TY - JOUR
T1 - Early sexual debut is associated with drug use and decreased educational attainment among males and females in Kisumu County, Kenya
AU - the RV393 Study Team
AU - Sing’oei, Valentine
AU - Owuoth, John K.
AU - Otieno, June
AU - Yates, Adam
AU - Andagalu, Ben
AU - Smith, Hunter J.
AU - Copeland, Nathanial K.
AU - Polyak, Christina S.
AU - Crowell, Trevor A.
AU - Adongo, Rachel
AU - Aguttu, Rachel
AU - Akala, Hosea
AU - Ake, Julie
AU - Bondo, Michael
AU - Broach, Erica
AU - Busisa, Christine
AU - Cowden, Jessica
AU - de Souza, Mark
AU - Eller, Leigh Anne
AU - Gogo, Milicent
AU - Hassen, Zebiba
AU - Hu, Dale
AU - Imbach, Michelle
AU - Juma, Anne
AU - Kasera, Oscar
AU - Li, Qun
AU - Mbuchi, Margaret
AU - Milazzo, Mark
AU - Modjarrad, Kayvon
AU - Ngonda, Eric
AU - Nwoga, Chiaka
AU - Nyariro, Jacob
AU - Ochola, Jew
AU - Ohore, Roseline
AU - Okumu, Thomas
AU - Omondi, Mary
AU - Omondi, Timothy
AU - Ooro, Linnah
AU - Orando, Beatrice
AU - Owira, Victorine
AU - Oyugi, Roselyn
AU - Robb, Merlin
AU - Rono, Eric
AU - Tran, Chi
N1 - Funding Information:
The authors are thankful to the study participants who made this work possible. Institutions that supported this work included the Kenya Medical Research Institute (KEMRI), US Army Medical Research Directorate – Africa (USMRD-A), Henry M. Jackson Foundation for the Advancement of Military Medicine (HJF), HJF Medical Research International (HJFMRI), US Military HIV Research Program (MHRP), Walter Reed Army Institute of Research (WRAIR), and the Kenya Ministry of Health. In addition to the masthead authors of this manuscript, the RV393 Study Group includes: Rachel Adongo, Rachel Aguttu, Hosea Akala, Julie Ake, Michael Bondo, Erica Broach, Christine Busisa, Jessica Cowden, Mark de Souza, Leigh Anne Eller, Milicent Gogo, Zebiba Hassen, Dale Hu, Michelle Imbach, Anne Juma, Oscar Kasera, Qun Li, Margaret Mbuchi, Mark Milazzo, Kayvon Modjarrad, Eric Ngonda, Chiaka Nwoga, Jacob Nyariro, Jew Ochola, Roseline Ohore, Thomas Okumu, Mary Omondi, Timothy Omondi, Linnah Ooro, Beatrice Orando, Victorine Owira, Roselyn Oyugi, Merlin Robb, Eric Rono, and Chi Tran.
Funding Information:
This work was supported by cooperative agreements (W81XWH-11-2-0174; W81XWH-18-2-0040) between the Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., and the U.S. Department of Defense. This research was funded, in part, by the U.S. National Institute of Allergy and Infectious Diseases.
Publisher Copyright:
© 2023, The Author(s).
PY - 2023/12
Y1 - 2023/12
N2 - Differing global sociocultural contexts of sexual relationships influence age at first sexual intercourse with potentially long-lasting region-specific effects such as increased risk of contracting HIV and other sexually transmitted infections (STIs). In these cross-sectional analyses of data from the screening and enrollment visits for an HIV incidence study in Kisumu County, Kenya, we evaluated factors associated with having experienced an early sexual debut (ESD) among males and females aged 18–35 years. Clinical evaluation was performed and sexual behaviors were assessed via questionnaire. ESD was defined as self-reported age 15 years or younger at first sexual intercourse. Robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ESD. Of 1057 participants, 542 (51.3%) were female. Participants' median age at study screening was 25 years (interquartile range [IQR]: 22–29), and at sexual debut was 16 years (IQR: 14–17). Five hundred and four participants (47.7%) reported ESD. ESD was less common among females (PR 0.78, CI 0.67–0.90) and participants with more than primary education (PR 0.56, CI 0.47–0.66). ESD was more common in participants with a history of drug use (PR 1.28, CI 1.10–1.49). Drug use removed the protective effect of education (some secondary education or less, no drug use: PR 0.72, CI 0.61–0.85; some secondary education or less, drug use: PR 0.94, CI 0.74–1.18). ESD was common in our study and associated with lower educational attainment and increased likelihood of drug use. Interventions are needed early in life, well before 15 years of age, to encourage engagement in schooling and prevent drug use. Comprehensive sexual education and interventions to prevent drug use may be beneficial before the age of 15 years.
AB - Differing global sociocultural contexts of sexual relationships influence age at first sexual intercourse with potentially long-lasting region-specific effects such as increased risk of contracting HIV and other sexually transmitted infections (STIs). In these cross-sectional analyses of data from the screening and enrollment visits for an HIV incidence study in Kisumu County, Kenya, we evaluated factors associated with having experienced an early sexual debut (ESD) among males and females aged 18–35 years. Clinical evaluation was performed and sexual behaviors were assessed via questionnaire. ESD was defined as self-reported age 15 years or younger at first sexual intercourse. Robust Poisson regression was used to estimate prevalence ratios (PRs) and 95% confidence intervals (95% CIs) for factors associated with ESD. Of 1057 participants, 542 (51.3%) were female. Participants' median age at study screening was 25 years (interquartile range [IQR]: 22–29), and at sexual debut was 16 years (IQR: 14–17). Five hundred and four participants (47.7%) reported ESD. ESD was less common among females (PR 0.78, CI 0.67–0.90) and participants with more than primary education (PR 0.56, CI 0.47–0.66). ESD was more common in participants with a history of drug use (PR 1.28, CI 1.10–1.49). Drug use removed the protective effect of education (some secondary education or less, no drug use: PR 0.72, CI 0.61–0.85; some secondary education or less, drug use: PR 0.94, CI 0.74–1.18). ESD was common in our study and associated with lower educational attainment and increased likelihood of drug use. Interventions are needed early in life, well before 15 years of age, to encourage engagement in schooling and prevent drug use. Comprehensive sexual education and interventions to prevent drug use may be beneficial before the age of 15 years.
KW - Africa South of the Sahara
KW - Early sexual debut
KW - HIV
KW - Kenya
KW - Sex initiation
KW - Sexual behavior
UR - http://www.scopus.com/inward/record.url?scp=85165875148&partnerID=8YFLogxK
U2 - 10.1186/s12978-023-01639-3
DO - 10.1186/s12978-023-01639-3
M3 - Article
C2 - 37501066
AN - SCOPUS:85165875148
SN - 1742-4755
VL - 20
JO - Reproductive Health
JF - Reproductive Health
IS - 1
M1 - 111
ER -