Vulnerabilities at First Sex and Their Association With Lifetime Gender-Based Violence and HIV Prevalence Among Adolescent Girls and Young Women Engaged in Sex Work, Transactional Sex, and Casual Sex in Kenya

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.

 

Link

https://pubmed.ncbi.nlm.nih.gov/30113403/