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TIMING OF SEXUAL DEBUT AMONG UNMARRIED YOUTHS AGED 15–24 YEARS IN SUB-SAHARAN AFRICA

Published online by Cambridge University Press:  06 April 2017

Joshua Amo-Adjei*
Affiliation:
African Population and Health Research Centre, Nairobi, Kenya Department of Population and Health, University of Cape Coast, Ghana
Derek Anamaale Tuoyire
Affiliation:
Department of Community Medicine, School of Medical Sciences, University of Cape Coast, Ghana
*
1Corresponding author. Email: joshua.amo-adjei@ucc.edu.gh

Summary

This study aimed to contribute to the evidence on the timing of sexual debut in young people in sub-Saharan African countries. Data were extracted from 34 nationally representative surveys conducted in the region between 2006 and 2014. The study sample comprised unmarried women (n=167,932) and men (n=76,900) aged 15–24 years. Descriptive techniques and Cox proportional regression models were used to estimate the timing of sexual debut, and Kaplan–Meier hazard curves were used to describe the patterns of sexual debut in each country by sex. For the countries studied, sexual debut for both women and men occurred between the ages of 15 and 18 years, with median ages of 16 for women and 17 for men. Overall, education and household wealth provided significant protection against early sexual debut among women, but the reverse was found among men for wealth. Women in rural areas, in female-headed households and in Central, South and West Africa reported higher hazards of early commencement of sexual activity than their counterparts in urban, male-headed households and East Africa. However, the impact of these variables on male sexual debut did not follow a consistent pattern. Varied timing, as well as country-specific risk factors associated with sexual debut for young women and men across sub-Saharan Africa, were identified. Sexual health programmes and interventions for young people may require different approaches for young women and men.

Type
Research Article
Copyright
Copyright © Cambridge University Press, 2017 

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References

Adamczyk, A. & Greif, M. (2011) Education and risky sex in Africa: unraveling the link between women’s education and reproductive health behaviors in Kenya. Social Science Research 40(2), 654666.Google Scholar
Akwara, P. A., Madise, N. J. & Hinde, A. (2003) Perception of risk of HIV/AIDS and sexual behaviour in Kenya. Journal of Biosocial Science 35(3), 385411.Google Scholar
Barkat, A. & Majid, M. (2003) Adolescent reproductive health in Bangladesh: status, policies, programs and issues. POLICY Project Report. USAID Asia/Near East Bureau.Google Scholar
Bearinger, L. H., Sieving, R. E., Ferguson, J. & Sharma, V. (2007) Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. The Lancet 369(9568), 12201231.Google Scholar
Bezuidenhoudt, J., Dube, N., Kuonza, L., Zungu, N. & Zuma, K. (2014) Age disparate sex among South African young females: National HIV Survey, 2008 – preliminary findings. International Journal of Infectious Diseases 21, 105.Google Scholar
Bruin, J. (2006) Newtest: Command to Compute New Test. Statistical Consulting Group, UCLA.Google Scholar
Campbell, C. & MacPhail, C. (2002) Peer education, gender and the development of critical consciousness: participatory HIV prevention by South African youth. Social Science & Medicine 55(2), 331345.CrossRefGoogle ScholarPubMed
Choudhry, V., Östergren, P-O., Ambresin, A-E., Kyagaba, E. & Agardh, A. (2014) Giving or receiving something for sex: a cross-sectional study of transactional sex among Ugandan university students. PLoS One 9(11), e112431.Google Scholar
Сox, D. (1972) Regression models and life-tables. Journal of the Royal Statistical Society . Series B 34(2), 187220.Google Scholar
Downing, J. & Bellis, M. A. (2009) Early pubertal onset and its relationship with sexual risk taking, substance use and anti-social behaviour: a preliminary cross-sectional study. BMC Public Health 9(446).Google Scholar
Doyle, A. M., Mavedzenge, S. N., Plummer, M. L. & Ross, D. A. (2012) The sexual behaviour of adolescents in sub‐Saharan Africa: patterns and trends from national surveys. Tropical Medicine & International Health 17(7), 796807.Google Scholar
Edwards, L. M., Haglund, K., Fehring, R. J. & Pruszynski, J. (2011) Religiosity and sexual risk behaviors among Latina adolescents: trends from 1995 to 2008. Journal of Women’s Health 20(6), 871877.Google Scholar
Fatusi, A. O. & Blum, R. W. (2008) Predictors of early sexual initiation among a nationally representative sample of Nigerian adolescents. BMC Public Health 8(136), 1.CrossRefGoogle ScholarPubMed
Fonner, V. A., Armstrong, K. S., Kennedy, C. E., O’Reilly, K. R. & Sweat, M. D. (2014) School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis. PLoS One 9(3), e89692.CrossRefGoogle ScholarPubMed
French, D. C. & Dishion, T. J. (2003) Predictors of early initiation of sexual intercourse among high-risk adolescents. Journal of Early Adolescence 23(3), 295315.Google Scholar
Ghebremichael, M., Larsen, U. & Paintsil, E. (2009) Association of age at first sex with HIV-1, HSV-2 and other sexual transmitted infections among women in northern Tanzania. Sexually Transmitted Diseases 36(9), 570.Google Scholar
Ghebremichael, M. S. & Finkelman, M. D. (2013) The effect of premarital sex on sexually transmitted infections (STIs) and high risk behaviors in women. Journal of AIDS and HIV Research 5(2), 5964.Google Scholar
Heywood, W., Patrick, K., Smith, A. M. A. & Pitts, M. K. (2015) Associations between early first sexual intercourse and later sexual and reproductive outcomes: a systematic review of population-based data. Archives of Sexual Behavior 44(3), 531569.Google Scholar
Higgins, J. A., Hoffman, S. & Dworkin, S. L. (2010) Rethinking gender, heterosexual men, and women’s vulnerability to HIV/AIDS. American Journal of Public Health 100(3), 435445.Google Scholar
Hindin, M. J. & Fatusi, A. O. (2009) Adolescent sexual and reproductive health in developing countries: an overview of trends and interventions. International Perspectives on Sexual and Reproductive Health 35(2), 5862.Google Scholar
Horrell, S. & Krishnan, P. (2007) Poverty and productivity in female-headed households in Zimbabwe. Journal of Development Studies 43(8), 13511380.Google Scholar
Houlihan, C. F., Baisley, K., Bravo, I. G., Kapiga, S., de Sanjosé, S., Changalucha, J. et al. (2016) Rapid acquisition of HPV around the time of sexual debut in adolescent girls in Tanzania. International Journal of Epidemiology 45(3), 762773.Google Scholar
Kabiru, C. W., Beguy, D., Undie, C-C., Zulu, E. M. & Ezeh, A. C. (2010) Transition into first sex among adolescents in slum and non-slum communities in Nairobi, Kenya. Journal of Youth Studies 13(4), 453471.CrossRefGoogle ScholarPubMed
Kabiru, C. W. & Orpinas, P. (2009) Factors associated with sexual activity among high-school students in Nairobi, Kenya. Journal of Adolescence 32(4), 10231039.Google Scholar
Kaestle, C. E., Halpern, C. T., Miller, W. C. & Ford, C. A. (2005) Young age at first sexual intercourse and sexually transmitted infections in adolescents and young adults. American Journal of Epidemiology 161(8), 774780.Google Scholar
Kaufman, C. E. & Stavrou, S. E. (2004) ‘Bus fare please’: the economics of sex and gifts among young people in urban South Africa. Culture, Health & Sexuality 6(5), 377391.CrossRefGoogle Scholar
Kumi-Kyereme, A., Awusabo-Asare, K., Biddlecom, A. & Tanle, A. (2007) Influence of social connectedness, communication and monitoring on adolescent sexual activity in Ghana. African Journal of Reproductive Health 11(1), 133.Google Scholar
Langley, C. (2016) Father knows best: paternal presence and sexual debut in African-American adolescents living in poverty. Family Process 55(1), 155170.Google Scholar
Lavikainen, H. M., Lintonen, T. & Kosunen, E. (2009) Sexual behavior and drinking style among teenagers: a population-based study in Finland. Health Promotion International 24(2), 108119.Google Scholar
Lindberg, L. D. & Maddow-Zimet, I. (2012) Consequences of sex education on teen and young adult sexual behaviors and outcomes. Journal of Adolescent Health 51(4), 332338.Google Scholar
Luke, N. (2003) Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Studies in Family Planning 34(2), 6786.Google Scholar
Maticka‐Tyndale, E., Gallant, M., Brouillard‐Coyle, C., Holland, D., Metcalfe, K., Wildish, J. & Gichuru, M. (2005) The sexual scripts of Kenyan young people and HIV prevention. Culture, Health & Sexuality 7(1), 2741.CrossRefGoogle ScholarPubMed
Mmbaga, E. J., Leonard, F. & Leyna, G. H. (2012) Incidence and predictors of adolescent’s early sexual debut after three decades of HIV interventions in Tanzania: a time to debut analysis. PLoS One 7(7), e41700.Google Scholar
Moore, A. M., Biddlecom, A. E. & Zulu, E. M. (2007) Prevalence and meanings of exchange of money or gifts for sex in unmarried adolescent sexual relationships in sub-Saharan Africa. African Journal of Reproductive Health 11(3), 4461.Google Scholar
Mumah, J., Kabiru, C., Izugbara, C. & Mukiira, C. (2014) Coping with Unintended Pregnancies: Narratives from Adolescents in Nairobi’s Slums. Kenya African Population and Health Research Center, Nairobi.Google Scholar
Nattrass, N. (2004) The Moral Economy of AIDS in South Africa. Cambridge University Press.Google Scholar
O’Donnell, L., O’Donnell, C. R. & Stueve, A. (2001) Early sexual initiation and subsequent sex-related risks among urban minority youth: the Reach for Health Study. Family Planning Perspectives 33(6), 268275.Google Scholar
Okigbo, C. C., Kabiru, C. W., Mumah, J. N., Mojola, S. A. & Beguy, D. (2015) Influence of parental factors on adolescents’ transition to first sexual intercourse in Nairobi, Kenya: a longitudinal study. Reproductive Health 12, 73.Google Scholar
Oman, R. F., Vesely, S. K. & Aspy, C. B. (2005) Youth assets and sexual risk behavior: the importance of assets for youth residing in one‐parent households. Perspectives on Sexual and Reproductive Health 37(1), 2531.Google Scholar
Pettifor, A. E., Van Der Straten, A., Dunbar, M. S., Shiboski, S. C. & Padian, N. S. (2004) Early age of first sex: a risk factor for HIV infection among women in Zimbabwe. AIDS 18(10), 14351442.Google Scholar
Price, M. N. & Hyde, J. S. (2009) When two isn’t better than one: predictors of early sexual activity in adolescence using a cumulative risk model. Journal of Youth and Adolescence 38(8), 10591071.CrossRefGoogle ScholarPubMed
Rector, R. E., Johnson, K. A., Noyes, L. R. & Martin, S. (2003) The Harmful Effects of Early Sexual Activity and Multiple Sexual Partners among Women: A Book of Charts. The Heritage Foundation, Washington.Google Scholar
Rutstein, S. O. & Johnson, K. (2004) The DHS Wealth Index. OCR Macro, Calverton, MD.Google Scholar
Salih, N. A., Metaferia, H., Reda, A. A. & Biadgilign, S. (2015) Premarital sexual activity among unmarried adolescents in northern Ethiopia: a cross-sectional study. Sexual & Reproductive Healthcare 6(1), 913.Google Scholar
Santelli, J. S., Lindberg, L. D., Abma, J., McNeely, C. S. & Resnick, M. (2000) Adolescent sexual behavior: estimates and trends from four nationally representative surveys. Family Planning Perspectives 33(4), 156194.Google Scholar
Santhya, K., Acharya, R., Jejeebhoy, S. J. & Ram, U. (2011) Timing of first sex before marriage and its correlates: evidence from India. Culture, Health & Sexuality 13(03), 327341.Google Scholar
Singh, S., Wulf, D., Samara, R. & Cuca, Y. P. (2000) Gender differences in the timing of first intercourse: data from 14 countries. International Family Planning Perspectives 26(1), 2143.Google Scholar
Smith, D. J. (2004) Youth, sin and sex in Nigeria: Christianity and HIV/AIDS‐related beliefs and behaviour among rural–urban migrants. Culture, Health & Sexuality 6(5), 425437.Google Scholar
Snyder, A. R., McLaughlin, D. K. & Findeis, J. (2006) Household composition and poverty among female‐headed households with children: differences by race and residence. Rural Sociology 71(4), 597624.CrossRefGoogle Scholar
Speizer, I. S., Fotso, J. C., Davis, J. T., Saad, A. & Otai, J. (2013) Timing and circumstances of first sex among female and male youth from select urban areas of Nigeria, Kenya, and Senegal. Journal of Adolescent Health 53(5), 609616.Google Scholar
Spriggs, A. L. & Halpern, C. T. (2008) Sexual debut timing and depressive symptoms in emerging adulthood. Journal of Youth and Adolescence 37(9), 10851096.Google Scholar
Stoebenau, K., Heise, L., Wamoyi, J. & Bobrova, N. (2016) Revisiting the understanding of “transactional sex” in sub-Saharan Africa: a review and synthesis of the literature. Social Science & Medicine 168, 186197.Google Scholar
Tenkorang, E. Y. & Maticka-Tyndale, E. (2008) Factors influencing the timing of first sexual intercourse among young people in Nyanza, Kenya. International Family Planning Perspectives 34(4), 177188.CrossRefGoogle ScholarPubMed
White, R., Cleland, J. & Caraël, M. (2000) Links between premarital sexual behaviour and extramarital intercourse: a multi-site analysis. AIDS 14(15), 23232331.Google Scholar
Yode, M. & LeGrand, T. (2012) Association between age at first sexual relation and some indicators of sexual behaviour among adolescents. African Journal of Reproductive Health 16(2), 173188.Google Scholar
Zaba, B., Pisani, E., Slaymaker, E. & Boerma, J. T. (2004) Age at first sex: understanding recent trends in African demographic surveys. Sexually Transmitted Infections 80(2), ii28–ii35.Google Scholar
Zembe, Y. Z., Townsend, L., Thorson, A. & Ekström, A. M. (2013) “Money talks, bullshit walks” interrogating notions of consumption and survival sex among young women engaging in transactional sex in post-apartheid South Africa: a qualitative enquiry. Globalization and Health 9(28).Google Scholar