Factors Associated with Risky Sexual Behaviour among Women Engaged in Cross-border Trade in Lusaka, Zambia

Abstract Background Women engaged in cross-border trader in Lusaka, Zambia, operate in highly mobile and economically vulnerable contexts that contribute to regional economies and household livelihoods. Women constitute approximately 70% of informal cross-border traders in Zambia. This study investigated the prevalence and determinants of risky sexual behaviour among these traders. Methods A cross-sectional survey was conducted among 499 women at COMESA Market. A sampling frame of 632 women-owned trading units was obtained from the CBTA register. Data on socio-demographic, migratory, sexual behaviour, health, and substance use characteristics were collected. Firth Penalised logistic, regression identified factors associated with risky sexual behaviour, reporting crude (cOR) and adjusted odds ratios (aOR) with 95% CIs). Results Eighty-three-point four percent (83.4%) of respondents were classified as high-risk sexual behaviour. Most respondents were married (39.4%), aged 35–44 years (35.1%), and had secondary education (57.1%). Majority of respondents (83.4%) reported high-risk sexual behaviour. In bivariate analysis, educational level ( p < 0.01), ability to read ( p < 0.01) and write ( p < 0.01), religious affiliation ( p < 0.05), days spent out for trading ( p < 0.01), and frequency of condom use ( p < 0.01) were significantly associated with risky sexual behaviour. In the adjusted Firth Penalised logistic regression model, respondents who spent less than 5 days out (aOR = 11.91, 95% CI: 4.12–34.45, p < 0.01) and 6 or more days out (aOR = 8.29, 95% CI: 3.16–21.74, p < 0.01) had significantly higher odds of risky sexual behaviour compared to those who spent no days out. Age and education showed a protective effect in the crude model but were not significant after adjustment. Marital status, residence, religion, paid sex, frequency of condom use, alcohol and drug use were not significantly associated with risky sexual behaviour in the adjusted model. Conclusion Mobility, specifically time spent away from home for trading, was the strongest predictor of risky sexual behaviour. The findings highlight the need to address mobile traders’ sexual health risks associated with extended time away from home, alongside efforts to improve educational and literacy levels.