Abstract
BACKGROUND: Adolescents are a key target for sexual health interventions because risky sexual behaviour (RSB) raises public health concerns, including sexually transmitted infections and unintended pregnancies. In Bulawayo, Zimbabwe, rising HIV rates among adolescents highlight the need for targeted research. This study aims to assess the prevalence of RSB among in-school adolescents and identify associated sociodemographic and sexual health educational factors. METHODS: An analytical cross-sectional survey was conducted among 314 adolescents aged 13-19 from four randomly selected high schools in Bulawayo Central. A self-administered, structured questionnaire was used to collect data on sexual behaviours, knowledge and risk factors. Data were analysed using descriptive statistics, χ² tests and multivariable logistic regression to identify significant predictors of sexual activity. Prevalence estimates are reported with 95% CIs. RESULTS: The analysis revealed that 52 of 314 respondents (16.6%, 95% CI 12.5% to 21.4%) reported ever having engaged in sexual intercourse. A higher prevalence was observed among males (28/122, 23.0%) over females (24/192, 12.5%). Adolescents in Forms 5-6 were more likely to engage in sexual activity (adjusted OR (AOR) 3.46, 95% CI 1.24 to 9.63, p=0.018), and those living with a single parent were also at increased risk (AOR 2.56, 95% CI 1.13 to 5.81, p=0.024). Among the 52 sexually active respondents, 38 (73.1%) reported unprotected sex at last intercourse, with higher rates among females (22/26, 84.6%) compared with males (16/26, 61.5%) (p=0.049). Although 268 participants (85.4%) reported receiving sexual health education, only 149 (47.5%) found it sufficient and 296 (94.3%) desired safe spaces for discussion. CONCLUSION: There is a significant gap between sexual health knowledge and safe practices, necessitating interventions that build skills, address communication gaps and foster supportive school environments to reduce RSB.