it

increased slightly. 
44 

Table 5.1 Among women and men age 15–49 who have heard about HIV/AIDS, changes in percentage expressing specific attitudes 

toward people living with HIV, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Attitudes toward people living with HIV/AIDS Having all four 

accepting 

attitudes toward 

people living 

with HIV Number

Would not want the HIV+ 

status of a family 

member to remain 

secret

Willing to care for a 

family member who 

has HIV

Would allow a 

female* teacher 

with HIV to 

continue teaching

Would buy 

vegetables from 

a vendor who 

has HIV

Women Men Women Men Women Men Women Men Women Men Women Men

West Africa

Benin 2001 80.7 75.9 40.1 47.5 n/a n/a n/a n/a n/a n/a 5,940 2,407 

Burkina Faso 2003 42.8 65.7 75.6 80.9 n/a n/a n/a n/a n/a n/a 11,953 3,098 

Cameroon 2004 37.8 55.1 69.3 82.3 47.9 55.7 41.2 50.0 9.0 18.5 10,423 4,777 

Chad 2004 52.9 40.6 75.0 50.5 59.2 47.0 27.4 18.3 9.5 8.9 4,861 1,511 

Cote d'Ivoire 2005 33.4 52.4 82.6 85.8 59.5 65.0 45.4 52.3 8.9 22.0 4,658 4,259 

Ghana 1998 n/a n/a 51.1 49.1 n/a n/a n/a n/a n/a n/a 4,683 1,367 

Ghana 2003 58.5 65.5 68.4 72.0 38.0 49.0 25.6 35.9 8.5 14.4 5,597 4,497 

Guinea 2005 71.2 72.8 47.2 71.1 20.3 34.6 8.5 20.8 1.7 6.2 7,715 2,676 

Mali 2001 74.3 77.1 65.4 81.8 44.7 46.6 n/a n/a n/a n/a 11,608 2,947 

Niger 2005 59.6 56.8 56.3 79.4 27.9 40.2 15.4 31.2 4.5 11.1 7,660 2,935 

Nigeria 2003 60.9 70.2 43.8 39.9 23.0 26.8 19.6 68.9 3.3 7.8 6,577 2,031 

Senegal 2005 32.0 40.3 70.9 83.4 38.8 44.5 26.4 36.1 3.9 9.3 14,113 3,345 

(Cont’d)

44
45 

Table 5.1 – cont’d

Country/year

Attitudes toward people living with HIV/AIDS Having all four 

accepting 

attitudes toward 

people living 

with HIV Number

Would not want the 

HIV+ status of a 

family member to 

remain secret

Willing to care for a 

family member who 

has HIV

Would allow a 

female* teacher 

with HIV to 

continue teaching

Would buy 

vegetables from 

a vendor who 

has HIV

Women Men Women Men Women Men Women Men Women Men Women Men

East Africa

Eritrea 2002 81.3 n/a 66.1 n/a n/a n/a n/a n/a n/a n/a 8,416 n/a

Ethiopia 2000 78.0 87.4 45.3 50.3 n/a n/a n/a n/a n/a n/a 13,010 2,208 

Ethiopia 2005 65.2 77.1 59.0 71.6 41.5 51.8 19.9 26.1 10.7 16.7 12,643 5,273 

Kenya 1998 n/a n/a 79.3 85.2 n/a n/a n/a n/a n/a n/a 7,804 3,202 

Kenya 2003 58.8 71.5 84.1 87.5 57.0 59.7 60.1 73.5 26.5 39.5 8,073 3,344 

Rwanda 2000 83.0 85.4 79.9 88.0 n/a n/a n/a n/a n/a n/a 10,384 2,523 

Rwanda 2005 77.1 73.4 93.5 95.8 74.4 79.5 68.9 79.8 46.1 51.0 11,308 4,410 

Tanzania 2004/05 52.7 62.3 89.5 89.8 71.7 67.9 45.2 20.5 21.7 8.7 10,216 2,612 

Uganda 2000/01 48.2 69.6 84.5 87.8 43.3 43.4 n/a n/a n/a n/a 7,227 1,879 

Uganda 2006 52.5 62.0 90.1 91.3 68.2 70.8 57.7 75.1 25.9 36.1 8,464 2,382 

Southern Africa

Madagascar 2003/04 52.8 78.0 55.9 54.6 n/a n/a n/a n/a n/a n/a 6,283 1,944 

Malawi 2000 n/a n/a 93.6 95.8 n/a n/a n/a n/a n/a n/a 13,076 2,905 

Malawi 2004 64.8 47.7 n/a n/a 66.6 79.5 66.6 83.9 n/a n/a 11,532 3,099 

Mozambique 2003 44.4 53.6 80.8 82.6 56.7 64.4 30.0 41.8 7.9 16.0 11,879 2,436 

Namibia 2000 66.5 63.3 92.5 92.3 68.5 55.5 n/a n/a n/a n/a 6,626 2,752 

Zambia 2001/02 58.2 68.0 90.2 89.8 n/a n/a n/a n/a n/a n/a 7,603 1,947 

Zimbabwe 1999 58.1 63.6 87.5 88.4 n/a n/a n/a n/a n/a n/a 5,698 2,482 

Zimbabwe 2005/06 49.2 45.7 91.0 70.9 71.4 74.6 56.8 67.3 17.1 10.7 8,719 6,808 

*Some surveys did not specify gender.

45
46 

In Uganda, the only country where data from two time points were available concerning attitudes 

allowing a female teacher with HIV to continue teaching, there were considerable increases (almost 25 

percentage points) in the proportion of both women and men who would allow a teacher to continue 

teaching. Among women, the proportion rose from 44 percent to 68 percent, and among men from 43 

percent to 71 percent. 

5.2 Attitudes toward Sex Education 

Table 5.2 presents the percentage of women and men age 15–49 who had heard of HIV/AIDS and 

who believed that children age 12–14 should be taught to wait until marriage to have sexual intercourse, 

and the percentage who believed that children age 12–14 years should be taught about condom use to 

prevent HIV infection. The proportion who believed that children age 12–14 should be taught to wait 

until marriage to have sex was over 80 percent among women and men in all countries, with the 

exception of women in Ethiopia (41 percent). The proportion who believed that children age 12–14 

should be taught about condom use to prevent HIV infection varied considerably: among women from 29 

percent in Ethiopia to 82 percent in Namibia, and among men from 45 percent in Nigeria to 81 percent in 

Namibia and Rwanda. 

Where data for two time points were available (Rwanda, Malawi, and Zimbabwe), the patterns of 

change varied. In Rwanda the percentage who believed that children age 12–14 should be taught about 

condom use to prevent HIV infection increased, among women from 67 percent to 80 percent, and among 

men from 72 percent to 81 percent. In Malawi, however, the percentage declined from 55 percent to 50 

percent among women, and from 66 percent to 57 percent among men. In Zimbabwe the percentage of 

women who believed that children should be taught about condom use increased from 37 percent to 41 

percent, but among men it decreased from 50 percent to 47 percent. 
47 

Table 5.2 Among women and men age 15–49 who have heard about HIV/AIDS, changes in 

percentage who believe that children age 12–14 should be taught to wait till marriage to have 

sexual intercourse, and percentage who believe that children age 12–14 should be taught about 

condom use to prevent HIV infection, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Believe that children age 12–14 should be taught

Number

to wait till marriage to 

have sex

about condom use to 

prevent HIV infection

Women Men Women Men Women Men

West Africa

Benin 2001 n/a n/a 68.2 68.9 5,940 2,407 

Burkina Faso 2003 n/a n/a n/a 71.1 11,953 3,098 

Cameroon 2004 n/a n/a 60.4 72.8 10,423 4,777 

Chad 2004 n/a n/a 53.8 67.8 4,861 1,511 

Cote d'Ivoire 2005 83.3 80.2 68.5 77.1 4,658 4,259 

Ghana 2003 n/a n/a 59.1 64.0 5,597 4,497 

Guinea 2005 91.4 92.0 64.1 72.2 7,715 2,676 

Mali 2001 n/a n/a 69.6 66.3 11,608 2,947 

Niger 2005 93.1 92.9 68.0 73.2 7,660 2,935 

Nigeria 2003 n/a n/a 40.6 44.8 6,577 2,031 

Senegal 2005 95.9 91.4 52.0 54.0 14,113 3,345 

East Africa

Ethiopia 2005 41.1 94.2 28.9 78.7 12,643 5,273 

Kenya 2003 n/a n/a 58.8 62.0 8,073 3,344 

Rwanda 2000 n/a n/a 66.6 71.5 10,384 2,523 

Rwanda 2005 95.2 90.8 79.6 80.9 11,308 4,410 

Tanzania 2004/05 92.2 n/a 65.0 71.7 10,216 2,612 

Uganda 2000/01 n/a n/a 64.6 57.8 7,227 1,879 

Southern Africa

Madagascar 2003/04 n/a n/a 52.3 68.5 6,283 1,944 

Malawi 2000 n/a n/a 55.1 65.8 13,076 2,905 

Malawi 2004 n/a n/a 50.2 56.5 11,532 3,099 

Mozambique 2003 n/a n/a 65.9 69.3 11,879 2,436 

Namibia 2000 n/a n/a 82.0 81.2 6,626 2,752 

Zambia 2001/02 n/a n/a 55.8 67.4 7,603 1,947 

Zimbabwe 1999 n/a n/a 37.3 50.0 5,698 2,482 

Zimbabwe 2005/06 95.4 95.8 40.6 46.7 8,719 6,808 
48 
49 

6 Sexual Behavior

This chapter presents indicators related to sexual behavior among adult women and men. The 

sexual behavior indicators discussed include: median age at first sex, multiple sexual partners (lifetime 

and recent), higher-risk sex, extramarital sex, paid sex among men, ever having used condoms, condom 

use at last sex, consistent condom use, condom use at last higher-risk sex, and alcohol use at last sexual 

encounter. 

6.1 Median Age at First Sex 

Table 6.1 presents the median age at first sexual intercourse among women and men age 20–24. 

Median age at first sex varied across countries and differed among women and men. For the most recent 

surveys, the median age at first sex ranged from 15.8 years in Niger to 21.5 years in Rwanda among 

women, and from 16.6 years in Kenya to 22.0 years in Niger among men. 

Comparing the more recent surveys with the earlier round shows a mixed pattern of changes in 

median age at first sex. Among women, the greatest change occurred in Rwanda, where the median age at 

first sex rose by 1.5 years. Among men, the greatest change was in Niger, where the median age rose by 

1.7 years. In most other countries the medians changed little. 

Table 6.1 Changes in median age at first sex among women and men age 20–24, in selected 

countries in sub-Saharan Africa, DHS 1992–2006

Country/year

Median age at first sex

Women Men

Median age Number Median age Number

West Africa

Benin 1996 17.2 1,020 17.6 295

Benin 2001 17.2 1,215 17.3 409

Burkina Faso 1998/99 17.3 1,159 20.0 395

Burkina Faso 2003 17.5 2,274 19.2 563

Cameroon 1998 16.3 1,128 17.0 528

Cameroon 2004 16.7 2,252 18.0 953

Chad 1996/97 16.0 1,369 18.4 373

Chad 2004 15.9 1,072 18.8 267

Cote d'Ivoire 1998/99 16.2 577 17.5 158

Cote d'Ivoire 2005 16.5 1,128 17.7 938

Ghana 1998 17.5 900 19.5 245

Ghana 2003 18.4 1,012 19.6 684

Guinea 1999 16.0 1,086 17.5 298

Guinea 2005 16.4 1,152 17.7 482

Mali 1995/96 15.9 1,594 18.7 286

Mali 2001 15.9 2,339 18.6 463

Niger 1998 16.2 1,364 20.3 501

Niger 2005 15.8 1,651 22.0 491

Nigeria 1999 18.1 1,521 19.6 319

Nigeria 2003 17.6 1,494 20.3 427

(Cont’d)
50 

Table 6.1 – cont’d

Country/year

Median age at first sex

Women Men

Median age Number Median age Number

Senegal 1997 19.3 1,664 19.8 824

Senegal 2005 19.6 2,844 19.1 645

East Africa

Eritrea 1995 17.9 823 n/a n/a

Eritrea 2002 18.3 1,454 n/a n/a

Ethiopia 2000 18.1 2,860 21.6 408

Ethiopia 2005 18.2 2,547 n/a n/a

Kenya 1998 17.3 1,548 16.2 589

Kenya 2003 18.1 1,692 16.6 681

Rwanda 2000 20.0 1,907 20.1 433

Rwanda 2005 21.5 2,354 21.1 946

Tanzania 1999 16.9 811 17.5 540

Tanzania 2004/05 17.1 2,007 18.3 493

Uganda 2000/01 16.7 1,504 18.8 321

Uganda 2006 16.9 1,710 18.0 402

Southern Africa

Madagascar 1997 17.0 1,325 n/a n/a

Madagascar 2003/04 17.3 1,391 17.8 416

Malawi 2000 17.1 2,957 17.7 598

Malawi 2004 17.4 2,870 18.1 587

Mozambique 1997 16.0 1,664 17.2 333

Mozambique 2003 16.0 2,456 16.9 404

Namibia 1992 18.6 1,119 n/a n/a

Namibia 2000 18.2 1,339 16.7 610

Zambia 1996 16.6 1,830 16.0 404

Zambia 2001/02 17.0 1,664 17.0 346

Zimbabwe 1999 18.9 1,294 19.5 506

Zimbabwe 2005/06 18.8 1,952 19.7 1,459

6.2 Multiple Sexual Partnerships 

The DHS surveys include questions on respondents‘ sexual partnerships during their lifetime and 

during the 12 months preceding the survey. Table 6.2 presents percent distributions of women and men 

age 15–49 by number of lifetime sex partners, and the percentage having two or more sex partners in last 

12 months. 
51 

Table 6.2 Changes in percent distribution of women and men age 15–49 by number of lifetime sex partners, and change in percentage 

having 2+ sex partners in last 12 months, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Number of lifetime sex partners 

Had 2+ sex partners in last 12 months1 Women Men

0 1 2 3+

Number

0 1 2 3+

Number

Women Men

% % % % % % % % % Number % Number

West Africa

Benin 1996 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2.6 4,064 26.3 1,105 

Benin 2001 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.6 4,617 28.2 1,957 

Burkina Faso 1998/99 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.9 4,389 15.7 1,554 

Burkina Faso 2003 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.4 8,168 23.4 2,014 

Cameroon 1998 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 11.5 4,441 40.7 1,879 

Cameroon 2004 12.9 31.2 17.9 37.8 10,656 17.8 8.9 7.9 65.3 4,815 7.6 8,060 40.4 3,660 

Chad 1996/97 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.3 5,770 18.5 1,609 

Chad 2004 13.2 66.1 15.6 5.1 6,085 21.3 17.8 13.4 47.5 1,682 1.1 4,512 23.4 1,232 

Cote d'Ivoire 1998/99 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 5.8 2,320 30.5 630 

Cote d'Ivoire 2005 9.2 31.7 23.2 34.3 5,183 12.3 8.0 9.5 66.7 4,503 4.5 4,116 30.5 3,497 

Ghana 1998 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 16.4 876 

Ghana 2003 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.6 3,863 15.5 2,906 

Guinea 1999 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 5.6 4,597 23.2 1,292 

Guinea 2005 9.3 55.3 22.6 11.5 7,954 14.5 10.1 13.4 58.6 2,709 3.0 5,345 33.3 2,014 

Mali 1995/96 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 10.3 1,694 

Mali 2001 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.4 10,840 22.7 2,259 

Niger 1998 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0.6 6,318 11.2 2,154 

Niger 2005 9.5 70.9 16.3 2.8 9,223 26.4 31.2 20.3 21.2 3,101 0.8 7,658 18.5 2,067 

Nigeria 2003 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2.0 5,855 22.3 1,373 

Senegal 2005 26.6 68.7 2.7 0.7 14,602 29.3 15.6 14.4 37.1 3,415 1.8 9,238 22.9 1,983 

(Cont’d)

51
52 

Table 6.2 – cont’d

Country/year

Number of lifetime sex partners 

Had 2+ sex partners in last 12 months1 Women Men

0 1 2 3+

Number

0 1 2 3+

Number

Women Men

% % % % % % % % % Number % Number

East Africa

Eritrea 1995 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 5.5 591 

Ethiopia 2000 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.6 10,007 10.7 1,419 

Ethiopia 2005 24.0 54.9 14.9 5.8 6,751 36.9 29.4 14.0 19.2 5,464 0.2 4,354 4.1 3,121 

Kenya 1998 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 3.9 5,924 23.1 2,566 

Kenya 2003 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2.5 5,710 16.5 2,380 

Rwanda 2000 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 0.5 5,301 4.2 1,427 

Rwanda 2005 31.0 49.2 14.2 5.5 11,321 30.9 26.5 17.6 24.9 4,413 0.6 5,887 5.1 2,399 

Tanzania 2004/05 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 4.3 8,038 30.1 1,975 

Uganda 2000/01 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2.1 5,594 24.6 1,376 

Uganda 2006 14.7 38.4 23.0 23.4 8,531 18.8 11.1 12.6 55.9 2,385 2.4 6,266 28.7 1,703 

Southern Africa

Madagascar 1997 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 8.2 5,619 n/a n/a

Madagascar 2003/04 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 3.3 6,201 20.0 1,851 

Malawi 2000 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.0 10,360 18.3 2,303 

Malawi 2004 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 1.1 9,087 11.8 2,402 

Mozambique 1997 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 39.8 1,650 

Mozambique 2003 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 6.2 9,824 35.5 2,117 

Namibia 2000 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2.9 4,568 21.5 2,094 

Zambia 1996 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 4.7 6,056 26.2 1,364 

Zambia 2001/02 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2.8 5,613 26.8 1,568 

Zimbabwe 1999 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a 2.4 4,132 18.8 1,711 

Zimbabwe 2005/06 20.7 52.2 16.9 9.9 8,907 26.1 14.1 13.4 45.0 6,863 1.3 5,879 14.1 4,382 

1 Based on women and men age 15–49 who had sex in last 12 months.

52
53 

Across all countries studied, a much higher percentage of men than women had two or more 

sexual partners in last 12 months, and had three or more lifetime partners (Table 6.2). The percentage of 

women with two or more partners was less than 5 percent in the majority of countries, and over time this 

level either remained fairly constant or declined (Figure 6.1a). Among men, the percentage declined in 

five countries in east Africa and southern Africa (Ethiopia, Kenya, Malawi, Mozambique, and 

Zimbabwe). However, the percentage reporting multiple partners increased in several west African 

countries (Burkina Faso, Chad, Guinea, Mali, and Niger), and remained high in the others (Figure 6.1b).
54 

Figure 6.1a Changes in percentage of women age 15–49 who had 2+ sexual partners 

in last 12 months, 1996–2006 
55 

Figure 6.1b Changes in percentage of men age 15–49 who had 2+ sexual partners 

in last 12 months, 1995–2006 
56 

6.3 Higher-Risk Sex 

Table 6.3 presents the percentage of women and men age 15–49 who had higher-risk sex (that is, 

sex with someone other than a marital or cohabiting partner) in the 12 months preceding the survey, 

among those who reported having had sex in last 12 months. In all countries studied, a larger percentage 

of men than women reported having higher-risk sex in last 12 months. The proportion of respondents who 

reported higher-risk sex varied widely in the recent round of surveys, among women from less than 1 

percent in Niger to 55 percent in Namibia, and was substantially higher among men, from 9 percent in 

Ethiopia and Niger to 62 percent in Namibia and Cameroon. 

Table 6.3 Changes in percentage of women and men age 15–49 who had higher-risk sex in last 

12 months, percentage who had extramarital sex in last 12 months, and percentage who paid 

for sex in last 12 months, in selected countries in sub-Saharan Africa, 1992–2006

 

Country/year

Had higher-risk sex in last 12 

months1

Had extramarital sex in last 12 

months2

Paid for sex 

in last 12 

months3

Women Men Women Men Men

% Number % Number % Number % Number % Number

West Africa

Benin 1996 13.6 4,064 50.2 1,105 1.0 3,546 33.1 822 2.1 1,105

Benin 2001 16.3 4,618 50.5 1,957 1.5 3,848 27.0 1,313 0.6 1,957

Burkina Faso 1998/99 8.3 4,389 35.2 1,554 0.8 4,056 8.7 1,103 0.9 1,554

Burkina Faso 2003 10.3 8,168 38.8 2,014 1.2 7,364 13.7 1,418 0.3 2,014

Cameroon 1998 28.3 4,441 64.4 1,880 5.7 3,375 38.1 1,080 2.7 1,880

Cameroon 2004 28.7 8,060 61.9 3,660 14.1 6,570 38.7 2,214 4.5 3,660

Chad 1996/97 7.3 5,770 32.8 1,609 0.7 5,386 15.1 1,273 3.0 1,609

Chad 2004 3.9 4,512 33.5 1,232 1.5 4,292 14.9 942 2.2 1,232

Cote d'Ivoire 1998/99 31.9 2,320 63.9 630 2.2 1,615 30.7 329 1.2 630

Cote d'Ivoire 2005 33.2 4,116 57.7 3,497 4.8 2,834 24.4 1,904 n/a n/a

Ghana 2003 20.8 3,863 38.3 2,906 3.7 3,116 15.7 2,109 2.4 2,906

Guinea 1999 12.9 4,597 57.0 1,292 4.8 4,206 29.7 789 0.5 1,292

Guinea 2005 15.6 5,345 53.6 2,014 4.8 4,692 26.8 1,267 0.5 2,014

Mali 1995/96 7.2 8,412 27.9 1,694 0.0 7,803 7.6 1,321 0.8 1,694

Mali 2001 7.7 10,840 33.5 2,259 2.0 10,108 12.7 1,701 0.3 2,259

Niger 1998 2.9 6,318 20.2 2,154 0.1 6,136 6.5 1,838 3.3 2,154

Niger 2005 0.7 7,658 8.8 2,067 0.1 7,529 1.9 1,904 2.1 2,067

Nigeria 1999 13.7 5,910 28.2 1,526 0.0 5,100 0.0 1,097 6.8 1,526

Nigeria 2003 13.9 5,855 39.1 1,373 0.9 4,989 14.6 970 4.4 1,373

Senegal 2005 5.9 9,238 42.7 1,983 3.8 8,913 21.4 1,442 0.6 1,983

East Africa

Eritrea 1995 3.9 3,348 14.6 591 0.0 3,217 3.4 523 2.5 591

Ethiopia 2000 4.5 10,007 19.9 1,419 1.3 9,349 4.9 1,169 4.4 1,419

Ethiopia 2005 2.7 4,354 8.5 3,121 0.5 4,142 0.8 2,840 0.7 3,121

Kenya 1998 21.9 5,924 49.0 2,566 1.6 4,702 17.2 1,581 0.9 2,566

Kenya 2003 17.6 5,710 39.6 2,380 2.3 4,693 11.1 1,597 4.1 2,380

(Cont’d)
57 

Table 6.3 – cont’d

Country/year

Had higher-risk sex in last 12 

months1

Had extramarital sex in last 12 

months2

Paid for sex 

in last 12 

months3

Women Men Women Men Men

% Number % Number % Number % Number % Number

Rwanda 2000 6.4 5,301 13.0 1,427 0.4 4,814 1.7 1,246 1.4 1,427

Rwanda 2005 8.1 5,887 13.6 2,399 0.5 5,279 3.0 2,114 0.4 2,399

Tanzania 2004/05 19.0 8,038 45.2 1,975 3.4 6,599 22.4 1,374 2.8 1,975

Uganda 2000/01 13.8 5,594 29.1 1,376 2.4 4,735 12.3 1,096 1.7 1,376

Uganda 2006 15.9 6,266 36.2 1,704 1.3 5,142 19.1 1,324 4.1 1,704

Southern Africa

Madagascar 2003/04 16.8 6,201 38.1 1,851 1.4 5,079 14.3 1,321 5.0 1,851

Malawi 2000 8.9 10,361 36.1 2,303 0.6 9,061 14.8 1,705 10.2 2,303

Malawi 2004 8.3 9,087 26.9 2,402 0.8 8,004 8.3 1,894 6.5 2,402

Mozambique 2003 21.8 9,825 52.1 2,117 3.8 7,664 28.1 1,398 15.5 2,117

Namibia 2000 54.6 4,568 62.0 2,094 18.4 2,438 20.5 861 2.1 2,094

Zambia 1996 23.2 6,056 52.8 1,364 1.5 4,722 20.9 814 3.0 1,364

Zambia 2001/02 17.5 5,613 45.4 1,568 1.8 4,496 21.6 1,076 13.2 1,568

Zimbabwe 1999 13.6 4,132 42.6 1,711 1.1 3,520 14.9 1,142 10.2 1,711

Zimbabwe 2005/06 11.4 5,879 35.7 4,382 0.6 5,018 10.8 3,102 5.8 4,382

1 Higher-risk sex is defined as sex with someone other than a marital or cohabiting partner and is based on women and 

men age 15–49 who had sex in last 12 months.

2 Extramarital sex is defined as sex with someone other than a marital or cohabiting partner and is based on women and 

men age 15–49 who were currently in union and had sex in past 12 months.

3 Based on men age 15–49 who had sex in last 12 months. 

Comparing the two survey rounds, there was no clear direction for changes in the proportion of 

women and men reporting higher-risk sex. In slightly more than one-half of the countries, the percentage 

reporting higher-risk sex declined by a few percentage points, but in the rest of the countries it increased 

slightly or remained unchanged (Figures 6.2a and 6.2b). Most noticeably, Burkina Faso, Mali, Nigeria, 

and Uganda observed a substantial increase in the proportion of men reporting higher-risk sex. 
58 

Figure 6.2a Changes in percentage of women age 15–49 who had higher-risk sex 

in last 12 months, 1996–2006 
59 

Figure 6.2b Changes in percentage of men age 15–49 who had higher-risk sex 

 in last 12 months, 1995–2006
60 

6.4 Extramarital Sex 

Extramarital sex, for women and men currently in union, is defined as sex with someone other 

than a marital or cohabiting partner in last 12 months. The percentage of women and men in union who 

reported having extramarital sex varied greatly across countries. In the more recent surveys, among 

women it ranged from less than 1 percent in Niger, Nigeria, Ethiopia, Rwanda, Malawi, and Zimbabwe to 

14 percent in Cameroon and 18 percent in Namibia, and among men from less than 2 percent in Ethiopia 

and Niger to 39 percent in Cameroon (Table 6.3). In all of the countries, the reported level of extramarital 

sex was substantially higher among men than among women. 

In 10 of the 16 countries with data on two time points, the percentage of women reporting 

extramarital sex increased slightly in recent years, and increased most in Cameroon. In contrast, among 

men the percentage reporting extramarital sex declined in the majority of countries, although it increased 

noticeably in Burkina Faso, Mali, Nigeria, and Uganda. Reasons for particularly large increases in 

extramarital sex among women in Cameroon and men in Nigeria are unclear. 

6.5 Paid Sex among Men 

The percentage of men age 15–49 who paid for sex in last 12 months varied, from less than 1 

percent in Benin, Burkina Faso, Guinea, Mali, Senegal, Ethiopia, and Rwanda to 13 percent in Zambia 

and 16 percent in Mozambique. Overall, countries in southern Africa had the highest levels of paid sex 

among men compared with east Africa or west Africa (Table 6.3). 

Based on available data for four countries (Cameroon, Kenya, Uganda, and Zambia) at two time 

points, some experienced notable increases in the proportion of men who paid for sex, whereas others 

experienced a decline or no change (Figure 6.3). 
61 

Figure 6.3 Changes in percentage of men age 15–49 who had paid sex 

in last 12 months, 1995–2006 
62 

6.6 Ever Use of Condoms and Condom Use at Last Sex 

Among respondents who ever had sex, the proportion who ever used a condom varied greatly, 

from less than 1 percent in Niger to 37 percent in Cameroon among women, and from 10 percent in Niger 

to 68 percent in Zimbabwe among men, in the recent round of surveys (Table 6.4). The percentage of 

women who used a condom during their most recent sexual encounter in last 12 months ranged from less 

than 1 percent in Niger to 28 percent in Namibia. Among men, the range was from 4–5 percent in Niger, 

Madagascar, and Ethiopia to 48 percent in Namibia. In all countries, the percentages reporting ever 

having used a condom and having used a condom in last 12 months were higher among men than among 

women. 

The percentage of women and men who reported ever using a condom increased in most 

countries. Regarding condom use in last 12 months, the percentage remained stable among women, 

except for moderate increases in Burkina Faso, Cameroon, Cote d‘Ivoire, Ghana, Mozambique, and 

Zambia (Figure 6.4a). The majority of these increases were in west Africa. Among men, condom use in 

last 12 months increased in nearly all west African countries studied. In east and southern Africa, condom 

use increased marginally in Tanzania and Uganda, and substantially in Mozambique, but remained steady 

in the other countries. In Kenya and Zimbabwe condom use at last sex in last 12 months declined among 

men (Figure 6.4b). 
63 

Table 6.4 Changes in percentage of women and men age 15–49 who ever used a condom, percentage who used a condom at last sex 

in last 12 months, percentage who used a condom consistently in last 12 months, and percentage who used a condom at last higherrisk sex in last 12 months, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Ever used condom1

Used condom at last sex in 

last 12 months2

Used condom consistently in 

last 12 months3

Used condom at last higherrisk sex in last 12 months4

Women Men Women Men Women Men Women Men

% Number % Number % Number % Number % Number % Number % Number % Number

West Africa

Benin 1996 6.9 4,925 30.9 1,228 2.1 4,064 10.2 1,105 1.0 4,064 2.3 1,105 n/a n/a n/a n/a

Benin 2001 10.6 5,608 40.1 2,164 3.9 4,618 16.0 1,957 3.9 4,618 14.0 1,957 16.2 751 31.3 989 

Burkina Faso 1998/99 7.8 5,665 37.7 1,773 5.2 4,389 23.9 1,554 2.2 4,389 6.0 1,554 n/a n/a n/a n/a

Burkina Faso 2003 11.6 10,911 45.6 2,375 8.6 8,168 31.2 2,014 8.6 8,168 29.1 2,014 52.9 844 69.1 781 

Cameroon 1998 24.6 5,019 52.4 2,006 5.9 4,441 17.1 1,880 2.2 4,441 3.2 1,880 n/a n/a n/a n/a

Cameroon 2004 36.6 9,280 n/a n/a 14.9 8,060 32.2 3,660 14.3 8,060 27.7 3,660 40.5 2,310 54.7 2,266 

Chad 1996/97 1.1 6,596 12.1 1,716 0.9 5,770 6.9 1,609 0.4 5,770 1.3 1,609 n/a n/a n/a n/a

Chad 2004 3.1 5,284 18.0 1,324 1.6 4,512 10.1 1,232 1.6 4,512 9.1 1,232 13.7 174 30.6 412 

Cote d'Ivoire 1998/99 25.7 2,743 59.2 691 8.3 2,320 28.2 630 1.8 2,320 3.3 630 n/a n/a n/a n/a

Cote d'Ivoire 2005 n/a n/a n/a n/a 13.9 4,116 29.3 3,497 8.2 4,116 19.6 3,497 33.6 1,366 51.5 2,018 

Ghana 1998 16.5 4,183 43.1 1,014 5.9 3,495 17.4 876 5.9 3,495 17.4 876 n/a n/a n/a n/a

Ghana 2003 21.6 4,807 54.1 3,376 8.6 3,863 20.0 2,906 8.4 3,863 19.4 2,906 28.1 802 44.8 1,114 

Guinea 1999 4.0 6,144 30.9 1,501 2.7 4,597 16.0 1,292 1.2 4,597 2.4 1,292 n/a n/a n/a n/a

Guinea 2005 6.0 7,213 35.8 2,315 4.6 5,345 20.0 2,014 4.5 5,345 17.9 2,014 25.2 834 39.5 1,079 

Mali 1995/96 3.5 9,004 24.0 1,800 1.5 8,412 11.1 1,694 0.7 8,412 2.4 1,694 n/a n/a n/a n/a

Mali 2001 3.3 11,810 25.2 2,447 1.6 10,840 10.1 2,259 1.6 10,840 9.4 2,259 14.5 837 33.3 756 

Niger 1998 0.8 6,806 11.8 2,383 0.8 6,318 6.6 2,154 0.5 6,318 1.6 2,154 n/a n/a n/a n/a

Niger 2005 0.5 8,342 10.1 2,283 0.4 7,658 4.0 2,067 0.2 7,658 3.3 2,067 20.4 52 45.3 183 

Nigeria 1999 8.3 6,872 29.3 1,712 4.9 5,910 15.1 1,526 4.9 5,910 15.1 1,526 n/a n/a n/a n/a

Nigeria 2003 11.8 6,530 36.2 1,535 4.8 5,855 18.4 1,373 4.7 5,855 16.5 1,373 23.8 813 46.9 537 

Senegal 1997 6.6 6,652 46.1 2,696 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Senegal 2005 7.1 10,716 47.3 2,414 3.3 9,238 26.1 1,983 3.1 9,238 24.3 1,983 37.5 549 61.9 847 

(Cont’d)

63
64 

Table 6.4 – cont’d

Country/year

Ever used condom1

Used condom at last sex in 

last 12 months2

Used condom consistently in 

last 12 months3

Used condom at last higherrisk sex in last 12 months4

Women Men Women Men Women Men Women Men

% Number % Number % Number % Number % Number % Number % Number % Number

East Africa

Eritrea 1995 2.1 4,067 18.7 640 1.1 3,348 9.6 591 1.1 3,348 1.6 591 n/a n/a n/a n/a

Eritrea 2002 3.3 6,815 n/a n/a 1.7 5,320 n/a n/a 1.7 5,320 n/a n/a n/a n/a n/a n/a

Ethiopia 2000 1.5 11,860 7.7 1,558 1.0 10,00

7 

5.6 1,419 1.0 10,007 5.1 1,419 13.6 454 30.6 282 

Ethiopia 2005 1.2 10,748 10.8 3,450 1.0 4,354 4.9 3,121 1.0 4,354 4.9 3,121 23.5 119 51.2 264 

Kenya 1998 11.1 6,639 46.2 2,788 5.5 5,924 21.4 2,566 2.3 5,924 5.0 2,566 n/a n/a n/a n/a

Kenya 2003 12.3 6,806 49.9 2,825 5.5 5,710 17.8 2,380 5.4 5,710 16.0 2,380 23.9 1,004 46.5 942 

Rwanda 2000 2.7 7,361 13.6 1,748 1.4 5,301 7.1 1,427 1.4 5,301 7.0 1,427 14.9 340 51.3 186 

Rwanda 2005 3.8 7,816 18.3 3,053 2.7 5,887 5.9 2,399 2.7 5,887 5.8 2,399 19.7 475 40.9 326 

Tanzania 1999 12.3 3,533 34.6 2,757 7.9 3,209 17.8 2,602 n/a n/a n/a n/a n/a n/a n/a n/a

Tanzania 2004/05 12.4 8,979 51.5 2,222 8.3 8,038 20.8 1,975 7.9 8,038 17.4 1,975 32.9 1,528 51.0 893 

Uganda 2000/01 15.2 6,399 40.5 1,560 6.9 5,594 15.5 1,376 6.9 5,594 14.8 1,376 38.2 771 60.2 401 

Uganda 2006 20.8 7,281 47.9 1,938 7.9 6,266 17.7 1,704 5.0 6,266 12.5 1,704 34.9 998 57.5 617 

Southern Africa

Madagascar 1997 5.0 6,206 n/a n/a 1.3 5,619 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Madagascar 2003/04 7.6 7,095 15.8 1,915 1.8 6,201 4.4 1,851 1.8 6,201 3.6 1,851 4.6 1,043 13.1 705 

Malawi 2000 9.4 11,845 40.7 2,609 4.7 10,36

1 

14.9 2,303 4.7 10,361 14.1 2,303 28.6 921 39.5 832 

Malawi 2004 9.6 10,397 46.5 2,716 5.2 9,087 15.7 2,402 5.2 9,087 14.7 2,402 30.1 755 47.1 646 

Mozambique 1997 2.9 8,181 16.7 1,825 1.2 7,140 6.9 1,650 1.2 7,140 6.9 1,650 n/a n/a n/a n/a

Mozambique 2003 11.9 11,712 31.7 2,264 6.3 9,825 14.4 2,117 6.1 9,825 12.2 2,117 25.0 2,144 33.1 1,103 

Namibia 1992 6.8 4,399 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Namibia 2000 33.0 5,775 66.9 2,474 28.4 4,568 47.9 2,094 28.1 4,568 45.7 2,094 42.7 2,493 67.8 1,298 

Zambia 1996 19.3 7,077 45.6 1,528 8.3 6,056 21.6 1,364 4.0 6,056 4.7 1,364 n/a n/a n/a n/a

Zambia 2001/02 23.7 6,751 56.1 1,772 11.8 5,613 21.0 1,568 11.6 5,613 18.2 1,568 33.1 985 44.0 712 

Zimbabwe 1999 22.1 4,685 67.0 1,866 9.1 4,132 28.7 1,711 8.9 4,132 27.8 1,711 42.8 561 70.3 728 

Zimbabwe 2005/06 25.3 7,060 67.9 5,070 8.3 5,879 25.4 4,382 8.1 5,879 18.9 4,382 45.6 673 69.6 1,564 

1 Based on women and men age 15–49 who ever had sex.

2 Based on women and men age 15–49 who had sex in last 12 months.

3 Consistent use of condom refers to the use of a condom at last sex with all sexual partners (up to three) in last 12 months.

4 Based on women and men age 15–49 who had higher-risk sex (i.e., sex with a non-marital, no-cohabiting partner) in last 12 months.

 

64
65 

Figure 6.4a Changes in percentage of women age 15–49 who used a condom at last sex 

in last 12 months, 1995–2006 
66 

Figure 6.4b Changes in percentage of men age 15–49 who used a condom at last sex 

in last 12 months, 1995–2006 
67 

6.7 Consistent Condom Use 

Consistent condom use among women in last 12 months ranged from less than 1 percent in Niger 

to 28 percent in Namibia, and among men from 3 percent in Niger and Madagascar to 46 percent in 

Namibia (Table 6.4). In west Africa consistent condom use increased in the vast majority of countries 

among both women and men. In west Africa the largest increases were in Benin, Burkina Faso, 

Cameroon, Cote d‘Ivoire, and Guinea. In east Africa and southern Africa, consistent condom use rose 

only in Kenya, Mozambique, and Zambia, among both women and men. Among men in Zimbabwe, 

consistent condom use decreased substantially, from 28 percent in 1999 to 19 percent in 2005–06. 

6.8 Condom Use at Higher-Risk Sex 

Among women and men who reported having higher-risk sex in last 12 months, the proportion 

reporting condom use during their last higher-risk sex varied considerably, both by sex and by country. 

Overall, men were much more likely than women to use a condom during higher-risk sex. In the recent 

round of surveys, the percentage of women reporting condom use at last higher-risk sex ranged from 5 

percent in Madagascar to 53 percent in Burkina Faso, and among men from 13 percent in Madagascar to 

70 percent in Zimbabwe (Table 6.4). 

In the five countries where data were available for two points in time (Ethiopia, Rwanda, Uganda, 

Malawi, and Zimbabwe) the pattern of change in condom use at last higher-risk sex was mixed. Among 

women, there was a marked increase in condom use at last higher-risk sex in Ethiopia (from 14 to 24 

percent) and Rwanda (from 15 to 20 percent). There was a slight increase in Malawi and Zimbabwe, but a 

slight decline in Uganda (Figure 6.5a). Among men, condom use at last higher-risk sex increased in 

Ethiopia (from 31 to 51 percent) and Malawi (from 40 to 47 percent), remained unchanged in Zimbabwe, 

declined substantially in Rwanda (from 51 to 41 percent), and declined to a lesser extent in Uganda (from 

60 to 58 percent) (Figure 6.5b). 
68 

Figure 6.5a Changes in percentage of women age 15–49 who used a condom at last higher-risk 

sex in last 12 months, 1999–2006 

Figure 6.5b Changes in percentage of men age 15–49 who used a condom at last higher-risk 

sex in last 12 months, 1999–2006 
69 

6.9 Alcohol Use 

Alcohol consumption tends to be associated with risky sexual behavior. Sexual intercourse when 

one or both partners are under the influence of alcohol is more likely to be unplanned than otherwise, and 

the partners are less likely to use condoms. 

Table 6.5 presents the percentage of women and men age 15–49 who never used alcohol, ever 

used alcohol, and used alcohol recently. Among women the percentage who recently consumed alcohol 

ranged from 4–6 percent in Malawi, Kenya, and Zimbabwe to 32 percent in Rwanda. Among men the 

percentage was considerably higher, ranging from 24 percent in Nigeria to 59 percent in Rwanda. There 

were wide intra-regional differences in alcohol use. 

Alcohol use by both partners at last sex in last 12 months varied across countries, from 1 percent 

or less in Guinea, Niger, Senegal, Ethiopia, and Rwanda to 10 percent in Uganda among women. Rates 

among men were similar. 
70 

Table 6.5 Percentage of women and men age 15–49 who used alcohol, and percentage who used alcohol at last sex in last 12 months, 

in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Alcohol use1 Alcohol use by partners at last sex in last 12 months2

Women Men Women Men

Never 

used

In 

the 

past3 Recently4 Number

Never 

used

In 

the 

past Recently Number

Neither 

used Either Both Number

Neither 

used Either Both Number

West Africa

Benin 2001 61.4 12.2 24.6 6,219 n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a

Burkina Faso 2003 65.4 8.3 26.1 12,477 11.6 56.8 31.4 3,209 n/a n/a n/a n/a n/a n/a n/a n/a

Cameroon 2004 n/a n/a n/a n/a n/a n/a n/a n/a 80.7 12.6 6.5 8,060 75.1 17.4 7.4 3,660 

Cote d'Ivoire 2005 n/a n/a n/a n/a n/a n/a n/a n/a 95.1 1.2 3.4 4,116 88.7 3.7 7.5 3,497 

Ghana 2003 n/a n/a n/a n/a n/a n/a n/a n/a 90.4 8.1 1.5 3,863 84.3 14.3 1.4 2,906 

Guinea 2005 n/a n/a n/a n/a n/a n/a n/a n/a 97.9 1.7 0.3 5,345 96.9 2.3 0.3 2,014 

Niger 2005 n/a n/a n/a n/a n/a n/a n/a n/a 99.6 0.0 0.0 7,658 99.2 0.3 0.2 2,067 

Nigeria 2003 86.4 4.4 8.9 7,620 70.2 5.8 24.0 2,093 n/a n/a n/a n/a n/a n/a n/a n/a

Senegal 2005 n/a n/a n/a n/a n/a n/a n/a n/a 99.5 0.4 0.0 9,238 99.3 0.5 0.1 1,983 

East Africa

Ethiopia 2005 n/a n/a n/a n/a n/a n/a n/a n/a 96.8 3.0 0.1 4,354 98.5 1.2 0.3 3,121 

Kenya 2003 88.3 6.6 5.0 8,195 50.7 19.7 29.5 3,363 n/a n/a n/a n/a n/a n/a n/a n/a

Rwanda 2000 42.1 26.0 31.8 10,421 27.9 19.4 52.3 2,532 n/a n/a n/a n/a n/a n/a n/a n/a

Rwanda 2005 n/a n/a n/a n/a 25.1 15.6 59.2 4,413 92.2 6.8 0.6 5,887 90.9 7.6 1.3 2,399 

Tanzania 2004/05 n/a n/a n/a n/a n/a n/a n/a n/a 86.3 13.7 n/a 8,038 n/a n/a n/a n/a

Uganda 2000/01 48.3 27.7 23.8 7,246 39.5 16.1 44.0 1,879 n/a n/a n/a n/a n/a n/a n/a n/a

Uganda 2006 n/a n/a n/a n/a n/a n/a n/a n/a 76.0 14.0 9.8 6,266 81.9 9.9 8.1 1,703 

Southern Africa

Madagascar 2003/04 49.9 32.3 17.7 7,949 31.6 15.2 53.0 2,216 n/a n/a n/a n/a n/a n/a n/a n/a

Malawi 2000 92.1 3.9 3.9 13,220 70.5 4.4 25.1 2,915 n/a n/a n/a n/a n/a n/a n/a n/a

Mozambique 2003 81.3 5.8 12.6 12,418 56.5 8.6 34.9 2,490 n/a n/a n/a n/a n/a n/a n/a n/a

Namibia 2000 64.0 10.3 24.8 6,755 36.7 22.6 40.2 2,766 n/a n/a n/a n/a n/a n/a n/a n/a

Zambia 2001/02 76.6 13.9 9.2 7,658 37.9 16.6 45.3 1,974 n/a n/a n/a n/a n/a n/a n/a n/a

Zimbabwe 1999 86.7 7.5 5.7 5,907 53.2 14.2 32.4 2,505 n/a n/a n/a n/a n/a n/a n/a n/a

Zimbabwe 2005/06 n/a n/a n/a n/a n/a n/a n/a n/a 89.4 9.2 1.3 5,879 89.8 9.0 0.7 4,382 

1

Information on alcohol use was collected differently across countries. Some countries asked about alcohol use in last month, while others asked about last 3 months.

2 Based on women and men age 15–49 who had sex in last 12 months, restricted to the last partner in last 12 months.

3 In the past refers to alcohol use one (three) or more months ago.

4 Recently refers to alcohol use in last one (three) months.

70
71 

7 Sexual Behavior of Youth 

This chapter presents a number of indicators that relate to the sexual behavior of youth, including 

age at sexual debut, sexual abstinence, higher-risk sex, forced sex, inter-generational sex, multiple sexual 

partnerships, and condom use. 

7.1 Sex before Age 15 

Table 7.1 presents the percentage of women and men age 15–19 who had sex before age 15 in the 

two rounds of DHS surveys studied. In the recent round, among women this indicator ranged from 5 

percent in Rwanda and Zimbabwe to 28 percent in Mozambique, and among men from 2 percent in 

Ethiopia to 31 percent in Mozambique, Kenya, and Namibia. In west Africa, generally a smaller 

percentage of young men than young women reported having sex before age 15. The reverse was 

observed in east Africa and southern Africa. 

Changes in the proportion of youth reporting sex before age 15 were uneven across countries. 

Among both women and men age 15–19, the percentage having sex before age 15 declined in more than 

half of the countries. However, among women there were modest increases in some countries, including 

Benin, Mali, Nigeria, Rwanda, Namibia, and Zimbabwe (Figure 7.1a), and among men in Chad, Cote 

d'Ivoire, Rwanda, and Mozambique (Figure 7.1b). 
72 

Table 7.1 Changes in percentage of women and men age 15–19 who had sex before age 15, percentage of women and men age 15–24 

who never had sex (primary abstinence), and percentage of women and men age 15–24 who ever had sex but not in last 12 months 

(secondary abstinence), in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Had sex before age 15 Primary abstinence 1 Secondary abstinence 2

Women Men Women Men Women Men

% Number % Number % Number % Number % Number % Number

West Africa

Benin 1996 13.5 1,075 n/a n/a 57.8 971 17.6 215 15.6 410 12.9 177 

Benin 2001 16.0 1,233 23.8 496 48.6 1,250 35.8 798 15.2 642 17.3 512 

Burkina Faso 1998/99 12.0 1,444 7.6 599 73.6 1,054 60.5 898 9.5 279 14.9 355 

Burkina Faso 2003 7.3 2,776 4.7 877 69.1 2,246 61.2 1,272 14.9 695 17.8 494 

Cameroon 1998 26.0 1,282 17.8 539 42.6 1,121 36.4 897 9.8 643 9.1 570 

Cameroon 2004 18.0 2,685 11.5 1,224 58.1 2,318 46.8 1,756 18.7 972 15.1 934 

Chad 1996/97 21.9 1,716 7.9 490 85.2 989 59.2 671 7.3 147 11.1 274 

Chad 2004 19.0 1,361 10.7 406 92.4 849 60.5 567 15.2 65 13.7 224 

Cote d'Ivoire 1998/99 22.1 775 13.8 180 37.4 785 32.2 302 10.3 492 9.7 204 

Cote d'Ivoire 2005 20.4 1,232 16.7 898 33.4 1,388 31.9 1,653 13.2 925 17.6 1,126 

Ghana 1998 7.3 910 3.7 330 62.6 1,022 68.8 502 18.3 383 22.1 157 

Ghana 2003 7.4 1,148 3.9 1,107 60.6 1,418 67.2 1,615 24.0 559 27.1 530 

Guinea 1999 27.3 1,321 19.8 392 67.1 887 38.4 622 16.9 292 15.6 383 

Guinea 2005 19.7 1,648 17.9 664 58.7 1,250 38.2 980 13.7 516 14.4 606 

Mali 1995/96 23.7 1,883 14.7 441 59.7 1,145 54.4 624 9.1 462 18.0 285 

Mali 2001 26.0 2,565 10.6 668 63.4 1,599 52.2 1,015 20.5 586 25.6 485 

Niger 1998 28.0 1,714 10.0 759 92.6 804 71.8 1,019 30.1 60 27.2 288 

Niger 2005 25.7 1,718 5.3 620 96.9 845 78.0 933 38.9 26 54.2 205 

Nigeria 1999 16.2 1,775 8.3 511 67.5 1,841 64.3 760 12.8 598 13.0 271 

Nigeria 2003 20.3 1,716 7.9 453 61.7 1,685 62.0 809 17.5 646 24.4 307 

Senegal 1997 9.6 1,937 n/a n/a 87.5 1,995 33.4 757 25.1 250 n/a n/a

Senegal 2005 9.1 3,556 12.7 926 95.7 3,407 64.7 1,321 51.3 147 40.8 467 

(Cont’d)

72
73 

Table 7.1 – cont’d

Country/year

Had sex before age 15 Primary abstinence 1 Secondary abstinence 2

Women Men Women Men Women Men

% Number % Number % Number % Number % Number % Number

East Africa

Eritrea 1995 18.5 1,129 n/a n/a 98.4 884 87.8 331 52.6 14 20.9 40 

Eritrea 2002 8.8 2,001 n/a n/a 96.0 1,778 n/a n/a 56.7 71 n/a n/a

Ethiopia 2000 13.5 3,710 5.1 600 96.4 3,366 77.8 891 33.8 123 30.2 198 

Ethiopia 2005 11.1 3,266 1.7 1,335 95.7 3,165 87.6 2,081 64.5 136 39.7 257 

Kenya 1998 15.0 1,851 31.7 811 58.3 2,084 33.7 1,261 22.9 868 14.8 836 

Kenya 2003 14.5 1,856 30.9 856 63.4 2,090 37.3 1,379 41.3 765 35.3 865 

Rwanda 2000 3.0 2,617 9.3 762 89.7 3,221 70.5 1,059 65.3 333 69.7 313 

Rwanda 2005 5.2 2,585 15.3 1,102 86.2 3,762 67.0 1,863 66.1 521 73.7 615 

Tanzania 1999 14.5 909 23.9 790 56.9 846 35.6 1,124 10.4 364 11.1 724 

Tanzania 2004/05 11.4 2,245 13.0 637 62.2 2,096 41.0 951 23.3 793 26.9 562 

Uganda 2000/01 14.2 1,615 15.5 441 62.7 1,324 52.8 588 27.4 494 34.0 278 

Uganda 2006 11.8 1,936 13.9 595 65.7 1,876 54.4 810 29.4 644 39.6 370 

Southern Africa

Madagascar 1997 19.4 1,553 n/a n/a 57.1 1,369 n/a n/a 12.5 587 n/a n/a

Madagascar 2003/04 16.0 1,528 7.7 416 57.6 1,391 46.4 621 24.5 589 6.9 333 

Malawi 2000 16.5 2,867 29.1 660 62.1 2,176 30.3 982 29.9 825 29.6 685 

Malawi 2004 14.1 2,392 18.0 650 67.9 1,869 40.1 937 34.1 600 34.8 561 

Mozambique 1997 28.6 1,836 23.5 382 51.4 1,157 28.8 509 11.0 562 14.2 362 

Mozambique 2003 27.7 2,454 31.3 673 39.2 1,774 26.5 828 11.0 1,079 9.0 609 

Namibia 1992 7.7 1,259 n/a n/a 48.2 1,932 n/a n/a 10.7 1,001 n/a n/a

Namibia 2000 9.8 1,499 31.3 694 37.8 2,375 23.0 1,186 26.7 1,478 23.9 913 

Zambia 1996 21.7 2,003 39.3 460 50.1 1,860 27.0 732 28.0 928 21.7 534 

Zambia 2001/02 17.5 1,812 27.2 459 50.3 1,732 28.2 688 37.0 861 28.5 494 

Zimbabwe 1999 3.2 1,447 6.3 713 79.6 1,482 56.9 1,094 26.7 302 20.5 472 

Zimbabwe 2005/06 4.9 2,152 5.2 1,899 81.1 2,195 57.6 2,988 33.8 414 33.7 1,266 

1 Based on women and men age 15–24 who never married.

2 Based on women and men age 15–24 who never married and ever had sex.

 

73
74 

Figure 7.1a Changes in percentage of women age 15–19 who had sex before age 15, 1992–2006 
75 

Figure 7.1b Changes in percentage of men age 15–19 who had sex before age 15, 1995–2006 
76 

7.2 Primary and Secondary Abstinence 

Table 7.1 also presents the percentage of never-married women and men age 15–24 who never 

had sex (primary abstinence), and the percentage who ever had sex but not in last 12 months (secondary 

abstinence). The percentage of young women and men who practiced primary abstinence varied greatly 

across countries. Among young women, primary abstinence ranged from 33 percent in Cote d'Ivoire to 97 

percent in Niger, and among young men from 23 percent in Namibia to 88 percent in Ethiopia, in the 

recent round of surveys. Primary abstinence was more common among young women than among young 

men, with the exception of Ghana where it was the reverse, and Cote d‘Ivoire and Nigeria where young 

women and men were about equally likely to practice primary abstinence. 

Changes in primary abstinence varied across regions. In about half the countries in west Africa, 

the proportion of young women reporting primary abstinence declined, while it increased in the other 

half. In east Africa, in three countries the levels increased among women but declined slightly in the other 

three; whereas in southern Africa levels remained steady in three countries, declined in two, and increased 

in one (Figure7.2a). Among young men the changes were similar (Figure 7.2b). 

Secondary abstinence also varied greatly across countries. In the recent round of surveys, among 

young women the proportion reporting secondary abstinence ranged from 11 percent in Mozambique to 

66 percent in Rwanda (Figure 7.3a), and among young men from 7 percent in Madagascar to 74 percent 

in Rwanda (Figure 7.3b). In general, similar proportions of young women and men practiced secondary 

abstinence, with a few exceptions in east Africa. In the overwhelming majority of countries, secondary 

abstinence increased among both young women and men. 
77 

Figure 7.2a Changes in percentage of women age 15–24 in primary abstinence*, 1992–2006 
78 

Figure 7.2b Changes in percentage of men age 15–24 in primary abstinence*, 1995–2006 
79 

Figure 7.3a Changes in percentage of women age 15–24 in secondary abstinence*, 1992–2006 
80 

Figure 7.3b Changes in percentage of men age 15–24 in secondary abstinence*, 1995–2006 
81 

7.3 Condom Use at First Sex 

Table 7.2 presents the percentage of women and men age 15–24 who used a condom at first 

sexual intercourse. The percentage of youth who used condoms the first time they had sex was low in 

general, but varied across countries. Condom use at first sex among young women ranged from 10 

percent in Ethiopia to 48 percent in Uganda, and similarly among young men from 10 percent in Chad 

and Mozambique to 47 percent in Zimbabwe. Data were not available to assess changes over time for 

countries in the study. 

Table 7.2 Percentage of women and men age 15–24 who used a condom at first sex, percentage 

of women age 15–19 who had higher-risk sex with a partner who was 10 or more years older, 

and percentage of women age 15–24 who were forced at first sex, and percentage of women age 

15–24 who were forced at sex in last 12 months, in selected countries in sub-Saharan Africa, 

1992–2006

Country/year

Condom use at first sex1 Women with a 

higher-risk sex 

partner 10 or 

more years 

older2

Women who were

Women Men

forced at first 

sex3

forced at sex 

in last 12 

months4

% Number % Number % Number % Number % Number

West Africa

Cameroon 2004 35.3 972 29.3 934 14.0 720 n/a n/a n/a n/a

Chad 2004 14.6 65 9.9 224 29.1 61 n/a n/a n/a n/a

Cote d'Ivoire 2005 45.0 925 43.2 1,126 9.6 882 6.5 3,206 1.8 2,802

Ghana 2003 33.8 559 40.1 530 5.2 262 n/a n/a n/a n/a

Guinea 2005 19.1 516 10.7 606 25.4 386 9.9 2,065 2.6 1,591

Niger 2005 11.1 26 23.7 205 26.2 7 5.8 2,547 0.5 2,355

Nigeria 2003 17.6 646 20.2 307 11.7 280 n/a n/a n/a n/a

Senegal 2005 19.0 147 17.0 467 18.2 128 18.1 2,987 3.4 2,604

East Africa

Ethiopia 2005 10.0 136 31.9 257 1.3 30 n/a n/a n/a n/a

Kenya 2003 20.3 765 14.8 865 3.6 289 n/a n/a 6.9 1,826

Rwanda 2005 17.4 521 13.3 615 9.1 80 17.4 1,697 3.0 1,287

Tanzania 2004/05 31.8 793 21.3 562 6.9 400 n/a n/a n/a n/a

Uganda 2006 47.7 644 32.1 370 6.6 308 5.7 2,414 0.9 2,131

Southern Africa

Malawi 2004 39.9 600 32.1 561 1.6 302 26.7 3,991 5.2 3,595

Mozambique 2003 22.4 1,079 10.2 609 3.2 772 n/a n/a n/a n/a

Zambia 2001/02 n/a n/a n/a n/a n/a n/a n/a n/a 8.2 2,150

Zimbabwe 2005/06 42.2 414 46.8 1,266 5.4 150 18.2 2,320 1.0 2,039

1 Based on women and men age 15–24 who never married and ever had sex.

2 Based on women age 15–19 who had higher-risk sex (i.e., had sex with a non-marital or non-cohabiting partner) in last 

12 months.

3 Based on women age 15–24 who ever had sex.

Note: some of the percentages are based on small Ns.
82 

7.4 Sex with an Older Partner 

Table 7.2 also shows the percentage of young women (age 15–19) engaging in higher-risk sex in 

last 12 month with a partner who was 10 or more years older. Sex with an older partner ranged from 1 

percent in Ethiopia to 29 percent in Chad. By region, levels were higher in west Africa compared with 

east Africa and southern Africa (Figure 7.4).

Figure 7.4 Percentage of women age 15–19 who had higher-risk sex with a partner 10 or more 

years older in last 12 months, 2003–2006 
83 

7.5 Forced Sex 

Table 7.2 also presents the percentage of women age 15–24 who were forced at first sex, and the 

percentage forced at last sex in last 12 months. The percentage of young women forced at first sex ranged 

from 6 percent in Niger and Uganda to 27 percent in Malawi. Young women forced to have sex in last 12 

months ranged from less than 1 percent in Niger and Uganda to 8 percent in Zambia. 

7.6 Multiple Sexual Partnerships 

Table 7.3 shows the percentage of women and men age 15–24 having three or more lifetime sex 

partners, and the percentage having two or more sex partners in last 12 months. The proportion of young 

women who had three or more lifetime sex partners varied from less than 1 percent in Niger, Senegal, and 

Ethiopia to 28 percent in Cote d‘Ivoire. The proportion was substantially higher among young men, 

ranging from 5 percent in Ethiopia to 48 percent in Cote d‘Ivoire. Overall, young men were many times 

more likely than young women to report three or more lifetime sexual partners. 

Table 7.3 Changes in percentage of women and men age 15–24 having 3+ lifetime sex partners, 

and percentage having 2+ sex partners in last 12 months, in selected countries in sub-Saharan 

Africa, 1992–2006

Country/year

3+ lifetime sex partners12+ sex partners in last 12 months2

Women Men Women Men

% Number % Number % Number % Number

West Africa

Benin 1996 n/a n/a n/a n/a 4.5 1,308 47.3 229 

Benin 2001 n/a n/a n/a n/a 2.5 1,557 34.6 522 

Burkina Faso 1998/99 n/a n/a n/a n/a 3.9 1,527 37.0 383 

Burkina Faso 2003 n/a n/a n/a n/a 2.7 2,869 23.2 558 

Cameroon 1998 n/a n/a n/a n/a 14.4 1,755 56.5 682 

Cameroon 2004 26.2 4,936 40.9 2,177 10.4 3,145 41.4 1,180 

Chad 1996/97 n/a n/a n/a n/a 1.5 2,080 43.3 420 

Chad 2004 1.9 2,433 28.4 673 1.7 1,489 27.6 294 

Cote d'Ivoire 1998/99 n/a n/a n/a n/a 9.6 941 43.8 219 

Cote d'Ivoire 2005 27.5 2,360 48.3 1,836 6.2 1,701 32.6 1,100 

Ghana 1998 n/a n/a n/a n/a n/a n/a 25.4 187 

Ghana 2003 n/a n/a n/a n/a 3.6 1,048 17.8 549 

Guinea 1999 n/a n/a n/a n/a 6.9 1,382 38.6 384 

Guinea 2005 7.1 2,800 38.7 1,146 4.1 1,591 33.4 659 

Mali 1995/96 n/a n/a n/a n/a n/a n/a 29.0 326 

Mali 2001 n/a n/a n/a n/a 2.7 3,537 22.0 472 

Niger 1998 n/a n/a n/a n/a 0.8 2,204 33.1 428 

Niger 2005 0.4 3,369 8.5 1,110 0.6 2,355 10.1 261 

Nigeria 1999 n/a n/a n/a n/a n/a n/a 41.1 297 

Nigeria 2003 n/a n/a n/a n/a 3.6 1,987 24.7 301 

Senegal 2005 0.2 6,400 18.9 1,571 1.9 2,604 21.0 472 

(Cont’d)
84 

Table 7.3 – cont’d

Country/year

3+ lifetime sex partners12+ sex partners in last 12 months2

Women Men Women Men

% Number % Number % Number % Number

East Africa

Eritrea 1995 n/a n/a n/a n/a n/a n/a 25.6 78 

Ethiopia 2000 n/a n/a n/a n/a 2.6 2,894 18.6 235 

Ethiopia 2005 0.8 5,813 4.5 2,399 0.5 1,212 4.8 446 

Kenya 1998 n/a n/a n/a n/a 5.9 1,953 46.2 840 

Kenya 2003 n/a n/a n/a n/a 3.1 1,826 24.2 717 

Rwanda 2000 n/a n/a n/a n/a 1.1 1,301 6.0 228 

Rwanda 2005 1.5 4,938 7.6 2,048 1.0 1,287 4.4 343 

Tanzania 2004/05 n/a n/a 35.0 1,130 5.0 2,624 33.2 585 

Uganda 2000/01 n/a n/a n/a n/a 2.5 2,091 23.9 355 

Uganda 2006 12.9 3,646 27.8 997 3.0 2,131 22.7 408 

Southern Africa

Madagascar 1997 n/a n/a n/a n/a 13.7 1,961 n/a n/a

Madagascar 2003/04 n/a n/a n/a n/a 5.3 1,883 29.6 519 

Malawi 2000 n/a n/a n/a n/a 1.5 3,979 19.7 752 

Malawi 2004 n/a n/a n/a n/a 1.7 3,595 13.2 658 

Mozambique 1997 n/a n/a n/a n/a n/a n/a 59.8 498 

Mozambique 2003 n/a n/a n/a n/a 8.1 3,638 39.1 795 

Namibia 2000 n/a n/a n/a n/a 4.4 1,514 23.9 804 

Zambia 1996 n/a n/a n/a n/a 7.1 2,491 46.4 548 

Zambia 2001/02 n/a n/a n/a n/a 3.9 2,150 30.3 468 

Zimbabwe 1999 n/a n/a n/a n/a 3.6 1,417 26.3 499 

Zimbabwe 2005/06 4.9 4,104 24.1 3,358 1.8 2,039 19.8 1,195 

1 Based on women and men age 15–24 who ever had sex.

2 Based on women and men age 15–24 who had sex in last 12 months.

The proportion of youth who had more than two sex partners in last 12 months also varied 

substantially across countries. Among young women the percentage ranged from 1 percent or less in 

several countries, including Niger, Ethiopia, and Rwanda, to 10 percent in Cameroon. Young men were 

substantially more likely to have had two or more sex partners in last 12 months, ranging from 4–5 

percent in Rwanda and Ethiopia to 41 percent in Cameroon. 

Over time, the percentage of young people reporting multiple sex partners declined in most 

countries, among both young women and young men. The declines were generally more marked for men 

than for women (Figures 7.5a and 7.5b). 
85 

Figure 7.5a Changes in percentage of women age 15–24 who had two or more sexual partners 

 in last 12 months, 1996–2005
86 

Figure 7.5b Changes in percentage of men age 15–24 who had two or more sexual partners 

in last 12 months, 1995–2006 
87 

8 Other Modes of HIV Transmission 

This chapter presents data on the prevalence of male circumcision, use of injections for health 

care needs, and prevalence of STIs. These practices have all been shown to be related to HIV 

transmission risk. 

8.1 Male Circumcision 

Table 8.1 and Figure 8.1 present the percentage of men age 15–49 who reported being 

circumcised. This percentage varied greatly across countries, from 10 percent in Rwanda and Zimbabwe 

to over 95 percent in Cote d‘Ivoire, Ghana, Guinea, Niger, and Senegal. Circumcision was most common 

in west Africa. East Africa showed wide inter-regional variation, from 10 percent in Rwanda to 92 

percent in Ethiopia. Data were not available to assess changes in prevalence of circumcision over time for 

the countries in this study. 

Table 8.1 Percentage of men age 15–49 who are circumcised, in selected countries in subSaharan Africa, 1992–2006

Country/year

Circumcised men

% Number

West Africa

Burkina Faso 2003 90.3 3,209 

Cameroon 2004 93.1 4,815 

Chad 2004 80.4 1,682 

Cote d'Ivoire 2005 96.0 4,503 

Ghana 2003 95.4 4,529 

Guinea 2005 99.1 2,709 

Niger 2005 99.4 3,101 

Senegal 2005 98.2 3,415 

East Africa

Ethiopia 2005 92.2 5,464 

Rwanda 2005 9.7 4,413 

Tanzania 2004/05 67.0 2,635 

Uganda 2006 24.4 2,385 

Southern Africa

Malawi 2004 20.6 3,114 

Mozambique 2003 59.5 2,490 

Zimbabwe 2005/06 10.3 6,863 
88 

Figure 8.1 Percentage of men age 15–49 who are circumcised, 2003–2006 

8.2 Injections by a Health Care Professional 

To measure the potential risk of transmitting HIV through medical injections, respondents in the 

DHS surveys were asked if they had received an injection from a health care professional in the recent 

past, and the number of injections received. (The recent past was defined variously, from 3 to 12 months, 

depending on the country. See footnote in Table 8.2 for details.) 

Table 8.2 presents the percentage of women and men age 15–49 who reported receiving 

injections in the recent past by a health care professional. The percentage of women who reported 

receiving four or more injections ranged from 1 percent in Niger to 19 percent in Uganda, and among 

men the range was from less than 1 percent in Malawi to 14 percent in Uganda. 

In Malawi, the only country with injection data for two time points, results showed an increase in 

women receiving one to three injections (from 16 percent to 25 percent) and receiving four or more 

injections (from less than 1 percent to 5 percent). The percentage did not change for men. 
89 

Table 8.2 Changes in percent distribution of women and men age 15–49 by number of injections 

in recent months1by a health care professional, in selected countries in sub-Saharan Africa, 

1992–2006

Country/year

Number of injections by a health care professional

Women Men

0 1–3 4+ Number 0 1–3 4+ Number

West Africa

Burkina Faso 2003 88.5 9.9 1.6 12,477 n/a n/a n/a n/a

Guinea 2005 80.4 11.2 8.4 7,954 n/a n/a n/a n/a

Niger 2005 88.9 10.0 1.1 9,223 n/a n/a n/a n/a

Senegal 2005 73.0 20.4 6.5 14,602 n/a n/a n/a n/a

East Africa

Ethiopia 2005 74.3 16.3 9.4 14,070 81.1 11.0 7.9 5,464 

Rwanda 2005 88.5 10.0 1.5 11,321 90.5 8.0 1.3 4,413 

Tanzania 2004/05 79.4 15.4 5.1 10,329 85.7 9.3 5.0 2,635 

Uganda 2006 56.0 24.9 19.0 8,531 67.6 18.5 14.0 2,385 

Southern Africa

Malawi 2000 83.2 16.3 0.5 13,220 94.0 5.3 0.7 2,915 

Malawi 2004 70.3 24.7 5.0 11,698 93.7 5.5 0.6 3,114 

Zimbabwe 2005/06 85.9 12.3 1.8 8,907 93.5 4.8 1.6 6,863 

1

The time frame for this question varied across countries. It was last 3 months in Burkina Faso 2003, Niger 2005, and 

Malawi 2000; 6 months in Guinea 2005, Senegal 2005, Rwanda 2005, Tanzania 2004/05, and Zimbabwe 2005/06; and last 

12 months in Ethiopia 2005, Uganda 2006, and Malawi 2004.

8.3 Prevalence of STI or STI Symptoms 

In the DHS surveys, respondents who ever had sex were asked if they had been diagnosed with an 

STI or had symptoms of STIs in the 12 months preceding the survey. Table 8.3 presents the percentage of 

women and men age 15–49 who had STIs or symptoms of STIs (genital sore or ulcer or abnormal genital 

discharge) in last 12 months, among those who ever had sex. The proportion of women who had an STI 

or STI symptoms ranged from 2 percent in Ethiopia to 32 percent in Guinea. Among men the range was 

from 1 percent in Eritrea to 13 percent in Uganda. 
90 

Table 8.3 Among women and men age 15–49 who ever had sex, changes in percentage who had 

sexually transmitted infections (STI) or symptoms of an STI* in last 12 months, in selected 

countries in sub-Saharan Africa, 1992–2006

Country/year

Had STI or STI symptoms in the last 12 months

Women Men

% Number % Number

West Africa

Benin 1996 n/a 4,925 5.2 1,228 

Benin 2001 2.9 5,608 4.4 2,164 

Burkina Faso 1998/99 n/a 5,665 2.9 1,773 

Burkina Faso 2003 4.6 10,911 4.0 2,375 

Cameroon 1998 n/a 5,019 12.2 2,006 

Cameroon 2004 12.1 9,280 9.2 3,959 

Chad 1996/97 n/a 6,596 2.9 1,716 

Chad 2004 5.9 5,284 4.3 1,324 

Cote d'Ivoire 1998/99 n/a 2,743 4.0 691 

Cote d'Ivoire 2005 20.1 4,707 8.2 3,951 

Ghana 2003 8.3 4,807 4.3 3,376 

Guinea 1999 n/a 6,144 9.0 1,501 

Guinea 2005 31.5 7,213 8.1 2,315 

Mali 1995/96 n/a 9,004 4.0 1,800 

Mali 2001 24.6 11,810 7.3 2,447 

Niger 1998 n/a 6,806 2.8 2,383 

Niger 2005 2.9 8,342 3.7 2,283 

Nigeria 1999 n/a 6,872 5.4 1,712 

Nigeria 2003 4.5 6,530 4.5 1,535 

Senegal 2005 11.9 10,716 3.8 2,414 

East Africa

Eritrea 1995 n/a n/a 0.7 640 

Ethiopia 2000 n/a n/a 3.2 1,558 

Ethiopia 2005 2.0 10,748 1.5 3,450 

Kenya 1998 n/a 6,639 6.1 2,788 

Kenya 2003 4.4 6,806 3.1 2,825 

Rwanda 2000 2.8 7,361 2.1 1,748 

Rwanda 2005 5.0 7,816 2.7 3,053 

Tanzania 2004/05 5.1 8,979 5.6 2,222 

Uganda 2000/01 16.6 6,399 5.5 1,560 

Uganda 2006 22.1 7,281 12.8 1,938 

(Cont’d)
91 

Table 8.3 – cont’d

Country/year

Had STI or STI symptoms in the last 12 months

Women Men

% Number % Number

Southern Africa

Madagascar 2003/04 2.9 7,095 4.6 1,915 

Malawi 2000 11.0 11,845 8.7 2,609 

Malawi 2004 8.4 10,397 5.6 2,716 

Mozambique 2003 7.8 11,712 8.2 2,264 

Namibia 2000 n/a n/a 2.0 2,474 

Zambia 1996 n/a 7,077 8.1 1,528 

Zambia 2001/02 5.9 6,751 8.7 1,772 

Zimbabwe 1999 8.7 4,685 6.8 1,866 

Zimbabwe 2005/06 10.6 7,060 7.5 5,070 

* This indicator is coded as yes if the response was yes to any one of the following three questions: (1) had diagnosed 

STI in last 12 months, (2) had a genital sore or ulcer in last 12 months, (3) had bad smelling, abnormal genital discharge 

in last 12 months. 

The prevalence of STIs or STI symptoms increased among women in all countries with data 

available for two surveys, except Malawi (Figure 8.2a). Among men, there was no clear overall pattern of 

change. In many countries prevalence remained steady, while in Cameroon, Kenya, and Malawi it 

declined somewhat, and in Cote d‘Ivoire, Mali, and Uganda prevalence of STIs or STI symptoms 

increased (Figure 8.2b). 

Figure 8.2a Changes in percentage of women age 15–49 reporting STI or STI symptoms 

in last 12 months, 1995–2006 
92 

Figure 8.2b Changes in percentage of men age 15–49 reporting STI or STI symptoms 

in last 12 months, 1995–2006 
93 

9 Voluntary Counseling and Testing 

To assess the awareness and coverage of HIV testing services, DHS respondents were asked 

whether they were ever tested for HIV. If they were tested, they were asked whether they received the 

results of their last test and where they were tested. If they were never tested, they were asked if they 

knew a place where they could go for testing. 

Table 9.1 presents the percentage of women and men age 15–49 who knew where to get tested for 

HIV, the percentage who ever got tested for HIV and received their test results, and the percentage who 

got tested for HIV and received the test results in last 12 months. 

9.1 Knowledge of HIV Testing Services 

The percentage of women who knew where to get tested for HIV ranged from 12–13 percent in 

Mali, Chad, and Madagascar to 81–82 percent in Malawi and Uganda, and among men from 14 percent in 

Madagascar to 86–87 percent in Rwanda, Malawi, and Uganda (Table 9.1). Levels of knowledge about 

where to get tested were lower in west Africa than in east Africa or southern Africa. Also in west Africa, 

the differences between women and men in this knowledge were more pronounced. 

For countries with information for two time points, there were sizeable increases in knowledge of 

where to get tested for HIV, among both women and men (Figures 9.1a and 9.1b). For example, in 

Uganda levels of such knowledge increased among women from 35 percent to 82 percent, and among 

men from 54 percent to 87 percent, comparing the 2000/01 and 2006 surveys. 
94 

Table 9.1 Changes in percentage of women and men age 15–49 who know where to get tested 

for HIV, percentage ever tested for HIV and received test results, and percentage tested for HIV 

in last 12 months and received test results, in selected countries in sub-Saharan Africa, 1992–

2006

Country/year

Know where to 

get tested for HIV

Ever tested for 

HIV and received 

test results

Tested for HIV in last 

12 months and 

received test results Number

Women Men Women Men Women Men Women Men

West Africa

Benin 2001 18.9 36.8 n/a n/a n/a n/a 6,219 2,465 

Burkina Faso 2003 n/a 35.6 n/a 6.3 n/a 2.3 n/a 3,209 

Cameroon 2004 n/a n/a 19.2 13.9 4.8 6.7 10,656 4,815 

Chad 2004 13.0 32.9 1.1 3.7 0.5 1.7 6,085 1,682 

Cote d'Ivoire 2005 19.8 37.8 10.9 7.9 3.7 3.2 5,183 4,503 

Ghana 2003 54.1 61.0 7.4 7.5 2.3 3.2 5,691 4,529 

Guinea 2005 18.1 44.3 2.1 6.0 1.1 2.9 7,954 2,709 

Mali 2001 11.8 30.4 n/a n/a n/a n/a 12,849 3,000 

Niger 2005 14.6 40.8 1.9 3.9 0.9 1.6 9,223 3,101 

Nigeria 2003 33.3 58.8 6.4 6.0 3.0 2.7 7,620 2,093 

Senegal 2005 37.7 45.9 2.8 4.2 1.0 1.5 14,602 3,415 

East Africa

Ethiopia 2005 31.3 47.4 3.3 4.9 1.6 2.3 6,751 5,464 

Kenya 1998 47.6 50.3 n/a n/a n/a n/a 7,881 3,224 

Kenya 2003 63.3 70.8 13.1 14.3 6.7 7.6 8,195 3,363 

Rwanda 2000 68.5 54.9 n/a n/a n/a n/a 10,421 2,532 

Rwanda 2005 72.7 86.3 21.4 20.1 11.6 11.0 11,321 4,413 

Tanzania 2004/05 56.5 74.9 12.1 12.3 6.2 6.5 10,329 2,635 

Uganda 2000/01 34.5 53.6 7.6 11.3 n/a n/a 7,246 1,879 

Uganda 2006 82.0 87.1 24.8 20.7 12.0 10.4 8,531 2,385 

Southern Africa

Madagascar 2003/04 13.3 14.4 0.9 0.9 0.4 0.5 7,949 2,216 

Malawi 2000 70.0 80.0 n/a n/a n/a n/a 13,220 2,915 

Malawi 2004 81.0 87.1 12.9 15.1 6.5 7.7 11,698 3,114 

Mozambique 2003 30.5 38.1 3.7 3.6 2.4 2.7 12,418 2,490 

Namibia 2000 79.2 75.5 21.9 22.5 n/a n/a 6,755 2,766 

Zambia 2001/02 64.4 72.2 n/a n/a n/a n/a 7,658 1,974 

Zimbabwe 1999 42.9 30.4 n/a n/a n/a n/a 5,907 2,505 

Zimbabwe 2005/06 74.7 74.3 21.7 16.4 6.6 6.7 8,907 6,863 
95 

Figure 9.1a Changes in percentage of women age 15–49 with knowledge of where to 

get tested for HIV, 1998–2006 

Figure 9.1b Changes in percentage of men age 15–49 with knowledge of where to 

get tested for HIV, 1998–2006 
96 

9.2 Knowledge of HIV Status 

The percentage of respondents who were ever tested for HIV and received test results generally 

was low, with substantial variation across countries (Table 9.1). Among women the range was from 1 

percent or less in Chad and Madagascar to 25 percent in Uganda, and among men from less than 1 percent 

in Madagascar to 23 percent in Namibia (Figures 9.2a and 9.2b). 

In Uganda, the only country with available data from two surveys, the percentage of respondents 

who were ever tested for HIV and received results increased substantially among both women and men. 

Still, in 2006 only about one man in every five and one woman in every four had ever been tested and 

received results (Figure 9.3). 

Table 9.1 also shows that less than 10 percent of women and men in all countries except Rwanda 

and Uganda were tested for HIV and received results in last 12 months. The percentage tested in last 12 

months ranged among women from less than 1 percent in Chad, Niger, and Madagascar to 12 percent in 

Uganda and Rwanda, and similarly among men, ranged from less than 1 percent in Madagascar to 11 

percent in Rwanda. 
97 

Figure 9.2a Percentage of women age 15–49 ever tested for HIV and received 

test results, 2000–2006 

Figure 9.2b Percentage of men age 15–49 ever tested for HIV and received 

test results, 2000–2006 
98 

Figure 9.3 Changes in percentage of women and men age 15–49 ever tested for HIV and 

received test results, Uganda 2000–2006 
99 

10 Gender Relations 

This chapter presents indicators of men‘s and women‘s attitudes toward negotiating safer sex 

with husbands, spousal communication about HIV/AIDS, and women‘s participation in major household 

decisions. Women‘s status relative to men, ability to negotiate safer sex, and participation in household 

decision-making can affect their vulnerability to HIV infection and their ability to take preventive action. 

10.1 Attitudes toward Negotiating Safer Sex with Husbands 

Table 10.1 presents the percentage of women and men age 15–49 who believe that a wife is 

justified in refusing to have sex with her husband if she knows that her husband has an STI, and the 

percentage who believe that a wife is justified in refusing sex if she knows that her husband had sex with 

other women. The table also shows the percentage who believe that a wife is justified in asking her 

husband to use a condom if he has an STI, and the percentage who believe that a woman can negotiate 

safer sex. 

Attitudes toward negotiating safer sex with husbands varied greatly across countries. Among 

women, the belief that a wife was justified in refusing to have sex with her husband if she knew that the 

husband had an STI ranged from 45 percent in Mali to 91 percent in Rwanda, and among men from 71 

percent in Zambia to 96 percent in Rwanda. In general, a higher proportion of men than women believed 

that a wife was justified in refusing sex with her husband if she knew that the husband had an STI. In the 

four countries where data from two consecutive surveys were available, there was a substantial increase in 

Malawi and Zimbabwe among both women and men having this belief. Among women, the percentage 

increased in Rwanda but declined in Uganda, while among men it remained stable in both countries 

(Figures 10.1a and 10.1b). 

The percentage of women and men who believed that a wife was justified in refusing to have sex 

with her husband if she knew that he had sex with other women also varied widely across countries. 

Among women, the percentage ranged from 32 percent in Mali to 87 percent in Madagascar, and among 

men from 44 percent in Mali to 90 percent in Zambia. 

Among the four countries with two data points, the proportions of women and men reporting that 

a wife was justified in refusing sex with her husband if she knew that he had sex with other women 

increased substantially in three countries (Rwanda, Malawi, and Zimbabwe), but declined slightly in 

Uganda (Figures 10.1a and 10.1b). 
100 

Table 10.1 Changes in percentage of women and men age 15–49 who believe that a wife is 

justified in refusing to have sex with her husband if she knows that the husband has an STI, 

percentage who believe that a wife is justified in refusing to have sex with her husband if she 

knows that her husband has sex with other women, percentage who believe that a wife is 

justified to ask her husband to use a condom if he has an STI, and percentage who believe that 

a woman can negotiate safer sex, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

A wife is justified 

in refusing to have 

sex with her 

husband if she 

knows that he has 

an STI

A wife is justified 

in refusing to 

have sex with her 

husband if she 

knows that he

has sex with 

other women

A wife is justified 

to ask her 

husband to use a 

condom if he has 

an STI

Woman’s ability 

to negotiate 

safer sex1 Number

Women Men Women Men Women Men Women Men Women Men

West Africa

Benin 2001 87.7 89.2 57.6 54.6 n/a n/a n/a n/a 6,219 2,465 

Burkina Faso 2003 78.4 85.8 63.8 66.7 n/a n/a n/a n/a 12,477 3,209 

Cameroon 2004 77.2 78.3 62.6 63.2 66.8 74.1 81.4 81.3 10,656 4,815 

Chad 2004 72.2 72.3 63.1 59.0 35.7 54.3 76.1 74.7 6,085 1,682 

Cote d'Ivoire 2005 69.9 87.5 n/a n/a 69.8 89.4 80.3 92.7 5,183 4,503 

Ghana 2003 86.2 90.6 79.0 82.7 n/a 91.5 n/a 96.8 5,691 4,529 

Guinea 2005 73.2 n/a 42.7 n/a 57.9 n/a 80.1 n/a 7,954 n/a

Mali 2001 45.2 73.8 31.7 43.9 n/a n/a n/a n/a 12,849 3,000 

Niger 2005 74.7 n/a 52.9 n/a 61.8 n/a 82.4 n/a 9,223 n/a

Nigeria 2003 83.5 91.2 68.2 73.0 72.8 80.6 89.1 94.8 7,620 2,093 

Senegal 2005 81.7 n/a 62.9 n/a 77.3 n/a 89.8 n/a 14,602 n/a

East Africa

Ethiopia 2005 81.3 85.2 82.1 82.8 41.6 64.6 84.5 89.1 14,070 5,464 

Kenya 2003 87.1 92.5 78.8 77.4 78.3 80.7 93.8 95.7 8,195 3,363 

Rwanda 2000 87.0 93.4 68.6 73.5 n/a n/a n/a n/a 10,421 2,532 

Rwanda 2005 91.3 95.8 83.7 87.2 86.0 95.3 95.5 99.0 11,321 4,413 

Tanzania 2004/05 87.8 89.7 73.0 77.2 74.8 82.6 93.9 96.1 10,329 2,635 

Uganda 2000/01 91.2 89.7 76.4 77.8 n/a n/a n/a n/a 7,246 1,879 

Uganda 2006 80.4 87.0 73.9 75.0 n/a n/a n/a n/a 8,531 2,385 

Southern Africa

Madagascar 2003/04 86.7 90.2 86.8 86.6 n/a n/a n/a n/a 7,949 2,216 

Malawi 2000 60.9 55.7 56.7 50.1 n/a n/a n/a n/a 13,220 2,915 

Malawi 2004 73.9 81.4 71.1 73.5 81.4 79.8 91.3 93.2 11,698 3,114 

Mozambique 2003 79.7 81.9 53.3 52.1 70.9 80.1 89.1 94.2 12,418 2,490 

Namibia 2000 81.5 77.0 76.8 71.2 n/a n/a n/a n/a 6,755 2,766 

Zambia 2001/02 85.6 70.7 72.9 90.4 n/a n/a n/a n/a 7,658 1,974 

Zimbabwe 1999 71.2 35.8 63.5 33.1 n/a n/a n/a n/a 5,907 2,505 

Zimbabwe 2005/06 79.4 77.4 71.2 72.2 82.8 85.5 91.9 93.1 8,907 6,863 

1 A women can negotiate safer sex if she can refuse sex or request condom use if she knows that her husband has an 

STI. 

 
101 

Figure 10.1a Changes in percentages of women age 15–49 who believe that a wife can refuse sex 

if she knows that her husband has an STI or if he has sex with other women, 1999–2006 

Figure 10.1b Changes in percentages of men age 15–49 who believe that a wife can refuse sex 

if she knows that her husband has an STI or if he has sex with other women, 1999–2006 
102 

The percentage of women who believed that a wife was justified in asking her husband to use a 

condom if he had an STI ranged from 36 percent in Chad to 86 percent in Rwanda. Among men the range 

was from 54 percent in Chad to 95 percent in Rwanda. For the most part, men were more likely than 

women to have this belief. 

Table 10.1 also shows the percentages of women and men who believed that a woman could 

negotiate safer sex, i.e., she could refuse sex or request condom use if she knew that her husband had an 

STI. The percentage of women with this belief ranged from 76 percent in Chad to 96 percent in Rwanda, 

while the range among men was from 75 percent in Chad to 99 percent in Rwanda. In general, men were 

more likely than women to respond that a woman can negotiate safer sex if she knows that her husband 

has an STI. 

10.2 Discussing HIV/AIDS with Sexual Partners 

Table 10.2 presents the percentage of respondents who said that they never discussed HIV/AIDS 

with any of their sexual partners, among women and men age 15–49 currently in union. The results varied 

widely across countries. Among women the range was from 22 percent in Rwanda to 69 percent in Mali, 

and among men from 12 percent in Malawi to 57 percent in Mali. In the great majority of countries, a 

higher proportion of women than men responded that they never discussed HIV/AIDS with any of their 

sexual partners. In several countries women were more than twice as likely as men to never have 

discussed HIV/AIDS with any of their sexual partners. 

Only two countries, Rwanda and Malawi, had data on discussion about HIV/AIDS for two time 

points. In Rwanda there was a substantial decline in the percentage who never discussed HIV/AIDS with 

any of their sexual partners—among women from 33 percent to 22 percent, and among men from 21 

percent to 16 percent. Malawi also showed a slight decline among men (from 14 percent to 12 percent), 

while the percentage remained fairly stable among women. 

 
103 

Table 10.2 Among women and men age 15–49 who are currently in union, changes in 

percentage who never discussed HIV/AIDS with any of their sexual partners, in selected 

countries in sub-Saharan Africa, 1992–2006

Country/year

Never discussed HIV/AIDS with any partner

Women Men

% Number % Number

West Africa

Benin 2001 65.7 4,563 43.2 1,378 

Burkina Faso 2003 60.4 9,655 34.3 1,636 

Cameroon 2004 38.2 7,166 15.3 2,271 

Chad 2004 51.0 4,663 40.0 977 

Ghana 2003 37.8 3,549 23.5 2,228 

Mali 2001 69.2 10,723 57.0 1,723 

Nigeria 2003 48.8 5,336 40.7 1,006 

East Africa

Eritrea 2002 58.8 5,733 n/a n/a

Ethiopia 2000 60.4 9,789 47.9 1,179 

Kenya 2003 33.4 4,919 13.8 1,615 

Rwanda 2000 33.3 5,053 21.0 1,249 

Rwanda 2005 21.9 5,510 15.9 2,126 

Uganda 2000/01 37.0 4,881 15.4 1,108

Southern Africa

Madagascar 2003/04 34.5 5,140 40.3 1,331 

Malawi 2000 26.8 9,452 13.6 1,745 

Malawi 2004 29.4 8,312 12.2 1,936 

Mozambique 2003 45.6 8,736 38.9 1,466 

Namibia 2000 27.0 2,610 22.7 887 

Zambia 2001/02 31.8 4,694 12.5 1,087 

Zimbabwe 1999 36.5 3,609 16.2 1,152 

10.3 Participation in Household Decision-Making 

Table 10.3 presents the percentage of women age 15–49 who participated in making various 

household decisions. Participation in decision-making on health care and large household purchases 

varied widely across countries. On health care, the range was from 16–20 percent in Mali, Burkino Faso, 

and Senegal to more than 80 percent in Zimbabwe, Madagascar, and Eritrea. For both health care 

decision-making and decision-making about large household purchases, the percentages were somewhat 

higher in east Africa and southern Africa than in west Africa. 
104 

Levels of decision-making on household purchases for daily needs were somewhat higher than 

the levels of the other indicators of women‘s participation. In west Africa, for example, the percentage 

ranged from 19 percent in Niger to 61 percent in Ghana; in east Africa, it ranged from 49 percent in 

Tanzania to 83 percent in Ethiopia; and in southern Africa the range was from 33 percent in Malawi to 92 

percent in Madagascar. Regarding the percentage of women who participated in decisions to visit family, 

the percentage who participated in two or more decisions, and those who participated in all four decisions, 

levels were generally higher in east Africa and southern Africa than in west Africa. 

Table 10.3 Changes in percentage of women age 15–49 who participate in making various 

household decisions, in selected countries in sub-Saharan Africa, 1992–2006

Country/year

Decision 

on own 

health 

care

Decision on 

making large 

household 

purchases

Decision on 

making 

household 

purchases for 

daily needs

Decision 

to visit 

family or 

relatives

2 or more 

of the 4 

household 

decisions

All 4 

household 

decisions Number

West Africa

Benin 2001 33.2 30.8 59.0 47.6 51.5 16.7 4,563

Burkina Faso 2003 19.3 23.5 38.5 32.0 30.3 9.8 9,655

Cameroon 2004 34.9 35.8 51.1 48.6 48.0 22.7 7,166

Ghana 2003 57.6 51.0 61.1 58.8 62.4 39.1 3,549

Guinea 2005 44.5 45.2 53.2 53.4 53.7 34.2 6,292

Mali 2001 16.4 16.3 26.6 28.7 23.5 7.9 10,723

Niger 2005 24.1 13.4 18.7 22.9 19.8 8.1 7,941

Nigeria 2003 23.1 19.5 32.8 38.1 29.5 13.4 5,336

Senegal 2005 19.7 15.8 24.9 29.2 23.0 9.2 9,866

East Africa

Eritrea 2002 87.5 54.3 64.9 71.7 75.3 48.5 5,733

Ethiopia 2005 65.8 57.1 82.9 78.4 83.5 43.5 9,066

Kenya 2003 54.1 36.0 59.7 58.0 61.8 24.4 4,919

Rwanda 2000 50.2 49.0 55.4 69.3 59.5 38.8 5,053

Rwanda 2005 59.5 57.6 66.9 74.2 70.6 46.4 5,510

Tanzania 2004/05 59.1 34.0 49.4 49.2 53.4 24.7 6,950

Uganda 2000/01 61.3 37.8 45.6 56.0 57.2 26.6 4,881

Uganda 2006 60.6 50.8 65.2 63.7 68.5 36.6 5,337

Southern Africa

Madagascar 2003/04 84.8 82.0 91.7 85.8 91.8 71.3 5,140

Malawi 2000 27.6 17.0 32.4 62.1 38.1 10.2 9,452

Malawi 2004 27.7 17.9 32.6 60.1 36.0 12.4 8,312

Mozambique 2003 61.6 36.9 57.4 63.4 63.7 27.2 8,736

Zambia 2001/02 41.0 36.4 n/a 42.5 37.9 n/a 4,694

Zimbabwe 1999 61.8 58.2 78.0 74.1 79.2 39.3 3,609

Zimbabwe 2005/06 81.7 90.3 88.0 89.2 93.5 71.6 5,143
105 

In three countries with data available for two time points (Rwanda, Uganda, and Zimbabwe), both 

the percentage of women who participated in at least two of the four decisions and the percentage who 

participated in all four decisions increased considerably. In the fourth country with data (Malawi) it 

changed little (Figure 10.2). 

Figure 10.2 Changes in women’s participation in major household decisions*, 1999–2006 
106 
107 

11 Summary and Conclusions 

This report summarizes levels and recent changes in key indicators of HIV-related knowledge, 

attitudes, and behaviors of adult women and men age 15–49 in 23 countries in sub-Saharan Africa. Data 

come from the two most recent rounds of population-based, nationally representative DHS surveys 

conducted between 1992 and 2006. 

11.1 Key Findings 

The results show that in most countries in sub-Saharan Africa education levels and exposure to 

the mass media have improved in recent years, yet men remain more educated than women and better 

exposed to the media. People are increasingly mobile and more likely to live in urban areas. There have 

been improvements in women‘s participation in household decision-making and in their ability to 

negotiate safer sex. 

Knowledge about HIV prevention methods has increased in recent years in most countries 

studied. However, many men and women still lack knowledge of specific prevention methods: abstinence, 

partner faithfulness, and condom use. The level of comprehensive knowledge about HIV/AIDS has 

increased, but in most countries, especially in west Africa, levels remain very low. 

Although men generally are more knowledgeable than women about HIV prevention methods, 

higher percentages of women than men know that HIV can spread from mother to child through breast 

milk. Few adults know about drugs that can prevent mother-to-child HIV transmission. 

The study results suggest that many people continue to have discriminatory attitudes toward 

people living with HIV. While the majority of adults report that they would care for an infected family 

member, only a minority would want others to know if someone in their own family were infected. Levels 

of acceptance of HIV-infected female teachers or vegetable vendors are also low, though improving. 

An overwhelming majority of adults agree that children age 12–14 should be taught to abstain 

from sex until they get married. In most countries, however, only about half of women and a slightly 

higher percentage of men say they would want children age 12–14 to be taught about condom use. 

In all countries a large majority of people perceive themselves to be at no risk or low risk of 

becoming infected with HIV. Nonetheless, many adults, particularly men, report being at no risk or low 

risk of HIV infection, even though they have had multiple lifetime sexual partners. The proportion of 

people who consider themselves to be at high risk or who already have HIV shows no correlation to HIV 

prevalence in the country. 

Age at sexual debut remains low, with considerable proportions of men and women having first 

sex before age 15. In recent years, the median age at first sex has remained generally unchanged in most 

countries. Men are much more likely than women to report multiple sexual partners in their lifetime, as 

well as in the year before the survey. Men are also much more likely than women to report non-spousal 

sex. In most countries women have become less likely to report multiple partners, but among men there is 

no clear pattern of change. The highest levels of paid sex among men were in southern Africa, where the 

prevalence of HIV is higher than in the other two regions. 

Among never-married youth age 15–24, no clear pattern of change appears in the practice of 

primary abstinence across countries, but secondary abstinence has increased in most countries. Results 
108 

also show that over time fewer youth report having multiple sex partners. Many young women report 

being forced at first sex and having sex with non-spousal partners 10 years or older than themselves. 

Overall, condom use has increased somewhat but remains very low in most sub-Saharan 

countries. Less than one woman in every six and one man in every three report using a condom at last sex 

in the year before the survey. Levels of consistent condom use are even lower. 

Although the percentage of respondents who know where to get tested for HIV is substantial in 

many countries in east Africa and southern Africa, the percentage who have ever been tested for HIV and 

received test results is quite low in most countries studied, at below 25 percent. For countries with data 

from both the earlier and more recent surveys, sizeable increases in the knowledge of where to get tested 

for HIV have occurred among both women and men. 

11.2 Limitations 

It is important to keep the following limitations of this study in mind when interpreting the 

findings. First, the DHS surveys exclude non-household population groups, such as those living on the 

street or in institutions (e.g., prisons, boarding schools, military barracks, refugee camps, and brothels). 

To the extent that these non-household populations have riskier behaviors than the household population, 

the prevalence of those behaviors is likely to be underestimated in this report. However, given that the 

proportion of such non-household populations in the total population tends to be small, the effect of 

excluding institutional and homeless populations on the national estimates obtained from a householdbased sample is likely to be small (Mishra et al. 2008). 

Second, the analysis is based on reported information on sexual behavior, and findings may be 

biased. In a given social context, men and women may misreport such behaviors, and the extent of 

misreporting may vary by sex, educational level, economic status, and area of residence (Hewett et al. 

2004; Mensch et al. 2003). For example, young men tend to overreport some sexual behaviors and 

underreport others (Smith 1992, Mensch et al. 2003), while young women tend to underreport sexual 

experiences (Buvé et al. 2001). The extent of misreporting may also vary across countries and over time 

within a country. The study results may be biased to the extent that such misreporting occurs in the 

surveys. 

Another limitation is that the study lacks longitudinal data to allow a more in-depth analysis of 

trends in HIV/AIDS-related indicators. Instead, analysis is based on two cross-sectional surveys in each 

country with independently drawn samples, which only allows assessing changes between the two 

surveys. Moreover, in several countries, data on some indicators are not available for both time points. 

The analysis is unable to link any changes observed in specific knowledge and behavior indicators to 

specific program efforts or policy interventions in the countries. 

It is also noteworthy that some of the observed variations in the levels and changes in HIV/AIDSrelated knowledge and behaviors may be because the surveys included in this analysis were conducted in 

different years and because the inter-survey periods varied across countries. 

11.3 Implications 

Despite these limitations, the study provides a comprehensive comparative look at the levels and 

direction of many important HIV/AIDS-related indicators in a large number of sub-Saharan countries. 

The study shows improvements in some HIV/AIDS-related knowledge and attitudes but also highlights 

persistent high levels of sexual risk-taking and very low levels of condom use for HIV prevention, as well 

as little voluntary counseling and testing coverage. These findings make a case for strengthening 
109 

prevention programs in sub-Saharan Africa to continue a range of efforts to promote safer sexual 

behavior. 

The study also highlights large differentials between women and men in a number of HIV-related 

indicators, and wide variations among countries in the levels of and recent changes in HIV-related 

knowledge, attitudes, and behaviors. Such differences suggest the need for policies and programs to be 

gender and context specific in their approach to HIV prevention, treatment, and care. The data provided in

this report are intended as a source of strategic information on key HIV-related indicators that can assist 

program managers and policymakers in devising tailored and effective responses to the HIV/AIDS 

epidemic in sub-Saharan Africa. 
110 
111 

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DHS Comparative Reports Series 

1. Westoff, Charles F. 2001. Unmet Need at the End of the Century.

2. Westoff, Charles F., and Akinrinola Bankole. 2002. Reproductive Preferences in Developing 

Countries at the Turn of the Century. 

3. Rutstein, Shea O. 2002. Fertility Levels, Trends, and Differentials 1995-1999.

4. Mahy, Mary. 2003. Childhood Mortality in the Developing World: A Review of Evidence from the 

Demographic and Health Surveys.

5. Westoff, Charles F. 2003. Trends in Marriage and Early Childbearing in Developing Countries.

6. Rutstein, Shea O., and Kiersten Johnson. 2004. The DHS Wealth Index.

7. Yoder, P. Stanley, Noureddine Abderrahim, and Arlinda Zhuzhuni. 2004. Female Genital Cutting 

in the Demographic and Health Surveys: A Critical and Comparative Analysis.

8. Stallings, Rebecca. 2004. Child Morbidity and Treatment Patterns.

9. Rutstein, Shea O., and Iqbal H. Shah. 2004. Infecundity, Infertility, and Childlessness in 

Developing Countries.

10. Mukuria, Altrena, Jeanne Cushing, and Jasbir Sangha. 2005. Nutritional Status of Children: 

Results from the Demographic and Health Surveys, 1994–2001.

11. Mukuria, Altrena, Casey Aboulafia, and Albert Themme. 2005. The Context of Women’s Health: 

Results from the Demographic and Health Surveys, 1994-2001.

12. Yoder, P. Stanley, Noureddine Abderrahim, and Arlinda Zhuzhini. 2005. L’excision dans les 

Enquêtes Démographiques et de Santé: Une Analyse Comparative.

13. Garenne, Michel, and Julien Zwang. 2006. Premarital Fertility and Ethnicity in Africa.

14. Westoff, Charles F. 2006. New Estimates of Unmet Need and the Demand for Family Planning.

15. Fort, Alfredo L., Monica T. Kothari, and Noureddine Abderrahim. 2006. Postpartum Care: Levels 

and Determinants in Developing Countries.

16. Khan, Shane, Vinod Mishra, Fred Arnold, and Noureddine Abderrahim. 2007. Contraceptive 

Trends in Developing Countries. 

17. Johnson, Kiersten, and Yuan Gu. 2009. Men’s Reproductive Health: Findings from the 

Demographic and Health Surveys, 1995-2005. 

18. Garenne, M. Michel. 2008. Fertility Changes in Sub-Saharan Africa.

19. Khan, Shane, and Vinod Mishra. 2008. Youth Reproductive and Sexual Health.

20. Kishor, Sunita, and Lekha Subaiya. 2008. Understanding Women’s Empowerment: A 

Comparative Analysis of Demographic and Health Surveys (DHS) Data.

21. Mishra, Vinod, Shane Khan, Li Liu, and Benny Kottiri. 2008. Medical Injection Use and HIV in 

Sub-Saharan Africa.

22. Mishra, Vinod, Amy Medley, Rathavuth Hong, Yuan Gu, and Bryant Robey. 2009. Levels and 

Spread of HIV Seroprevalence and Associated Factors: Evidence from National Household 

Surveys. 

23. Sneeringer, Stacy E. 2009. Fertility Transition in Sub-Saharan Africa: A Comparative Analysis of 

Cohort Trends in 30 Countries. 

24. Mishra, Vinod, Praween Agrawal, Soumya Alva, Yuan Gu, and Shanxiao Wang. 2009. Changes 

in HIV-Related Knowledge and Behaviors in Sub-Saharan Africa.