Measuring sexual behavior among in-school youth in Rwanda: a cross-sectional analysis of self-reported timing of first sex and correlates of early sexual debut

Abstract

PurposeUnderstanding the timing of sexual debut is critical for informing sexual and reproductive health interventions. We investigated sexual behavior and early sexual debut among Rwandan youth. MethodsWe conducted a cross-sectional analysis of data from a cluster-randomized trial with 6079 students ages 12–19 years in Rwanda. We examined predictors of early sexual debut (<15 years) using logistic regression to estimate odds ratios and factors associated with the timing of first sex using Cox models to estimate hazard ratios. Interpretations of sex were also explored. ResultsParticipants were 15 years and 51.5% female on average; 1723 (28.3%) reported sexual activity. Among the 1320 participants who provided an age of sexual debut, 51.4% reported sex at ≤12 years and 75.7% at<15 years. Males had a higher odds of early sexual debut (adjusted odds ratio: 2.40; 95% CI: 1.99, 2.90) and a higher hazard of sex occuring at an earlier age than females (adjusted hazard ratio: 1.91; 95% CI: 1.67, 2.20). One-third of participants considered “sexual intercourse” to include kissing, touching, or masturbation. ConclusionsSex at ≤12 years was frequently reported, indicating that interventions facilitating access to youth-friendly sexual and reproductive health services are necessary before age 12. Validation studies are needed to evaluate how interpretations of sexual intercourse influence the assessment of sexual activity. Clinical trialNCT04198272.