Patterns of Inconsistent Condom Use and Risky Sexual Behaviors among Female Sex Workers in Mozambique

Abstract Background Female sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, due to inconsistent condom use and engagement in risky sexual behaviors. Understanding the determinants of these practices is crucial for developing targeted interventions. Methods This cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019–2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Logistic regression models were used to assess the association of various socio-demographic, economic, and behavioral factors with the outcomes, providing adjusted odds ratios (aOR) with 95% confidence intervals (CI). Results Among 2,570 FSWs reporting inconsistent condom use, the majority were younger (15–24 years old, 69.5%), single (68.2%), with secondary or higher education (69.9%), nationals (66.6%), and residents of Quelimane City (77.2%). Initiating sex work < 18 years (73.3%), having 5 + clients in the last month (61.8%), binge drinking (61.7%), and experiencing physical violence (82.9%) were significantly associated with this behavior. From the 2,514 FSWs reporting risky sexual behaviors, the majority aged 15–24 (83.0%) had secondary or higher education (84.2%), were nationals (82.5%), and resided in Quelimane (87.3%). Early sexual debut (< 15 years, 87.4%) and starting sex work < 18 years (86.4%) were linked to increased risks, as was drug use (86.8%). FSWs older > 25 years (aOR = 1.4, 95% CI: 1.0–2.0, p = 0.034), from Tete (aOR = 5.8, 95% CI: 3.6–9.3, p < 0.001), with 5 + clients in the last month (aOR = 2.3, 95% CI: 1.3–4.7, p = 0.003), were more likely to report inconsistent condom use. Additionally, FSWs aged 15–24 years (aOR = 1.4, 95% CI: 1.1–1.9, p = 0.011) with early sexual debut (aOR = 1.4, 95% CI: 1.1-2.0, p = 0.002). Conclusion The study highlights the complex interplay factors as individual characteristics, geographic location, client volume, early sexual debut, and substance use that influence sexual risks behaviour among FSWs in Mozambique. Tailored interventions addressing not only sexual health education and services, but also economic empowerment and substance use are imperative for mitigating these risks.