This study sought to assess sexual HIV risk behaviour and its associated factors among pregnant women in Mpumalanga, South Africa. Results indicate that among pregnant women (6.5 months mean gestational age) HIV sexual risk behaviour was quite prevalent, including unprotected sex, multiple partners and sexual partners of unknown serostatus. Regarding sexual risk, previous studies had similar findings related to increased HIV risk behaviour (unprotected sex, multiple sexual partners) among pregnant women [10, 11, 23–25].
Further, the study found that being single and alcohol use were associated with multiple sexual partners. Other studies in South Africa also found that drinking prior to pregnancy recognition or during pregnancy and being single was associated with having a greater number of sexual partners or a greater history of sexual risk-taking [26, 27]. Moreover, fewer antenatal visits, being HIV negative and not having used alcohol were associated with unprotected intercourse. This seems to show the importance of antenatal care attendance, which can be used to reinforce condom use. Also other studies [28, 29] show that being HIV positive was associated with protected sexual intercourse. Previous studies also found that alcohol use was inconsistently related to protective behaviours (e.g., condom use) .
This study found, as in other studies [31, 32], that being HIV positive was associated with having been diagnosed with a sexually transmitted infection (other than HIV). Further, having experienced physical partner violence and psychological distress were found to be associated with having been diagnosed with an STI (other than HIV). This finding is conforming to other studies about the co-occurrence of intimate partner violence and STIs (including HIV) [15, 16, 33–35] and psychological distress has been found to be associated with HIV risk behaviour [36, 37]. In a study among pregnant women in rural Haiti, results showed that gender and power factors were most significant for condom use. These results suggest the need to create prevention interventions that restore power imbalances, strengthen communication skills  and partner communication on sexual matters . Treating intimate partner violence, mental health and alcohol use problems may aid in reducing HIV infection .
Finally, educational factors (lower education, the belief that antiretrovirals can cure HIV, unplanned pregnancy), lack of male involvement (non-antenatal care attendance by expectant father) and being HIV positive were found to be associated with having a partner with HIV positive or unknown status. Having unprotected sexual intercourse with partners of HIV positive or unknown HIV status includes an increased HIV risk and should be avoided and calls for improved partner communication on sexual matters . In addition, health education should address misconceptions about the effects of antiretrovirals. In this study HIV knowledge was not found to be associated with HIV risk behaviour, unlike in a previous study in South Africa .
The measures used in the study were all by self report, so there is a possibility of a degree of biased reporting. It is possible that respondents underreported sexual risk behaviour. Furthermore, this study was based on data collected in a cross-sectional survey. We cannot, therefore, ascribe causality to any of the associated factors in the study. Prospective studies are required to confirm the sexual behaviour findings.