Community behavioural resilience and STIs: Predictors of pandemic preparedness in a low-resource setting in Cameroon

Sexually transmitted infections (STIs) infect 374 million people annually, with sub-Saharan Africa bearing the highest burden. Community behavioural resilience remains poorly understood in low-income settings, creating a critical gap in STI pandemic preparedness. This study identifies predictors of willingness to adopt protective behaviours during a hypothetical STI outbreak in rural Cameroon.

We conducted a community-based survey in 2022 among residents of three riverine health areas in the Bafia Health District, Cameroon. Participants (N=372; 202 females [54.3%], 170 males [45.7%]) ≥18 y of age were enrolled; 336 with complete data were included in regression analyses. All participants were assessed for STI knowledge (awareness of 10 pathogens), self-reported STI history, current symptoms, willingness to undertake STI screening and willingness to abstain from sexual intercourse in a hypothetical STI pandemic scenario. Multivariable logistic regression identified independent predictors of willingness to abstain.

Among 336 participants, 247 (73.5%) reported a willingness to abstain from sexual intercourse during a hypothetical STI pandemic. The strongest independent predictors of protective intention were willingness to undertake STI screening (adjusted odds ratio [aOR] 10.3 [95% confidence interval {CI} 4.55 to 24.2], p<0.001) and self-reported history of an STI (aOR 4.88 [95% CI 2.16 to 11.5], p<0.001). Knowledge of Chlamydia trachomatis (aOR 3.91 [95% CI 1.16 to 13.0], p=0.026) and hepatitis B (aOR 3.50 [95% CI 1.55 to 8.02], p=0.003), as well as age 30-39 y (aOR 5.94 [95% CI 1.51 to 28.3], p=0.016), were also significant predictors. In this study, a low overall STI knowledge score was paradoxically associated with higher odds of protective intention (aOR 10.7 [95% CI 1.57 to 76.7], p=0.016). The wide CI reflects statistical instability from small cell counts, thus the estimates should be regarded as exploratory.

Community behavioural intentions during a hypothetical STI pandemic are driven more by experiential factors (personal STI history and willingness to seek testing) than by general STI knowledge. These findings are based on stated behavioural intentions in a hypothetical scenario, not observed behaviour. Still, the implication is clear. Pandemic preparedness policies must therefore integrate experiential drivers, including routine asymptomatic screening and accessible diagnostic services, to strengthen community behavioural resilience. This experience-aware model offers scalable insights for low- and middle-income countries and global health security planning.