Breaking barriers: predictors of condom use negotiation among adolescent girls and young women in Mozambique.

Background: Effective condom use negotiation is crucial for reducing HIV risk and unintended pregnancies. While studies have emphasized condom use, they often overlook the negotiation process, a critical factor in mitigating sexual health risks. This study examines factors influencing condom use negotiation among adolescent girls and young women (AGYW) in Mozambique.

Methods: Data from the 2022-23 Mozambique Demographic and Health Survey (MZDHS) were analyzed, focusing on 2,624 AGYW aged 15-24. Condom use negotiation, defined as the ability to ask a partner to use a condom, was treated as a binary variable. Ten independent variables measured as binary, nominal, or ordinal were included: age, education, residence, wealth status, religion, early sexual debut, adolescent motherhood, multiple sexual partners, HIV testing, and inequitable gender attitudes. Multivariable logistic regression identified the predictors of condom use negotiation, with interaction terms assessing whether gender attitudes and condom negotiation varied by age. Average marginal effects were calculated to evaluate the impact of these factors.

Results: Only 35.11% of AGYW reported the ability to negotiate condom use. Multivariate analysis showed that AGYW with secondary or higher education (adjusted Odds ratio [aOR] = 2.17, 95% Confidence Intervals [CI] = 1.48-3.17; p < 0.001) and those from rich households wealth index (aOR = 2.51, 95% CI = 1.81-3.48; p < 0.001) were more likely to negotiate. HIV testing was also associated with higher odds of condom use negotiation (aOR = 1.39, 95% CI = 1.01-1.91; p = 0.043). Conversely, inequitable gender attitudes reduced the likelihood of condom use negotiation (aOR = 0.62, 95% CI = 0.46-0.83; p = 0.001). AGYW aged 15-19 with inequitable attitudes had the lowest predicted probability of condom use negotiation (31%).

Conclusions: Findings emphasize the role of education, wealth, gender attitudes, and HIV testing in enhancing condom use negotiation among AGYW in Mozambique. Public health initiatives should address these factors to strengthen negotiation skills and support HIV prevention efforts.