Early sexualdebutand associated
factors am ong in-schooladolescents
in eightA frican countries
KarlPeltzer
Presentation:IC C A P
M elbourne
Background
• Young age atfirstsexualintercourse is
thoughtto increase the risk of
acquiring H IV infection
• is m ore likely to reportsexualrisk
behaviours and
• m ay be particularly prone to otherrisky
behaviours laterin life
Early sexualdebut,prevalence
• Sexualactivity initiation <15 yrs
in Eastern and Southern Africa
17% fem ale 14% form ales,
W estand M iddle Africa
21% fem ales 12% m ales
• H ealth Behaviourin School-aged
C hildren (H BSC )in 30 m ostly highincom e countries,15 yearolds
• 27% had had sex
Early sexualdebut,risk factors
• living w ith otherthan tw o biologicalparents,
being less m onitored by parents,
• having m ore advanced physicalm aturity
and m ore involvem entin dating behaviour,
• having m ore perm issive attitudes tow ard
sex,
• alcoholuse,delinquency,schoolproblem s
and (forgirls)depressive sym ptom s
M ethod
• Secondary analysis ofexisting data from the
G lobalSchool-Based H ealth Survey (G SH S)
from eightAfrican countries
• D etails and data ofthe G SH S can be
accessed at
http://w w w .w ho.int/chp/gshs/m ethodology/en
/index.htm l
• Students,prim arily 13-15 years
• R epresentative sam ple ofcountry
Sam ple,15 year-olds only
Country (yearofstudy)
1.Botsw ana (2005)
2.K enya (2003)
3.N am ibia (2004)
4.Senegal(2005)
5.Sw aziland (2004)
6.U ganda (2003)
7.Zam bia (2004)
8.Zim babw e (2003)
Total
Total
N
694
1001
1482
869
2831
938
552
1703
10070
Early sexualdebutby country
Country
1.Botsw ana (2005)
2.K enya (2003)
3.N am ibia (2004)
4.Senegal(2005)
5.Sw aziland (2004)
6.U ganda (2003)
7.Zam bia (2004)
8.Zim babw e (2003)
Sex below 15:all
%
18.1
32.0
31.3
24.4
11.2
23.5
37.0
12.6
Sexualbehaviour,15 year-olds
A ll
%
M ale
%
Fem ale
%
33.0
45.0
20.4
11.8
5.5
3.9
6.1
7.2
17.1
8.1
5.8
7.2
8.0
6.3
2.8
2.1
4.6
6.4
Tw o orm ore sex partners 16.3
Sex in past12 m onths
14.6
Condom use atlastsex
54.6
23.1
20.4
54.7
8.3
8.4
54.5
Everhad sex
A ge firstsex
≤11
12
13
14
15
M ultivariate regression analyses:
early sexualdebut
•
•
•
•
•
•
•
•
Boys
-currently sm oking
-truancy
G irls
-low ereducation,
-everdrunk,
-having no close friends and
-poorparentalconnectedness
D iscussion:prevalence ofearly
sexualdebut15 year-olds
H igh rates ofearly sexualdebut:
27.3% had experienced sexualdebutbefore age 15
(38.1% am ong boys and 15.8% am ong girls)school
children from eightA frican countries
In Eastern/Southern A frica [D H S,population survey]
17% fem ales and 14% m ales
33% sexualdebutatage 15 in this study
also higherthan 27% found in nationally representative
sam ples of15 yearolds in schoolclassroom s in 30
m ostly high-incom e countries in 2005/6
D iscussion:H IV risk
•16.3% ofthe 15-year-old schoolchildren
reported to have had tw o orm ore sexualpartners
during theirlifetim e,
•am ong the sexually active slightly m ore than half
(54.6% )reported condom use atlastsex.
•Considering the high H IV prevalence in m ostof
the study countries,condom use w as low.In
com parison,65% reported using condom s atlast
intercourse in 30 m ostly high-incom e countries
D iscussion:correlates early sexual
debut
• correlates ofearly sexualintercourse included in
concordance w ith otherstudies:
• alcohol,tobacco and drug use,
• schoolfactors (truancy),
• parentalorguardian factors (lack ofparentalor
guardian connectedness and supervision),
• sedentary leisure behaviour,
• unintentionalinjuries and violence (having been
in a physicalfightand seriously injured),and
• forgirls poorm entalhealth and low ersocioeconom ic status (low ereducation and econom ic
status)
C onclusion
• H igh prevalence ofearly sexualdebutam ong 15
year-olds in eightAfrican countries.
• R isk factors identified w ere consistentw ith
Problem BehaviourTheory in w hich early onset
ofadolescentsexualbehaviouris shared w ith
otherproblem behaviours.
• Prevention program m es should broaden sexual
health prom otion including problem behaviour
such as substance use and m entaldistress for
boys and girls in the preteen years,before
sexualdebut.
Study lim itations
-The G SH S only enrolls adolescents w ho are in school.
-The analysis w as restricted to a single age group,notthe full
range.
-The self-reportofsexualbehaviour[underreported],especially
fem ales.
-M easured differentconcepts such as m entaldistress variables
w ith single item s.
-A num berofrisk factors associated w ith early sexualdebut
found in otherstudies such as schoolstatus,physicalm aturity,
involvem entin dating behavior,attitudes tow ard sex,
delinquency,schoolproblem s,parentfactors and characteristics
ofthe sexualpartnerw ere notassessed and should be assessed in
future studies.
Acknow ledgem entss
• W orld H ealth
O rganization form aking
the data available for
analysis.
• M inistries ofEducation
and H ealth and study
coordinators of
participating eight
African countries