Is Early Sexual Debut a Risk Factor for HIV Infection Among Women in Sub‐Saharan Africa? A Systematic Review
Heidi Stöckla b✉, Naira Kalrac, Jantine Jacobid e f g h i, Charlotte Wattsa b
- aDepartment of Global Health and Development London School of Hygiene and Tropical Medicine London UK
- bDepartment of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK
- cIndependent Consultant Geneva Switzerland
- dGender Equality and Diversity Division RGCM department UNAIDS Geneva Switzerland
- eGender Equality and Diversity Division
- fRGCM department
- gUNAIDS
- hGeneva
- iSwitzerland
- ✉Corresponding author
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Abstract
PROBLEM: In Africa, adolescent girls have high HIV risk. Early sexual debut may be a risk factor, although evidence has not been systematically compiled. METHODS: A systematic review was conducted. Quantitative studies from sub-Saharan Africa with biologically confirmed HIV infection measures were included. RESULTS: A total of 128 full texts were screened. Twenty-five met the inclusion criteria, most cross-sectional. Half of studies, and all with large sample sizes, reported significant bivariate associations. These remained significant in all three studies controlling for socio-demographic factors; both studies controlling for sexual activity duration and four of eight studies controlling for subsequent risk behaviour. CONCLUSIONS: Higher-quality studies consistently find significant bivariate associations between early sexual debut and HIV. In some studies, the increase in women's HIV infection risk seems to result from women's later engagement in risky sexual behaviours, rather than being directly related to early onset of sexual debut. In other studies, the increase in risk did not seem to be due to specific behavioural risk characteristics of the respondents or their sexual partners, suggesting that the risk may relate more to the potential for biological factors, for example, genital trauma, or other factors that have not been captured by the studies in this review.