Abstract
BackgroundAge at sexual debut is a key behavioural indicator used in HIV behavioural surveillance. Early age at menarche may precipitate early sex through perceived readiness for sex, or through school drop-out, but this is rarely studied. We investigated trends and circumstances of sexual debut in relation to schooling and age at menarche.Methods and FindingsA cross-sectional sexual behaviour survey was conducted on all individuals age 15–59 within a demographic surveillance site in Karonga District, Malawi. Time trends were assessed using birth cohorts. Survival analysis was used to estimate the median age at menarche, sexual debut and first marriage. The 25th centile was used to define “early” sex, and analyses of risk factors for early sex were restricted to those who had reached that age, and were done using logistic regression. Of the 8232 women and 7338 men resident in the area, 88% and 78%, respectively, were seen, and, 94% and 92% of these were interviewed. The median reported age at first sex was 17.5 for women and 18.8 for men. For women, ages at menarche, sexual debut and first marriage did not differ by birth cohort. For men, age at sexual debut and first marriage decreased slightly in later birth cohorts. For both men and women increased schooling was associated with later sexual debut and a longer delay between sexual debut and first marriage, but the associations were stronger for women. Earlier age at menarche was strongly associated with earlier sexual debut and marriage and lower schooling levels. In women early sexual debut (<16 years) was less likely in those with menarche at age 14–15 (odds ratio (OR) 0.31, 95%CI 0.26–0.36), and ≥16 (OR 0.04, 95%CI 0.02–0.05) compared to those with menarche at <14. The proportion of women who completed primary school was 46% in those with menarche at <14, 60% in those with menarche at 14–15 and 70% in those with menarche at ≥16. The association between age at menarche and schooling was partly explained by age at sexual debut. The association between age at menarche and early sex was not altered by adjusting for schooling.ConclusionsWomen with early menarche start sex and marry early, leading to school drop-out. It is important to find ways to support those who reach menarche early to access the same opportunities as other young women.
Highlights
Age at first sexual intercourse is one of the key sexual behaviour indicators recommended in second generation HIV surveillance [1]
The analysis explored secular trends in ages at first sexual intercourse and first marriage and in partner types; and risk factors for early sex and for a long delay between first sex and first marriage
At the time of the survey there were 8232 women and 7338 men aged 15–59 resident within the demographic surveillance area. 987 (12%) women and 1613 (22%) men were not found and seen by the interviewers. Of those who were seen 6825 (94%) women and 5283 (92%) men agreed to be interviewed about their sexual behaviour, and 6796 women and 5253 men were interviewed
Summary
Age at first sexual intercourse is one of the key sexual behaviour indicators recommended in second generation HIV surveillance [1]. Age at sexual debut has been shown to correlate with subsequent risk behaviour: on average those with younger ages at debut have more partners [2] and a higher risk of HIV [3] Another important indicator of risk is the delay between sexual debut and first marriage, as this can be a time of high partner change, and is associated with a higher number of partners later [4]. Girls who reach menarche may be regarded as ‘‘ready’’ to start sex and marry [8]. For those who do start sex, pregnancy is more likely if they are physically mature. We investigated trends and circumstances of sexual debut in relation to schooling and age at menarche
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