Gender disparities are pronounced in Zomba district, Malawi. Among women aged 15–49 years, HIV prevalence is 16.8%, compared with 9.3% among men of the same age. Complex structural factors are associated with risky sexual behaviour leading to HIV infection. This study’s objective was to explore associations between multilevel measures of economic resources and women’s empowerment with risky sexual behaviour among young women in Zomba. Four measures of risky sexual behaviour were examined: ever had sex, condom use and two indices measuring age during sexual activity and partner history. Multilevel regression models and regression models with cluster-robust standard errors were used to estimate associations, stratified by school enrolment status. Among the schoolgirl stratum, the percentage of girls enrolled in school at the community level had protective associations with ever having sex (OR = 0.76; 95% CI: 0.60, 0.96) and condom use (OR = 1.06; 95% CI: 1.01, 1.11). Belief in the right to refuse sex was protective against ever having sex (OR = 0.76; 95% CI: 0.60, 0.96). Participants from households with no secondary school education had higher odds of ever having sex (OR = 1.59; 95% CI: 1.14, 2.22). Among the dropout stratum, participants who had not achieved a secondary school level of education had riskier Age Factor and Partner History Factor scores (β = 0.51; 95% CI: 0.23, 0.79, and β = 0.24; 95% CI: 0.07, 0.41, respectively). Participants from households without a secondary school level of education had riskier Age Factor scores (β = 0.26; 95% CI: 0.03, 0.48). Across strata, the most consistent variables associated with risky sexual behaviour were those related to education, including girl’s level of education, highest level of education of her household of origin and the community percentage of girls enrolled in school. These results suggest that programmes seeking to reduce risky sexual behaviour among young women in Malawi should consider the role of improving access to education at multiple levels.

中文翻译：

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妇女赋权和经济资源对马拉维 Zomba 区年轻女性危险性行为的多层次影响

马拉维 Zomba 区的性别差异很明显。在 15 至 49 岁的女性中，艾滋病毒感染率为 16.8%，而同龄男性为 9.3%。复杂的结构因素与导致 HIV 感染的危险性行为有关。本研究的目的是探讨经济资源的多层次测量与妇女赋权与 Zomba 年轻女性危险性行为之间的关联。对危险性行为的四项测量进行了检查：曾经发生过性行为、使用安全套以及测量性活动期间的年龄和伴侣历史的两个指标。多级回归模型和具有集群稳健标准误差的回归模型用于估计关联，按入学状况分层。在女生阶层中，在社区一级入学的女孩百分比与曾经发生过性行为（OR = 0.76；95% CI：0.60，0.96）和使用安全套（OR = 1.06；95% CI：1.01，1.11）有保护性关联。相信拒绝性行为的权利可以防止发生性行为（OR = 0.76；95% CI：0.60, 0.96）。来自没有受过中学教育的家庭的参与者发生性行为的几率更高（OR = 1.59；95% CI：1.14, 2.22）。在辍学阶层中，未达到中学教育水平的参与者的年龄因素和伴侣历史因素得分较高（来自没有受过中学教育的家庭的参与者发生性行为的几率更高（OR = 1.59；95% CI：1.14, 2.22）。在辍学阶层中，未达到中学教育水平的参与者的年龄因素和伴侣历史因素得分较高（来自没有受过中学教育的家庭的参与者发生性行为的几率更高（OR = 1.59；95% CI：1.14, 2.22）。在辍学阶层中，未达到中学教育水平的参与者的年龄因素和伴侣历史因素得分较高（β= 0.51; 95% CI：0.23、0.79 和β= 0.24; 95% CI：分别为 0.07、0.41）。来自没有受过中学教育的家庭的参与者的年龄因素得分更高（β= 0.26; 95% CI：0.03, 0.48)。在各个阶层中，与危险性行为相关的最一致变量是与教育相关的变量，包括女孩的教育水平、其原籍家庭的最高教育水平和社区女孩入学率。这些结果表明，旨在减少马拉维年轻女性危险性行为的计划应考虑在多个层面改善受教育机会的作用。