Background: According to the World Health Organization (WHO), currently over three in ten of all new HIV cases globally occur among youth aged 15 to 25 years. It is increasingly suggested that health risk behavior among the youth contributes to this rising HIV incidence among Rwandan youth; however, these suggestions are unsubstantiated by documented evidence. Objective: In this study, we investigated youth health risk behavior and their likely influence on HIV incidence. We also explored the hypothesis that limiting early sexual debut contributes to minimizing HIV incidence among Rwandan youth, consequently facilitating achievement of the global agenda for health and sustainable development to end HIV/AIDS ambition by the year 2030. Methods: The Rwanda Demographic Health Survey 2014–15 was used for this study. Youth who met the eligibility criteria were 1528. Descriptive statistic was performed in percentages and proportion. Bi-variate and multivariate logistic regressions were used with 95% confidence interval and statistical significance determined at p < 0.05. Adjusted odds ratio was used to calculate population attributable fraction (PAF) for age of sexual debut. All statistical analyses were performed using STATA v13.0. Results: Of all study participants, 2.6% (n = 40) were HIV positive. Multiple logistic regression showed that youth who practice earlier sexual debut at ages 15–17 had higher odds of being infected with HIV, compared to the reference population, albeit statistically non-significant (OR = 1.4, 95% CI = 0.74–2.75, p = 0.287). PAF results demonstrate that approximately 2% of HIV infection could be avoided if the age of sexual debut was older than the national mean age of 17 years among the Rwandan youth. Conclusion: Risky sexual behavior remains a major healthcare challenge among the youth in Rwanda with a female sex preponderance. The present study established an association between these health risk behaviors and incidence of HIV among Rwandan youth, and also determined that the rising incidence of HIV among youth in Rwanda could be attenuated if prudent familial interventions, including parental involvement in the reproductive lives of youth, and evidence-based governmental healthcare policies are initiated and effectively executed.
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