This study focuses on understanding the HIV prevalence and its determinants among YFSWs in Lubumbashi. The research provides insight into the complex dynamics surrounding HIV risk factors within the city’s sex work industry, highlighting the nuanced factors that influence HIV transmission. The World Health Organization categorizes the global population’s vulnerability to HIV/AIDS into different groups, with FSWs being a key population susceptible to high HIV infection rates [19]. The study found a 3.3% hospital proportion of HIV infection among YFSWs, higher than the general Congolese population’s 0.7% [13]. However, a Zimbabwean study found a significantly higher HIV prevalence among 2387 YFSWs at 23.6% [4]. These results raise questions about regional determinants and socio-economic factors that could contribute to these variations in HIV prevalences, such as differences in access to health services, sex education, condom availability, and other socio-economic variables.

This study reveals significant variations in HIV hospital proportion rates among YFSWs across different age groups. YFSWs aged 18–19 have a rate of 2.3%, while those aged 20–21 have a rate of 3.3%. The rate increases to 4.1% for those aged 22–24. This indicates a worrying trend of increasing HIV prevalence as YFSWs age, highlighting the need for targeted interventions tailored to each age group. Factors contributing to this trend include prolonged exposure to risky sexual behaviors, unsafe practices, social stigma, and limited access to health services. YFSWs who have been working for several years also face increased challenges due to growing stigmatization, persistent social vulnerability, socio-economic situations, and lack of a social safety net. The Ghanaian study by Guure et al. [5] found variations in HIV prevalence rates between the two age groups studied, with the under-20s having a higher rate of 4.22% and the 20-24s having a slightly lower rate of 2.93%. These differences highlight the need for a comprehensive analysis of socio-cultural contexts, risky sexual practices, and HIV prevention interventions specific to each region.

The study shows that YFSWs engaged in anal sex have a significantly higher risk of being HIV-positive. The risk of HIV transmission through anal sex is 16–18 times greater than penile-vaginal intercourse [20]. Anal intercourse can compromise natural barriers to HIV transmission, causing microtrauma to the rectal mucosa, which is more susceptible to injury than vaginal mucosa [21, 22]. Additionally, the rectum is also rich in immune cells that can be susceptible to HIV infection [22].

Forced sex among YFSWs can lead to increased risk of HIV infection due to barriers such as physical or psychological coercion that sex can compromise the ability to negotiate condom use. Similar to the present study, Sarkar et al. [23] also found that forced sex was significantly associated with HIV infection among FSWs. Forced sex exposes women to high-risk sexual partners, such as those living with HIV who do not know their HIV status. Additionally, AGYW who have been victims of forced sex may develop significant psychological trauma, which may lead them to adopt risky behaviors such as substance use, engagement in unprotected sex, and reduced compliance with HIV prevention measures. A Russian study reported a strong association between drug use, unprotected anal sex and forced sex among FSWs [24].

The isolation and marginalization experienced by FSWs make it difficult for them to negotiate safer sex practices, increasing their risk for HIV infection [25]. Regular condom use significantly reduces the risk of HIV/STIs transmission among FSWs [26, 27]. However, when unprotected sex becomes the norm, the probability of contracting HIV increases considerably. Condom non-use during sex among Ghanaian YFSWs was influenced by higher payments, drug and/or alcohol use, fear of violence sexual, and police harassment [28].

YFSWs’ motivation to engage in risky sexual behavior is influenced by various factors, including economic, social, psychological, and cultural aspects. Economic pressures may lead YFSWs to provide specific sexual services, such as not using condoms and/or anal sex, to receive higher remuneration. Fear of losing clients or rejection may also deter them from refusing specific requests [5]. Lack of adequate sex education and access to accurate information on risky sexual practices can lead to an underestimation of the dangers of sex. Stigmatization and marginalization can also lead YFSWs to adopt risky sexual behaviors to meet clients’ expectations [25]. Psychosocial factors, such as trauma, violence, or poor past treatment, can also influence YFSWs’ sexual choices. The interconnection between unprotected sex, anal sex, and forced sex creates a complex dynamic that amplifies vulnerability and the risk of HIV transmission. This interconnection between these risky sexual behaviors generates a spiral of risk and vulnerability, with each practice reinforcing the others. Anal sex can lead to opportunistic decisions not to use a condom and is often associated with higher financial compensation [29]. Forced sex, by creating situations where control over condom use is limited, increases the risk of HIV transmission and establishes a climate of persistent vulnerability. Targeted interventions such as HIV prevention programs, psychological support services, and awareness-raising campaigns are crucial to break this spiral and improve the overall sexual health of this vulnerable population.

This study investigates risky sexual practices among YFSWs in Lubumbashi. However, it has limitations, including the cross-sectional design that doesn’t establish causal relationships between high-risk sexual practices and HIV infection, and recall bias due to participants’ difficulty remembering past practices. The sample’s representativeness is limited to a single health center, limiting generalizability to all Congolese YFSWs. Socially desirable responses could affect data validity. Despite these limitations, the study has strengths, such as carefully selecting a limited sample, collecting data from participants’ medical records (ensuring clinical accuracy and minimizing recall bias), using robust statistical methods like logistic regression, and highlighting the specific needs of YFSWs, including economic barriers and obstacles to condom use. This study provides a foundation for further research and targeted interventions aimed at reducing risky sexual practices and improving sexual health among YFSWs in Lubumbashi.