Early Sexual Debut Research Articles

Early sexual debut and pregnancy termination: uncovering the link among sexually active young women in 23 sub-Saharan African countries

Abstract Background Unplanned pregnancy could be a socio-economic burden for many young women in sub-Saharan Africa (SSA) which often leads to pregnancy termination. The role of age at sexual debut in pregnancy termination in countries with lower income remains unknown. Hence, this study examines the association between age at sexual debut and pregnancy termination among sexually active young women between the ages of 15 -24 in 23 SSA countries. Methods Cross-sectional secondary datasets from the most recent Demographic and Health Survey conducted in 23 countries in SSA conducted between 2010 and 2018 among 34,343 sexually active young women were analysed using bivariate and multivariable logistic regression to examine the association between age at sexual debut and pregnancy termination with statistical significance of p < 0.05. Results The pooled prevalence of pregnancy termination among sexually active young women in SSA was 11.00%. Higher odds of pregnancy termination were found among those who had early sexual debut (below 16 years) [(aOR = 1.34, 95% CI = (1.22–1.48)] compared to those who had late sexual debut. Furthermore, those who were exposed to mass media [(aOR = 1.29, 95% CI = (1.16–1.43)] were more likely to report pregnancy termination compared to those who were not exposed. On the other hand, those residing in rural areas and those within the richest wealth index were associated with lower odds of pregnancy termination. Conclusion The study concluded that early sexual debut of sexually active young women in SSA was significantly associated with pregnancy termination. Mass media exposure was found to be a risk factor for pregnancy termination whilst residing in rural areas, and those within the richest wealth index were protective factors. Interventions should be designed to target young women with early sexual debut to provide comprehensive sexual and reproductive health education to enable them to make informed decisions on pregnancy termination.

The Prevalence and Pattern of Risky Sexual Behaviour among Secondary School Adolescents in Yenagoa Local Government Area, Nigeria

Aim: To determine the prevalence, pattern and socio-demographic factors associated with risky sexual behaviour (RSB) among adolescents in secondary schools in Yenagoa LGA, Bayelsa state. Study Design: A cross-sectional analytical study. Place and duration: Yenagoa Local Government Area in Bayelsa state. The study was conducted in March/April 2021. Methodology: The study utilized self-administered questionnaires among 750 secondary school adolescents selected via multistage sampling. The proportion of adolescents with RSB and the socio-demographic determinants of RSB were analysed using Chi-square test and binary logistic regression with significance level set at p-value=0.05. Results: Of the 739 responses analysed, the prevalence of RSB was 156 (21.1%) and the mean age at sexual debut was 13.42±2.62 years. All sexually exposed adolescents had an early sexual debut, 23.7% had multiple sexual partners, and 98.1% reported inconsistent use of condoms. Transactional sex and sexual intercourse after alcohol/illicit drug use occurred in 56.4% and 15.4% of them, respectively. The predictors of RSB were attending a public school (AOR:2.046, 95%CI:1.243 to 3.368), peer pressure (AOR:10.451, 95%CI:6.460 to 16.909), difficulty in communicating with mother (AOR:2.050, 95%CI:1.203 to 3.493) and low maternal education (primary:AOR:2.834, 95%CI:1.300 to 6.181; and secondary: AOR:2.067, 95%CI:1.139 to 3.753). However, age below 18years (10-13years: AOR:0.194, 95%CI:0.051 to 0.741 and 14-17years: AOR:0.259, 95% CI:0.081 to 0.832) was protective of RSB. Conclusion: RSB is high among adolescents attending secondary schools in Yenagoa. Sex education, peer-based programmes and parent-adolescent communications should be encouraged to reduce the prevalence of RSB among adolescents.

Early sexual debut among adolescent girls and young women in Sierra Leone: A multilevel analysis of prevalence and predictors.

Early sexual debut among young women is associated with adverse sexual and reproductive health outcomes, including unintended pregnancies and sexually transmitted infections. Despite its negative impact, there is limited research on this issue in Sierra Leone. This study aims to address this gap by examining the prevalence of early sexual debut and its associated factors among adolescent girls and young women aged 15-24 years in Sierra Leone. Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. Provincial variations in the proportion of early sexual debut were visualised using a spatial map. A mixed-effect multilevel binary logistic regression analysis was performed to examine the factors associated with early sexual debut. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI) and intraclass correlation coefficients. The prevalence of early sexual debut was 26.1% [24.3, 28.0]. Adolescent girls and young women aged 20-24 were less likely to engage in early sexual debut [aOR = 0.52; 95% CI: 0.41, 0.65] than those aged 15-19. The odds of early sexual debut was lower among adolescent girls and young women with secondary/higher education [aOR = 0.62; 95% CI: 0.45, 0.85] compared to those with no education. Adolescent girls and young women who used the internet in the last 12 months [aOR = 0.50; 95% CI: 0.34, 0.73] and those who belonged to the Fullah ethnic group [aOR = 0.25; 95% CI: 0.07, 0.85] were less likely to engage in early sexual debut relative to those who did not use the internet and those belonging to the Creole ethnic group respectively. Adolescent girls and young women who intend to use contraceptives [aOR = 0.60; 95% CI: 0.46, 0.77] and those who do not intend to use contraceptives [aOR = 0.65; 95% CI: 0.49, 0.88] were less likely to engage in early sexual debut than those who were using contraceptives.Conversely, adolescent girls and young women who were working [aOR = 1.41; 95% CI: 1.12, 1.77] had higher odds for early sexual debut than those not working. The odds of early sexual debut were higher among adolescent girls and young women who were married/cohabiting [aOR = 1.72; 95% CI: 1.32, 2.22] and previously married [aOR = 3.26; 95% CI: 1.61, 6.56] than those who were never married. Adolescent girls and young women living in the North Western area[aOR = 1.81; 95% CI: 1.05, 3.13] had higher odds for early sexual debut than those living in the Eastern province. Early sexual debut is prevalent among adolescent girls and young women in Sierra Leone. Age, education, internet use, ethnicity, contraceptive use intention, marital status, employment status, and province of residence were the factors associated with early sexual debut. The study underscores the need for policymakers, government, and non-governmental organisations to design and implement comprehensive and multifaceted interventions to promote informed decision-making and reproductive health among adolescent girls and young women in Sierra Leone.

Suicidal behaviour, depression and generalized anxiety and associated factors among female and male adolescents in Mozambique in 2022–23

BackgroundThe purpose of the study was to assess the prevalence and associated factors of major depressive disorder (MDD), generalized anxiety disorder (GAD), and past 12-month suicidal behaviour (PSB) among adolescents in Mozambique.MethodsData from 3,109 females (aged 15–19 years) and 1,439 males (aged 15–19 years) that participated in the 2022-23 Mozambique Demographic and health Survey were analysed. MDD was assessed with the PHQ-9 and GAD with the GAD-7.ResultsResults indicate that among girls the prevalence of PSB was 4.3% (attempt 1.0%, plan 1.9% and/or ideation 3.6%) and among boys 2.5% (attempt 0.3%, plan 0.7% and/or ideation 2.4%). Among girls and boys, the prevalence of MDD (≥ 8 scores) was 15.5% and 3.7%, respectively, and the prevalence of GAD (≥ 5 scores) was 25.0% and 10.3%, respectively. In adjusted logistic regression analysis, among girls, GAD was positively and solid fuel use was negatively associated with PSB, while among boys MDD and urban residence were positively associated with PSB. Among female adolescents, currently being pregnant and “big problem to get money for medical treatment” increased the odds of MDD. While among male adolescents, urban residence, having a genital sore or ulcer, has living children, and early sexual debut were positively associated with MDD. Urban residence, current alcohol use, and early sexual debut were positively associated with GAD in male adolescents, while poorer wealth status, being pregnant, and having a “big problem to get money for medical treatment” were positively associated with GAD in female adolescents.ConclusionAbout 3% of participants had PSB, among girls one in five had MDD or GAD and among boys more than 5% had MDD or GAD. Public health interventions can be guided by several associated factors that have been identified.

Age at first sex and other determinants of multiple sexual partnerships among sexually active adolescent girls in Ghana: a regression analysis of the 2022 Ghana demographic and health survey

BackgroundEarly sexual debut is a widely recognized public health issue due to its influence on lifetime multiple sexual partners which can lead to complications such as teenage pregnancy, abortion, HIV/AIDS and other sexually transmitted infections. However, there is paucity of research evidence on sexual behaviour such as age at first sexual intercourse and the number of sexual partnerships among adolescent girls in Ghana. This study aims to examine the influence of age at first sexual intercourse and other determinants on multiple sexual partnerships among adolescent girls aged 15–19 years in Ghana.MethodsData for this study were obtained from the 2022 Ghana Demographic and Health Survey (GDHS) conducted between October 17, 2022 and January 14, 2023. A total weighted sample of 719 sexually active adolescent girls who reported having sexual partners was extracted from the women’s data file. Data were analyzed with SPSS version 27, employing multilevel logistics regression modelling. Statistical significance was set at p < 0.05.ResultsThe average age at sexual debut for adolescent girls aged 15–19 years in Ghana is 15.5 years. A little over half (51.6%) of adolescent girls reported having two or more lifetime sexual partners. Adolescent girls who initiated sex before reaching age 15 were more likely (aOR = 2.00; C.I 1.39–2.87) to have multiple partners compared to those who had their first sex before attaining age 20. After controlling for other factors, girls who had their sexual debut before age 15 had higher odds (aOR = 1.85; C.I:1.30–3.31) of engaging in multiple sexual partnerships. Girls living female headed households (aOR = 2.25; C.I:1.18–4.29] and consuming alcohol (aOR = 2.38; C.I 2.38–1.09–5.17) had higher odds of having multiple sexual partners.ConclusionThe study findings show that early sexual debut, living in female headed household, and consuming alcohol are strong predictors of multiple sexual partnerships among adolescent girls in Ghana. It suggests the need for policies promoting delayed sexual debut and empowering adolescents to make informed decisions to improve sexual health outcomes.

Risky Sexual Behaviour and the Associated Factors Among Secondary School Youths in Khorixas, Namibia

Background: Like most African countries, Namibia has a large percentage of its population in the youthful age group, most of whom are in secondary school. In Namibia, the age of consent for sex is 16 years but, in most cases, children have their sexual debut way below the age of 16 years. Objective: The aim of this study was to assess the prevalence of risky sexual behaviour and the associated factors among secondary school youths aged 15-21 years in the Khorixas district of the Kunene Region in Namibia. Methods: This was a quantitative descriptive cross-sectional study. A self-administered pre-tested questionnaire was used to collect data from 276 learners, selected from three public schools in the Khorixas district employing a cluster sampling technique. Information on demographics and factors associated with risky sexual behaviour was gathered. Data were analyzed using SPSS version 25 software which included descriptive statistics generating frequencies and percentages. Results: The study revealed the prevalence of risky sexual behaviour among secondary school youths in Khorixas district, Kunene region of Namibia to be 78.9%. The risky sexual behaviour identified included multiple partners, nonuse of condoms and early sexual debut. Gender, place of residence, parental educational level, peer pressure, alcohol use/abuse, and watching pornographic content were some of the factors found to lead to risky sexual behaviour among the youths in this district of Namibia. Conclusion: Risky sexual behaviour is common in secondary schools in Khorixas district of Namibia. This sexual behaviour may follow these youngsters to adulthood and may significantly affect their social and reproductive life. Complications resulting from risky sexual behaviour among school youths include contracting STIs and HIV, getting unwanted/unplanned pregnancies and dropping out of school prematurely.

Prevalence and neighbourhood determinants of early sexual debut and multiple sexual partnerships among young people in Rwanda, Ghana and South Africa

Background: The consequences of engaging in risky sexual behaviours (RSB) can lead to HIV infection, sexually transmitted diseases and unintended pregnancy. The relationship between neighbourhood characteristics and youth involvement in RSB such as early sexual debut and multiple sexual partnerships has been of great concern to government, researchers and policymakers. However, there are very few empirical studies using demographic and health surveys to unpack the nature of this relationship in Rwanda, Ghana and South Africa. The objective of this study was to estimate the prevalence and determinants of early sexual debut and condom use, and to explore the neighbourhood factors associated with early sexual debut and condom use in Rwanda, Ghana and South Africa. Methods: This was a cross-sectional study using the most recent Demographic and Health Survey Data (DHS 2014–2016) from Ghana, Rwanda and South Africa to investigate the relationship between neighbourhood characteristics and risky sexual behaviour among the youth. Results: The prevalence of risky sexual behaviour in the three countries ranges from 56% (South Africa), 30% (Ghana) and 12% (Rwanda). Male youth in the 20-to-24-year-old category had increased odds of engaging in multiple sexual partnerships for the three countries (AOR 4.58; 95% CI 3.40–6.16), Rwanda (AOR 2.72; 95% CI 2.04–3.68) and South Africa (AOR 4.56; 95% CI 3.33–6.24). Meanwhile, at the community level, community education significantly increased the odds of age sexual debut among female adolescents by 50% (South Africa), and 46% (Ghana), while in Rwanda, this factor had decreased odds with higher community education. Conclusion: To lower the incidence of risky sexual behaviour in the community, programmes aimed at appropriate policy options must be intensified. The implications of these findings is helpful for a developmental approach aimed at reaching Africa’s long-term development goal of eliminating STIs among young people.

Patterns of inconsistent condom use and risky sexual behaviors among female sex workers in Mozambique

BackgroundFemale sex workers (FSWs) in Mozambique face significant health risks, including high HIV prevalence, combination of factors, including inconsistent condom use, engagement in risky sexual behaviors, and various socio-ecological determinants of health. Understanding the determinants of these practices is crucial for developing targeted interventions.MethodsThis cross-sectional study analyzed data from the second round of Biobehavioral Survey (BBS) conducted from 2019 to 2020 in five urban areas to examine determinants of inconsistent condom use and risky sexual behaviors among FSWs. Modified Poisson regression models were used to assess the effect of various socio-demographic, economic, and behavioral factors on the outcomes, providing adjusted relative risk (aRR) with 95% confidence intervals (CI).ResultsAmong the 2,565 FSWs who reported inconsistent condom use, younger FSWs (15–24 years old, 29.1%), single (27.3%), with secondary or higher education (26.1%), nationals (25.9%), and residents of Tete City (30.5%) had a higher prevalence of inconsistent condom use. Initiating sex work < 18 years (31.0%), binge drinking (23.7%), and experiencing physical violence (29.0%) were significantly associated with this behavior. Among the 2,564 FSWs reporting risky sexual behaviors, a higher prevalence was observed in FSWs aged 15–24 (75.6%), those with secondary or higher education (75.8%), nationals (74.4%), and those residing in Quelimane (87.3%). Early sexual debut (< 15 years, 79.3%), initiating sex work before 18 years of age (77.7%), and illicit drug use (82.2%) were all associated with increased risky sexual practices. Inconsistent condom use among FSWs was significantly associated with residing in Tete (aRR = 2.4, 95% CI: 1.77–3.25), not being aware of female condom (aRR = 1.22, 95% CI: 1.03–1.45) and having experienced sexual a physical violence. Moreover, being married was significantly linked to risky sexual behavior among female sex workers (aRR = 1.27, 95% CI: 1.19–1.37), along with initiating sexual activity before age 15, having at least five years of sex work experience, engaging in binge drinking, and experiencing sexual and physical violence.ConclusionThe study highlights the complex set of factors as age, education, geographic location, years of sex work services, early sexual debut, and illicit drug use that influence sexual risks behavior among FSWs in Mozambique. Tailored interventions addressing not only sexual health education and services, but also economic empowerment and illicit drug use is imperative for mitigating these risks.

Prevalence of Early Sexual Debut among Young Adolescents in Ten States of the United States

Prevalence of Early Sexual Debut among Young Adolescents in Ten States of the United States

School-Based Protective Factors for HIV Prevention in the United States: Secondary Analysis of the Youth Risk Behavior Survey 2015-2019.

This secondary analysis of the National Youth Risk Behavior Survey (years 2015-2019) examines associations between school-based protective factors (i.e., safe school environments and academic achievement) and HIV risk behaviors among sexually experienced adolescent gay and bisexual men ( n = 644), a population with the highest prevalence of undiagnosed HIV infections. Demographics included Hispanics/Latinos (25%, n = 158), Other race/ethnicity (14%, n = 88), and non-Hispanic Blacks/African Americans (13%, n = 81). Adjusted models showed that protective factors reduced odds for early sexual debut, multiple sexual partners, sex under the influence of drugs/alcohol, and condomless sex, with an additive effect demonstrated when two protective factors were present. Hispanics/Latinos had greater odds of reporting multiple sexual partners and HIV testing, indicating opportunities for school-based HIV prevention and further research. Our findings provide support for school-based programs that aim to improve social and structural determinants of health and ultimately reduce adolescent HIV burdens.

Developmental Trajectories of Transactional Sex and Age-Disparate Relationships During Adolescence: An HPTN 068 Analysis.

Transactional sex and sexual relationships with older partners increase HIV risk in adolescent girls and young women (AGYW), yet little is known about how these behaviors co-evolve over time. We characterize temporal patterns of transactional sex and age-disparate relationships among AGYW in South Africa. Longitudinal data are from a randomized controlled trial (HPTN 068) of school-aged, HIV-negative, AGYW who attended ≥ 3 study visits. We used group-based trajectory modeling to identify trajectories of transactional sex and age-disparate relationships (partner ≥ 5 years older) in the last year and assessed the interrelationship (conditional probability) between both trajectories. At baseline, median age was 14 years, 14.5% of girls were sexually active, and transactional sex (2.1%) and age-disparate relationships were uncommon (2.7%). We identified two trajectories for transactional sex ("low" [81.9%] and "increasing" [18.1%]) and two for age-disparate relationships ("low" [91.7%] and "increasing" [8.3%]). In a separate joint trajectory analysis, nearly a third (28%) had increasing trajectories for both transactional sex and age-disparate relationships, but most (53%) had a low trajectory of both outcomes. Baseline reporting of early sexual debut, depression, and inequitable gender norms were highest in the increasing transactional sex group. Prior pregnancy, early sexual debut, and IPV were highest among those with increasing age-disparate relationships. AGYW who engage in transactional sex or age-disparate partnerships in early adolescence are more likely to experience sustained engagement in both behaviors as they transition to adulthood, increasing HIV risk. Engaging girls early may maximize effectiveness of behavioral and biomedical HIV prevention efforts.

The Influence of Parental Role on Adolescent Sexual Behaviour and HIV/AIDS in KwaZulu-Natal, South Africa.

Background: HIV/AIDS risky behaviour remains a critical health concern for adolescents, specifically at high school level. In South Africa, the rapid increase of risky lifestyles and sexual behaviours among adolescents could be mainly attributed to poor parental skills and broken family structures. Four identified sexual risk behaviours that are of concern in South Africa are age at sexual debut, multiple sexual partners, condom use and transactional sex.Methods: Data was collected using a quantitative cross-sectional survey with samle consist with 450 male and female high school adolescents between 14 to 18 years from 3 different South African school settings. Collected data was analyzed using SPSS descriptive statistics procedure.Result: 79.7% of the respondents had only one parent still alive with 4.9 % of the respondents indicated to have lost both parents. Only 13.5% of the respondents were from a nuclear family. The majority of the respondents were (41.2%) living with grandparents. This high level of family disintegration, parental absence and poor parenting skills in South Africa exposed 73.3% (330) of the respondents to early sexual debut, transactional sex, unprotected sex and having multiple sexual partners. The study proved that there is a statistical association between guardianship and age at sexual debut; guardianship and multiple sexual partners; guardianship and condom use; guardianship and transactional sex.Conclusion : The revealed significant high risk sexual behaviour among adolescents in KwaZulu-Natal should inform Health and educational authorities to utilize these key findings to design more effective local strategies to train and assist parents and caregivers on parenting skills

Child welfare workers’ understanding of young people’s sexual health when conducting assessments due to substance use problems

Young people with substance use problems often have an early sexual debut, an increased risk of sexually transmitted infections and unplanned pregnancies, and a high risk of experiencing sexual violence. At the same time, according to the national action plan on sexual and reproductive health and rights (SRHR), the social services in Sweden have an important role in addressing sexual health in various contexts, such as in child welfare investigations. Therefore, this study has investigated how Swedish child welfare workers understand and relate to sexual health issues in child welfare investigations regarding young people with substance use problems. Following a strategic sampling, 15 child welfare workers were interviewed. The interviews were examined with a thematic content analysis with results showing that sexual health issues represented an area where knowledge was lacking. This was largely connected to that the child welfare workers had not been taught about SRHR in their bachelor’s degree nor in their continued education within the child welfare system. As a result of this, they often developed their own individual, professional approach for assessing sexual health matters, guided by the principle of “not investigating more than necessary”. When addressing sexual health in their assessment work, the child welfare workers primarily focused on risk, vulnerability and exposure. Not assessing young peoples’ sexual health was seen as protecting the right to confidentiality and privacy. In summary, this meant that young people with a problematic substance use were seldom given opportunities to talk about their sexual health, and especially not about positive sexual experiences related to their substance use.

Analysis of risky sexual behaviors among male college students who were sexually active in Sichuan, China: a cross-sectional survey

BackgroundMales have accounted for a significant share of new HIV infections among young people in the recent years. This study aimed to identify the factors associated with risky sexual behaviors, including early sexual debut, multiple sexual partnership and condomless sex, among sexually active male college students and provide implications for tailored health interventions.MethodsThe cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges that were located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with early sexual debut, multiple sexual partnership and condomless sex.ResultsThe average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, 48.60% reported multiple sexual partnership, and 16.52% did not use condoms at the latest sexual intercourse. Students who were younger (age ≤ 19, AOR = 7.60, 95%CI: 4.84–11.93; age20-21, AOR = 3.26, 95%CI: 2.04–5.21) and self-identified as sexual minorities (AOR = 2.38, 95%CI: 1.69–3.36) were more likely to have early sexual debut. The odds of having multiple sexual partners were higher among those who were ethnic minorities (AOR = 1.79, 95%CI: 1.33–2.41) and accepted extramarital sex (AOR = 1.33, 95%CI: 1.03–1.71). The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among those who had sufficient knowledgeable about HIV (AOR = 0.63, 95%CI: 0.44–0.89), were very confident in condom use efficacy (AOR = 0.26, 95%CI: 0.16–0.43) and confident (AOR = 0.48, 95%CI: 0.34–0.69). Early sexual debut was positively associated with multiple sexual partnership (AOR = 3.64, 95%CI: 2.82–4.71) and condomless sex at the latest intercourse (AOR = 1.53, 95%CI: 1.07–2.20), respectively.ConclusionEarly sexual debut, multiple sexual partnership and condomless sex were of considerable concern among male college students. Comprehensive sex education curricula were advised by developing customized information on HIV prevention, sexuality and empowering students with assertiveness and negotiation skills with regard to condom use during and before college.

Risky sexual behavior and associated factors among university students in Ethiopia: a cross-sectional national survey

BackgroundRisky sexual behavior (RSB) is one of the major youth sexual and reproductive health problems globally, including in Ethiopia. RSB among youth increases the risk of HIV infection, other sexually transmitted infections (STIs), unintended pregnancy, and unsafe abortion. Therefore, the aim of this study was to examine RSB and its associated factors among university students in Ethiopia.MethodsA cross-sectional study was employed in six randomly selected public universities in Ethiopia from August 2021 to February 2022. A stratified two-stage sampling technique was applied to reach the required number of study participants, and a structured self-administered questionnaire was used. RSB was defined as having had sexual relationships with more than one partner and using condoms with a new sexual partner irregularly or not at all in the last 12 months. Bivariable and multivariable logistic regression analyses were used to identify factors associated with RSB among those participants who were sexually active.ResultsThe prevalence of RSB among those who had had sexual intercourse in the last 12 months (n = 523) was 19.5% (n = 102). One hundred forty-four (29.9%) students had multiple sexual partners, and 325 (69.3%) students did not always use condoms with a new sexual partner. Adjusted odds ratios (AOR) showed that those students aged 21–24 years had lower odds of RSB than those aged above 25 years AOR 0.18 (95% CI 0.03–0.98). The adjusted odds of RSB were 6.7 times higher (95% CI 1.26–35.30) among students who started sex at the age of 10–17 years than those who started sex at 21 years and above and 3.9 times higher (95% CI 1.33–11.39) among students who had experienced emotional violence.ConclusionRSB continues to be a problem among university students in Ethiopia. Those students who started sex at an early age and those who experienced emotional violence were more likely to engage in RSB. Therefore, universities in Ethiopia should implement strategies such as RSB targeted health education programs that consider early sexual debut, experiences of emotional violence, and safe sexual practices.

Association Between Early Sexual Debut and New HIV Infections Among Adolescents and Young Adults in 11 African Countries

We investigated the association between early sexual debut and HIV infection among adolescents and young adults. Analyzing data from nationally representative Population-Based HIV Impact Assessment (PHIA) surveys in 11 African countries, the research employed a multivariate logistic regression model to assess the relationship between the early sexual debut and new HIV infections in the age group of 10–24 years. The results revealed a significant and robust association, indicating that young individuals who experienced early sexual debut were approximately 2.65 times more likely to contract HIV than those who did not, even after accounting for other variables. These findings align with prior research suggesting that early initiation of sexual activity may increase vulnerability to HIV infection due to factors such as biological susceptibility and risky behaviors like low condom use and multiple sexual partners. The implications of these findings for HIV prevention strategies are substantial, suggesting that interventions aimed at delaying sexual debut could be an effective component in reducing HIV risk for this population. Targeted sex education programs that address the risks of early sexual debut may play a pivotal role in these prevention efforts. By employing a comprehensive approach, there is a possibility to advance efforts towards ending AIDS by 2030.

Varying behavioral differences and correlates of HPV infection among young adolescents in Benue state, Nigeria

BackgroundHuman Papillomavirus (HPV) infection is a significant public health concern globally, especially in low- and middle-income countries. In Africa, including Nigeria, HPV prevalence is high, contributing to a substantial burden of cervical cancer. Despite challenges, massive HPV vaccination campaigns in Africa show promise for preventing cervical cancer cases. In Benue State, Nigeria, limited research exists on several aspects of HPV knowledge and attitudes towards HPV among secondary school students. This study aims to bridge this gap by assessing HPV knowledge, prevention practices, willingness to uptake HPV vaccination, and associated attitudes and behaviors among secondary school students in the state.MethodsThe cross-sectional study was conducted among adolescents aged 10–19 years in six secondary schools in three local government areas (LGAs) in Benue State, Nigeria. Two-stage sampling was used to select the LGAs and schools, with a final sample size of 591 students. The selected schools represent both junior and senior secondary school levels and span across the three senatorial districts of the state. Data were collected using a self-administered questionnaire covering sociodemographic characteristics, HPV knowledge, prevention practices, and willingness for HPV vaccination. Statistical analyses included univariate analyses and tests of association, with significance set at p < 0.05 or 0.001 depending on the level of the stringency of the evidence required. Data were analyzed using SPSS version 25.ResultsOnly 35.4% of the participants were males, and 86.8% were between the ages of 10 and 16. Only 24.7% acknowledged that HPV can be transmitted during sexual intercourse, and 36.2% recognized that HPV can be transmitted via skin-to-skin contact. 48.1% noted that HPV can cause cervical cancer. Half (50.9%) acknowledged that early sexual debut increases the risk of acquiring HPV, while only 28.1% recognized vaccination as a preventive strategy against HPV infection. Only 35% correctly stated the best time for the HPV vaccine. In assessing the practice of HPV prevention, 14.9% are in a sexual relationship and 10.3% admitted to not using condoms during sexual intercourse. Also, 11.8% have had STIs, and 27.2% have previously undergone HIV screening. Various bivariate analyses showed some varying behavioral differences and correlates of HPV infection among young adolescents in Benue State, Nigeria.ConclusionsThis study provides valuable insights into HPV knowledge, prevention practices, and willingness to uptake HPV vaccination among secondary school students in Benue State, Nigeria. The significance of the differences and correlates was discussed using themes. The research has unpacked complex relationships that could have public health implications for researchers and policymakers. Moreover, ten actionable policy recommendations were prescribed. Several interventions and areas for further study were proposed.

Associations between lifetime pregnancy and sexual risk behaviors among 15-24-year-old adolescent girls and young women in South Africa: Secondary analyses of the 2016 Demographic Health Survey.

Adolescent girls and young women (AGYW) in South Africa are highly vulnerable to HIV and poor sexual and reproductive health (SRH) outcomes. Interventions must respond to the unique needs of different AGYW groups, such as AGYW who have ever been pregnant. The objective of the study is to examine associations between pregnancy and sexual risk behaviors among AGYW in South Africa. This study used the 2016 nationally representative Demographic and Health Survey (DHS) of South Africa (n = 1935, 15-24 years old). Sexual risk behavior outcomes included: early sexual debut (defined as having sexual intercourse before the age of 15 years), age-disparate relationship (defined as having sexual partners who are five years and older in the past one month), multiple sexual partnerships, no condom use at last sex, and lastly, cumulative sexual risk (defined as reporting at least two of the outcomes: early sexual debut, age-disparate relationship, multiple sexual partners, and no condom use at last sex). Data analyses were conducted using logistic regression in STATA version 16. Statistical significance was determined at a P-value less than 0.05, with 95% confidence interval reported. AGYW who experienced lifetime pregnancy were more likely to report early sexual debut (OR = 1.71, 95%CI = 1.30-2.32), age-disparate relationships (OR = 1.58, 95%CI = 1.20-2.08), no condom use at last sex (OR = 2.77, 95%CI = 2.09-3.69), and cumulative sexual risk (OR = 1.82, 95%CI = 1.38-2.41). Multiple sexual partnerships showed no significant associations with lifetime pregnancy. Married or cohabiting AGYW were more likely to report cumulative sexual risk behaviors. (OR = 2.67, 95%CI = 1.91-3.71). Cumulative sexual risk behaviors were lower among AGYW with secondary education (OR = 0.57, 95%CI = 0.33-0.99) and those from rich households (OR = 0.62, 95%CI = 0.43-0.88). The findings underscore the need for interventions promoting safe sex and relationships, especially among AGYW who have experienced pregnancy. Programming should address the structural, socio-economic drivers of early pregnancy.

Individual and community-level factors associated with repeat induced abortion among women in Ghana: a multivariable complex sample logistic regression analysis of 2017 Ghana maternal health survey

BackgroundRepeat induced abortion is a serious public health issue that has been linked to adverse maternal health outcomes. However, knowledge about repeat induced abortion and its associated factors among reproductive age women in Ghana is very scarce. The objective of this study is to examine individual and community factors associated with repeat induced abortion in Ghana which would be helpful to design appropriate programmes and policies targeted at improving the sexual and reproductive health of women.MethodsWe used secondary cross-sectional data from the 2017 Ghana Maternal Health Survey. The study included a weighted sample of 4917 women aged 15–49 years with a history of induced abortion. A multivariable complex sample logistic regression analysis was used to investigate individual and community factors associated with repeat induced abortion among women in Ghana. Adjusted odds ratios (AOR) with 95% confidence intervals (CI) was used to measure the association of variables.ResultsOf the 4917 reproductive women with a history of abortion, 34.7% have repeat induced abortion. We find that, compared to women who experience single induced abortion, women who experience repeat abortion are age 25–34 years (AOR:2.16;95%CI = 1.66–2.79) or 35–49 years (AOR:2.95;95%CI:2.18–3.99), have Middle/JHS education (AOR:1.69;95%CI = 1.25–12.27), use contraceptive at the time of conception (AOR:1.48: 95%CI = 1.03–2.14), had sexual debut before 18 years (AOR:1.57; 95%CI: 1.33–1.85) and reside in urban areas (AOR:1.29;95%CI = 1.07–1.57). On the other hand, women who reside in Central (AOR:0.68;95%CI: 0.49–0.93), Northern (AOR:0.46;95%CI:0.24–0.88), Upper West (AOR:0.24; 95%CI: 0.12–0.50) and Upper East (AOR:0.49; 95%CI = 0.24–0.99) regions were less likely to have repeat induced abortion.ConclusionThe study showed that both individual and community level determinants were significantly associated with repeat induced abortion. Based on the findings, it is recommended to promote sexual and reproductive health education and more emphasis should be given to adult, those with early sexual debut, those with Middle/JHS education and those who live in urban centers.

Spatial Heterogeneity in Determinants of No Condom Use at First Sex in South Africa

Background Condom use, especially at first sex for unmarried people, is an important behaviour that reduces the risk of HIV transmission, and other Sexually Transmitted Diseases (STDs), as well as unwanted pregnancies. In reviewing the literature, little information was found to elucidate the spatial context of condom use among people who had an early sexual debut. Understanding factors that influence no condom use at first sex in different local or geographical areas can add value in addressing these risky first-sex practices and minimise the risk of getting HIV, STDs, and unwanted pregnancies in South Africa, especially among young people. Therefore, this paper aimed to determine the spatial heterogeneity of factors associated with no condom use at first sex in South Africa using Geographically Weighted Regression (GWR) with Poisson distribution and local bivariate relationships. Methods This article used data from the fifth South African National HIV Prevalence, HIV Incidence, Behaviour and Communication Survey (SABSSM V) of 2017. Spatial autocorrelation, GWR using Poisson distribution, and local bivariate relationships were undertaken using ArcGIS Pro. Results Geographically weighted regression using Poisson distribution results highlighted being female, being young, having never married, being unemployed, having sexual debut at a younger age, having two or more sexual partners, having no risk of being infected with HIV, and having good Self-perceived Health (SPH) to be significant factors influencing no condom use at first sex, with pseudo R2 = 0.96 and AICc = 692. Local bivariate relationships showed the relationship between no condom use at first sex and most explanatory variables to exhibit a positive linear relationship in most districts with the exception of having never married, which showed a positive linear relationship in only 18 districts, while 33 districts showed a concave relationship. These relationships were all significant with p &lt; 0.05. Conclusion This localised analytical approach may contribute to the development of geo-targeted interventions and policies tailored to specific regions within South Africa, thereby improving the effectiveness of efforts to promote safe first sexual practices. Educational programs targeting youth should be developed to further raise awareness of the risks associated with unprotected sex and the importance of condom use. More efforts should be made to break the barriers, such as sexual relationship power, gender, and sociocultural and religious influences, which tend to put young, never-married, and unemployed women at risk of no condom use at first sexual debut. It is further recommended that the type of relationship between no condom use at first sex and each explanatory factor at the local region be considered during geo-targeted interventions as this will assist in the type of intervention and duration of intervention.