"They Push Her to Dance…, Devalue Her If She is a Virgin…, and Beat Her as a Sign of Love…": Multilevel Factors Shaping Sexual Risk and Protection Among Pastoralist Youth in Omo Valley of Ethiopia

BackgroundPastoralist adolescents and youth in Ethiopia's Omo Valley live within social and structural conditions that may shape sexual risk and protection differently from settled populations.ObjectivesThis study explored perceived risk and protective factors shaping sexual risk behaviors among Hamer pastoralist adolescents and youth aged 10-24 years in southern Ethiopia.MethodsA qualitative descriptive study was conducted in selected kebeles of Hamer district from February to March 2025. Semi-structured in-depth interviews were held with 25 purposively selected young people and 17 key informants. Data were analyzed using framework analysis guided by a modified socio-ecological model.ResultsParticipants described early sexual initiation, multiple and concurrent partnerships, unprotected sexual intercourse, and sexual coercion as recurring sexual risk behaviors among Hamer adolescents and youth. These behaviors were perceived to be shaped by factors across socio-ecological levels, including limited HIV knowledge, low perceived risk, alcohol use, masculine status-seeking, peer pressure, gendered power imbalances, family expectations, Evangadi dance, devaluation of virginity, ritualized initiation practices, economic vulnerability, pastoralist mobility, limited schooling, and poor access to youth-responsive sexual and reproductive health services. Participants also identified protective resources, including schooling, religious teaching, elder authority, youth engagement, and community-based outreach.ConclusionSexual risk behaviors among Hamer pastoralist adolescents and youth arise from a complex social ecology rather than individual choices alone. Prevention efforts should combine culturally grounded sexuality education, gender-transformative community engagement, strengthened schooling and livelihood opportunities, and mobile, youth-responsive sexual and reproductive health services.