Marissa L Becker 1, Parinita Bhattacharjee 1 2, James F Blanchard 1, Eve Cheuk 1, Shajy Isac 1 3, Helgar K Musyoki 4, Peter Gichangi 5, Sevgi Aral 6, Michael Pickles 1, Paul Sandstrom 7, Huiting Ma 8, Sharmistha Mishra 8 9
Affiliations
- 1Center for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada.
- 2Technical Support Unit, Partnership for Health and Development in Africa, Nairobi, Kenya.
- 3India Health Action Trust, Bangalore, India.
- 4National AIDS and STI Control Programme, Nairobi, Kenya.
- 5International Center for Reproductive Health Kenya, Mombasa, Kenya.
- 6Centers for Disease Control and Prevention, Atlanta, GA.
- 7Retrovirology Laboratory, JC Wilt National HIV, Winnipeg, WB, Canada.
- 8Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON, Canada.
- 9Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.
PMID: 30113403 PMCID: PMC6203425
DOI: 10.1097/QAI.0000000000001826
Abstract
Background: Adolescent girls and young women (AGYW) experience high rates of HIV early in their sexual life course. We estimated the prevalence of HIV-associated vulnerabilities at first sex, and their association with lifetime gender-based violence (GBV) and HIV.
Methods: We conducted a cross-sectional biobehavioral survey among AGYW (14-24 years) in Mombasa, Kenya in 2015. We compared the prevalence of first sex vulnerabilities across AGYW who self-identified as engaging in sex work (N = 408), transactional sex (N = 177), or casual sex (N = 714) and used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes (GBV after first sex; HIV).
Results: The median age at first sex was 16 years (interquartile range 14-18). A total of 43.6% received gifts or money at first sex; 41.2% and 11.2% experienced a coerced and forced first sex, respectively. First sex vulnerabilities were generally more common among AGYW in sex work. GBV (prevalence 23.8%) and HIV (prevalence 5.6%) were associated with first sex before age 15 [GBV adjusted odds ratio (AOR) 1.4, 95% confidence interval (CI): 1.0 to 1.9; HIV AOR 1.9, 95% CI: 1.1 to 1.3]; before or within 1 year of menarche (GBV AOR 1.3, 95% CI: 1.0 to 1.7; HIV AOR 2.1, 95% CI: 1.3 to 3.6); and receipt of money (GBV AOR 1.9, 95% CI: 1.4 to 2.5; HIV AOR 2.0, 95% CI: 1.2 to 3.4).
Conclusions: HIV-associated vulnerabilities begin at first sex and potentially mediate an AGYW’s trajectory of risk. HIV prevention programs should include structural interventions that reach AGYW early, and screening for a history of first sex vulnerabilities could help identify AGYW at risk of ongoing GBV and HIV.
Conflict of interest statement
The authors have no funding or conflicts of interest to disclose.
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