Factors Associated With Risky Sexual Behaviors Among People on Antiretroviral Therapy at Selected Health Centers in Rulindo District, Rwanda

Background As access to antiretroviral therapy (ART) expands, the health and longevity of people living with HIV (PLHIV) have improved. This may contribute to reduced risk perception and increased engagement in behaviours that facilitate HIV transmission. Risky sexual behaviours in this study include inconsistent condom use, multiple sexual partners, oral or anal sex, sex under the influence of alcohol, and transactional sex. This study assessed the prevalence of such behaviours and identified associated factors among PLHIV receiving ART at selected health centres in Rulindo District, Rwanda. Methods A cross-sectional quantitative study was conducted among 400 consenting PLHIV receiving ART at selected health centres. Probability proportional to size sampling ensured representative recruitment across centres. Data were collected via structured questionnaires. Modified Poisson regression with robust variance was performed using SPSS version 27 to estimate prevalence ratios with 95% confidence intervals. Ethical approval was obtained from Mount Kenya University, and Rutongo District Hospital granted permission. Results Of 400 PLHIV, 381 were sexually active, with complete data for risk assessment. Risky sexual behaviour was prevalent in 95.2% (362/381), with 71.6% classified as high risk. In adjusted models, female sex (aPR = 1.15; 95% CI: 1.03–1.29), age ≥ 46 years (aPR = 1.15; 95% CI: 1.03–1.28), and longer ART duration 10–15 years (aPR = 1.36; 95% CI: 1.18–1.58) or ≥ 16 years (aPR = 1.36; 95% CI: 1.17–1.57) were significantly associated with increased risk. Participants who missed ART doses showed lower risk (aPR = 0.88; 95% CI: 0.80–0.97). Sensitivity analyses confirmed the robustness of these associations. Conclusions Risky sexual behaviour was highly prevalent among PLHIV attending ART clinics in the Rulindo District. Several individual and treatment-related characteristics were associated with increased risk. These findings highlight the need to consider behavioural risk alongside clinical care in long-term ART settings.