Mozambique has a high burden of HIV and is currently ranked sixth worldwide for adult prevalence. In Mozambique, HIV prevalence is not uniformly distributed geographically and throughout the population. We investigated the spatial distribution of HIV infection among adolescents and young people in Mozambique using the 2009 AIDS Indicator Survey (AIS). Generalized geoadditive modeling, combining kriging and additive modeling, was used to study the geographical variability of HIV risk among young people. The nonlinear spatial effect was assessed through radial basis splines. The estimation process was done using two-stage iterative penalized quasi-likelihood within the framework of a mixed-effects model. Our estimation procedure is an extension of the approach by Vandendijck et al., estimating the range (spatial decay) parameter in a binary context. The results revealed the presence of spatial patterns of HIV infection. After controlling for important covariates, the results showed a greater burden of HIV/AIDS in the central and northern regions of the country. Several socio-demographic, biological, and behavioral factors were found to be significantly associated with HIV infection among young people. The findings are important, as they can help health officials and policy makers to design targeted interventions for responding to the HIV epidemic.

Climate change poses severe consequences, particularly in sub-Saharan Africa, where poverty rates may escalate by 2050 without significant climate and development action. The health impacts are diverse, encompassing communicable and non-communicable diseases. Mozambique, a climate-vulnerable nation, has experienced significant natural disasters in the past 42 years, impacting its health system. This study aims to assess Mozambique’s health sector’s vulnerability and adaptation needs to climate change. Following a methodology proposed by the World Health Organization and the Intergovernmental Panel for Climate Change, a six-step vulnerability and adaptation assessment was conducted to conduct the Health Vulnerability Index (HVI) for Mozambique’s regions $(n=161)$. The HVI integrates historical climate, epidemiological, and socio-economic data at the district level, and was computed using exposure, sensitivity, and adaptive capacity dimensions. The results revealed spatial patterns in exposure to climate variables, extreme weather events, and variations in sensitivity and adaptive capacity across the country. The HVI mirrored the exposure findings. Notably, high vulnerability was observed in several districts, while major urban centers displayed lower vulnerability. These findings highlight the country’s vulnerability to climate change and underscore the potential for adverse impacts on livelihoods, the economy, and human health. The study provides a foundation for developing strategies and adaptation actions.

Female sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, combination of factors, including inconsistent condom use, engagement in risky sexual behaviors, and various socio-ecological determinants of health. Understanding the determinants of these practices is crucial for developing targeted interventions. This cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019 to 2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Modified Poisson regression models were used to assess the effect of various socio-demographic, economic, and behavioral factors on the outcomes, providing adjusted relative risk (aRR) with 95% confidence intervals (CI). Among the 2,565 FSWs who reported inconsistent condom use, younger FSWs (15–24 years old, 29.1%), single (27.3%), with secondary or higher education (26.1%), nationals (25.9%), and residents of Tete City (30.5%) had a higher prevalence of inconsistent condom use. Initiating sex work < 18 years (31.0%), binge drinking (23.7%), and experiencing physical violence (29.0%) were significantly associated with this behavior. Among the 2,564 FSWs reporting risky sexual behaviors, a higher prevalence was observed in FSWs aged 15–24 (75.6%), those with secondary or higher education (75.8%), nationals (74.4%), and those residing in Quelimane (87.3%). Early sexual debut (< 15 years, 79.3%), initiating sex work before 18 years of age (77.7%), and illicit drug use (82.2%) were all associated with increased risky sexual practices. Inconsistent condom use among FSWs was significantly associated with residing in Tete (aRR = 2.4, 95% CI: 1.77–3.25), not being aware of female condom (aRR = 1.22, 95% CI: 1.03–1.45) and having experienced sexual a physical violence. Moreover, being married was significantly linked to risky sexual behavior among female sex workers (aRR = 1.27, 95% CI: 1.19–1.37), along with initiating sexual activity before age 15, having at least five years of sex work experience, engaging in binge drinking, and experiencing sexual and physical violence. The study highlights the complex set of factors as age, education, geographic location, years of sex work services, early sexual debut, and illicit drug use that influence sexual risks behavior among FSWs in Mozambique. Tailored interventions addressing not only sexual health education and services, but also economic empowerment and illicit drug use is imperative for mitigating these risks.

Background: Hazardous drinking and drug consumption are associated with an increased risk of HIV due to the complex interplay of factors influencing decision-making capability, stigma and social marginalization. In this study, we explore the patterns of hazardous alcohol and drug use and correlates of risk factors among female sex workers (FSW) and men who as sex with men (MSM) in Mozambique. Methods: We conducted a secondary data analysis of bio-behavioral surveys (BBS) among FSW and MSM using a respondent-driven sampling methodology conducted in five main urban areas of Mozambique from 2019 to 20. The survey included a standardized questionnaire, where hazardous drinking was assessed (using AUDIT-C scores ≥ 4 for men, ≥ 3 for women) and drug use in the last year (FSW). Chi-squared test was used to analyze the association between socio-demographic and behavioral variables, and multivariate logistic regression measured the impact of the associated factors. Results: The prevalence of hazardous alcohol drinking was 47.1% (95% CI:44.8–49.5) for FSW and 46.5 (95% CI: 44.0–49.0) for MSM. Current drug use was reported in 13.3% of FSW. FSW engaging in hazardous alcohol drinking reported more sexual partners in the last month than those no reporting hazardous alcohol use (55.3% vs. 47,1%, p < 0.001), higher rates of self-reported STIs in the last year (62,5% vs. 48,2%, p < 0.001), physical (53.5% vs. 46.7%, p < 0.0001) and sexual violence (54.7% vs. 44.2%, p < 0.001), and HIV prevalence (55.2% vs. 44.2 p < 0.001). Among MSM with hazardous alcohol drinking, there was a higher prevalence of self-reported STIs (52.8% vs. 45.4%, p < 0.001), experiences of sexual violence (18.0% vs. 8.3%, p < 0.001), and HIV prevalence (53.0% vs. 46.3%, p < 0.001). In addition, FSW who reported illicit drug use were more likely to self-reported HIV own risk (14.2% vs. 9.7%), early start sexual activity (15.4% vs. 5.3%), self-reported STIs (17.9% vs. 10.2%), and experiences of both physical (17.4% vs. 7.0%) and sexual violence (18.6% vs. 8.9%). Conclusion: There is an immediate need for the introduction and integration of comprehensive substance use harm mitigation and mental health interventions into HIV prevention programs, particularly those targeting key populations in Mozambique.

Engaging in sexual activity before the age of 15, known as early sexual debut, is a significant public health concern due to its association with increased risks of sexually transmitted infections, unintended pregnancies, and reduced educational achievements. This research investigates the factors influencing early sexual initiation among adolescents and youth aged 15 to 24 years in Mozambique, utilizing data of 5,283 individuals from the 2021 Mozambique AIDS indicator survey. Geoadditive models for censored time-to-event outcomes were employed to explore regional disparities and key determinants of the time to sexual debut, aiming to inform region-specific public health interventions and policies. The model was fitted using Poisson approximation within the framework of mixed model formulation for generalized additive models. The results revealed that approximately 80% of individuals have engaged in sexual activity, with 18.9% reporting having had sex before the age of 15. Among women, the percentage was 16.3%, while among men, it was 26.7%. Regional disparities were also observed, with the northern region exhibiting a higher prevalence of sexual debut before the age of 15 (26.7%). The median age at which individuals initiate sexual activity was estimated to be 16 years. After adjusting for significant covariates, the findings indicated a higher incidence of early sexual debut in the northern and southern regions of Mozambique, with notable gender differences. Age, occupation, alcohol consumption, illicit drug use, and living with parents were statistically significant factors associated with the age of sexual debut. These results highlight the need of addressing both individual behaviors and broader structural determinants—such as education and socio-economic conditions—to delay sexual initiation and reduce adverse health outcomes among Mozambican adolescents and youth. This study adds to the limited geospatial literature on sexual behavior in Mozambique.

Background: Substance use among youth has significant implications for health, development, and society. In Mozambique, where youth form a large segment of the population, understanding the prevalence and factors associated with alcohol and drug use is essential for effective public health strategies. This study aimed to assess the prevalence and factors associated with alcohol and drug use among adolescents and young adults in Mozambique. Methods: This study is a secondary data analysis of the 2019 Violence Against Children Survey (VACS), a nationally representative cross-sectional survey targeting individuals aged 13–24 years. Data collection were collected using face-to-face interviews with a structured questionnaire. The analysis focused on the prevalence and patterns of self-reported alcohol and drug use and identified potential socio demographic and behavioral factors associated with substance use among the youth. Results: The overall prevalence of alcohol use was 29.7%, and drug use was 22.5%. Among individuals aged 18–24 years, alcohol use was significantly higher (aOR = 3.8, 95% CI: 2.9–4.9, p < 0.001) compared to those aged 13–17 years, while drug use followed a similar pattern (aOR = 2.4, 95% CI: 1.6–3.5, p < 0.001). Gender differences were observed, with females being significantly less likely to report drug use (aOR = 0.5, p < 0.001). Marital status was associated with a lower likelihood of alcohol use, as married or cohabiting individuals reported less alcohol use (aOR = 0.6, p < 0.001). Higher educational attainment was associated with an increased likelihood of alcohol use (aOR = 1.8, p < 0.001). Employment in the past 12 months was protective against both alcohol (aOR = 0.7, p < 0.001) and drug use (aOR = 0.7, p = 0.014). Notably, those who experienced sexual violence in childhood were less likely to consume alcohol (aOR = 0.4, p < 0.001) and use drugs (aOR = 0.5, p = 0.004), while those whose first sexual intercourse was pressured or forced were more likely to engage in substance use. Conclusion: The findings highlight the significant prevalence of alcohol and drug use among adolescents and young adults in Mozambique, with notable socio-demographic and behavioral disparities. Factors such as age, gender, marital status, educational attainment, and employment status influence substance use patterns. Additionally, traumatic experiences, including childhood sexual violence and forced or pressured first sexual intercourse, play a complex role in shaping substance use behaviors. These findings emphasize the need for integrated public health interventions that address prevention, mental health support, and socio-economic disparities to reduce substance use and promote the well-being of Mozambique’s youth.