Is Early Sexual Debut a Risk Factor for <scp>HIV</scp> Infection Among Women in Sub‐Saharan Africa? A Systematic Review

Stöckl, Heidi; Kalra, Naira; Jacobi, Jantine; Watts, Charlotte

doi:10.1111/aji.12043

Cited by 99 publications

(92 citation statements)

References 36 publications

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“…The overall results showed that HIV risk was higher among currently and previously married individuals, low circumcision rates and high-risk sexual behaviours. These findings are consistent with those observed in previous studies based on DHS data [12,14,17,39,41,44]. A possible explanation for increased likelihood for HIV infections among divorced/separated individuals could be that previously married individuals tend to have more sexual partners than single or married individuals [45].…”

Section: Discussionsupporting

confidence: 92%

Spatial analysis of factors associated with HIV infection among young people in Uganda, 2011

Chimoyi

Musenge

2014

BMC Public Health

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BackgroundThe HIV epidemic in East Africa is of public health importance with an increasing number of young people getting infected. This study sought to identify spatial clusters and examine the geographical variation of HIV infection at a regional level while accounting for risk factors associated with HIV/AIDS among young people in Uganda.MethodsA secondary data analysis was conducted on a survey cross-sectional design whose data were obtained from the 2011 Uganda Demographic and Health Survey (DHS) and AIDS Indicator Survey (AIS) for 7 518 young people aged 15-24 years. The analysis was performed in three stages while incorporating population survey sampling weights. Maximum likelihood-based logistic regression models were used to explore the non-spatially adjusted factors associated with HIV infection. Spatial scan statistic was used to identify geographical clusters of elevated HIV infections which justified modelling using a spatial random effects model by Bayesian-based logistic regression models.ResultsIn this study, 309/533 HIV sero-positive female participants were selected with majority residing in the rural areas [386(72%)]. Compared to singles, those currently [Adjusted Odds Ratio (AOR) =3.64; (95% CI; 1.25-10.27)] and previously married [AOR = 5.62; (95% CI: 1.52-20.75)] participants had significantly higher likelihood of HIV infections. Sexually Transmitted Infections [AOR = 2.21; (95% CI: 1.35-3.60)] were more than twice likely associated with HIV infection. One significant (p < 0.05) primary cluster of HIV prevalence around central Uganda emerged from the SaTScan cluster analysis. Spatial analysis disclosed behavioural factors associated with greater odds of HIV infection such as; alcohol use before sexual intercourse [Posterior Odds Ratio (POR) =1.32; 95% (BCI: 1.11-1.63)]. Condom use [POR = 0.54; (95% BCI: 0.41-0.69)] and circumcision [POR = 0.66; (95% BCI: 0.45-0.99)] provided a protective effect against HIV.ConclusionsThe study revealed associations between high-risk sexual behaviour and HIV infection. Behavioural change interventions should therefore be pertinent to the prevention of HIV. Spatial analysis further revealed a significant HIV cluster towards the Central and Eastern areas of Uganda. We propose that interventions targeting young people should initially focus on these regions and subsequently spread out across Uganda.

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Section: Discussionsupporting

confidence: 92%

Spatial analysis of factors associated with HIV infection among young people in Uganda, 2011

Chimoyi

Musenge

2014

BMC Public Health

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“…These include risky sexual behaviours such as multiple partners, sex under the influence of alcohol or drugs, unplanned pregnancy and sexually transmitted infections (STIs), including HIV. [1][2][3] Early sexual debut not only increases risks to sexual and reproductive health but is also associated with experiences of sexual coercion. [4][5][6] Sexual coercion has been defined as the act of forcing (or attempting to force) another individual, through violence, threats, verbal insistence, deception, cultural expectations or economic circumstances, to engage in sexual behaviour against his or her will.…”

mentioning

confidence: 99%

Early sexual debut: Voluntary or coerced? Evidence from longitudinal data in South Africa – the Birth to Twenty Plus study

et al. 2015

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Background. Early sexual debut, voluntary or coerced, increases risks to sexual and reproductive health. Sexual coercion is increasingly receiving attention as an important public health issue owing to its association with adverse health and social outcomes. Objective. To describe voluntary and coerced experience at sexual debut. Methods. A longitudinal perspective among 2 216 adolescents (1 149 females, 1 067 males) in a birth cohort study in South Africa, analysing data collected on six occasions between 11 and 18 years. Results. The median age of sexual debut was 16 years for females and 15 for males. Reported coerced sexual debut included children <11 years of age. Males reported earlier sexual debut, with both voluntary and coerced sexual experience, than females (p<0.0001). Sexual coercion at early sexual debut among both male and female adolescents occurred mostly through sexual intercourse with older adolescents and partners of the same age. Conclusion. The identified time periods and age groups need to be targeted for interventions to delay sexual debut and prevent sexual coercion among young people. More research is needed to understand underlying predisposing risk factors for sexual coercion at sexual debut, both early and not early.

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“…This association may suggest biologic susceptibility during physical development, high-risk sexual behaviours and lack of access to or low use of condoms at a young age, and/or an association with duration of sexual activity [33,34]. Likewise, the association of prevalent HIV infection with older current age may be due to higher cumulative risk exposures for acquisition of HIV.…”

Section: Discussionmentioning

confidence: 99%

“…Likewise, the association of prevalent HIV infection with older current age may be due to higher cumulative risk exposures for acquisition of HIV. However, estimating the duration of sexual activity is challenging as sexual behaviours are not static, but vary across the life course and as partnerships change [34]. While study-related factors such as low power and potential misclassification of behaviours may partially explain insignificant findings, broader factors such as high background prevalence of HIV in the MSM population [35], biologic susceptibility of rectal mucosa [36] and network-level characteristics may also be more determinative in driving HIV transmission and acquisition risks among these men [35,37].…”

Section: Discussionmentioning

confidence: 99%

The epidemiology of HIV and prevention needs among men who have sex with men in Africa

Wolf¹,

Cheng²,

Kapesa³

2013

Journal of the International AIDS Society

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IntroductionMen who have sex with men (MSM) in Kenya are at high risk for HIV and may experience prejudiced treatment in health settings due to stigma. An on-line computer-facilitated MSM sensitivity programme was conducted to educate healthcare workers (HCWs) about the health issues and needs of MSM patients.MethodsSeventy-four HCWs from 49 ART-providing health facilities in the Kenyan Coast were recruited through purposive sampling to undergo a two-day MSM sensitivity training. We conducted eight focus group discussions (FGDs) with programme participants prior to and three months after completing the training programme. Discussions aimed to characterize HCWs’ challenges in serving MSM patients and impacts of programme participation on HCWs’ personal attitudes and professional capacities.ResultsBefore participating in the training programme, HCWs described secondary stigma, lack of professional education about MSM, and personal and social prejudices as barriers to serving MSM clients. After completing the programme, HCWs expressed greater acknowledgement of MSM patients in their clinics, endorsed the need to treat MSM patients with high professional standards and demonstrated sophisticated awareness of the social and behavioural risks for HIV among MSM.ConclusionsFindings provide support for this approach to improving health services for MSM patients. Further efforts are needed to broaden the reach of this training in other areas, address identified barriers to HCW participation and evaluate programme effects on patient and HCW outcomes using rigorous methodology.

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Is Early Sexual Debut a Risk Factor for HIV Infection Among Women in Sub‐Saharan Africa? A Systematic Review

Abstract: CitationSt€ ockl H, Kalra N, Jacobi J, Watts C. Is early sexual debut a risk factor for hiv infection among women in sub-Saharan Africa? A systematic review.

Cited by 99 publications

References 36 publications

Spatial analysis of factors associated with HIV infection among young people in Uganda, 2011

Spatial analysis of factors associated with HIV infection among young people in Uganda, 2011

Early sexual debut: Voluntary or coerced? Evidence from longitudinal data in South Africa – the Birth to Twenty Plus study

The epidemiology of HIV and prevention needs among men who have sex with men in Africa

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