BMC Womens Health. 2026 Jul 4. doi: 10.1186/s12905-026-04657-y. Online ahead of print.
ABSTRACT
INTRODUCTION: Across sub-Saharan Africa, and Nigeria in particular, young women and adolescent girls aged 15 to 24 continue to face a disproportionate risk of HIV – and a large part of that risk comes down to unprotected sex. Knowing about HIV is widely assumed to lead to safer behaviour, yet the evidence that knowledge actually translates into condom use is far from straightforward. This study takes a closer look at that relationship, comparing comprehensive HIV knowledge and condom non-use among unmarried adolescent girls and young women (AGYW) in Nigeria across three points in time.
METHODS: We drew on data from the Nigeria Demographic and Health Surveys conducted in 2008, 2013, and 2018. Condom non-use at last sexual intercourse – a standard DHS indicator – served as our measure of risky sexual behaviour. The analysis focused on sexually active unmarried women in two age groups: adolescent girls aged 15 to 19, and young women aged 20 to 24. We excluded participants with missing or unclear responses for the outcome variable or key covariates. Weighted descriptive statistics and survey-weighted binary logistic regression models were run separately for each age group and survey year, with all analyses accounting for the clustered, stratified sampling design of the NDHS. Stata 16.1 was used throughout.
RESULTS: HIV knowledge improved over the study period, particularly among young women in the older age group, while trends in condom use followed a less predictable pattern. Among adolescent girls, comprehensive HIV knowledge was not meaningfully linked to condom use in 2008, but that association became statistically significant by 2013 and held through 2018. Importantly, though, condom non-use actually rose in 2018 even as knowledge levels reached their highest point – a clear sign that knowing is not the same as doing. Socioeconomic status and region of residence were both significantly associated with condom use.
CONCLUSION: Comprehensive HIV knowledge among unmarried AGYW in Nigeria has grown, but it has not reliably translated into condom use. This gap between what young women know and what they are able to do points to barriers that go well beyond information – structural, social, and economic forces that shape the choices available to them. Closing that gap will require interventions that take those realities seriously.
PMID:42401873 | DOI:10.1186/s12905-026-04657-y
