Background In January 2008, the Saudi Arabian health authority included mandatory testing for HIV, HBV and HCV viruses in the premarital screening program. Epidemiologically, there were few justifications for their inclusion as disease prevalences and distributions are poorly understood in the population. This study aims to provide information about HBV, HCV and HIV prevalences and risk factors for disease transmission and so produce evidence for informed decision-making on the inclusion of these infectious diseases in the screening program.

Methods This is a cross-sectional descriptive study embedded in the existing national premarital screening program for thalassaemia and sickle cell disease to estimate the prevalence of HIV, HBV and HCV infections (n=74 662 individuals), followed by a case-control study to identify risk factors responsible for infection transmission (n=540).

Results The average HIV prevalence is 0.03%, 1.31% for HBV and 0.33% for HCV. Sharing personal belongings particularly razors, blood transfusions, cuts at barbershops and extramarital relationships showed the highest significant associations with the transmission of these viruses.

Conclusion The prevalences of HIV, HBV and HCV in Saudi Arabia are among the lowest worldwide. However, all the important risk factors associated with transmitting these viruses are significantly present in the Saudi community. Saudi Arabia is financially capable of screening for these infections in the mandatory premarital program and of providing medical care for the discovered cases, but focusing on the health education programs may offset the need to mandatory testing.