The relationship between age of coital debut and HIV seroprevalence among women in Durban, South Africa: a cohort study

Abstract

Objectives

To investigate the impact of early sexual debut on HIV seroprevalence and incidence rates among a cohort of women.

Design

Prospective study.

Setting

KwaZulu-Natal, South Africa.

Participants

A total of 3492 sexually active women who consented to screen a HIV prevention trial during September 2002 to September 2005; a total of 1485 of them were followed for approximately 24 months.

Primary and secondary outcome measures

HIV seroprevalence among those who were screened for the trial and HIV seroconversion among those who seroconverted during the study.

Results

Lowest quintiles of age at sexual debut, less than high school education, a higher number of lifetime sexual partners and lack of cohabitation, being diagnosed as having herpes simplex virus 2 and other sexually transmitted infections were all significantly associated with prevalent HIV infection in multivariate analysis. During follow-up, 148 (6.8 per 100 person-years, 95% CI 5.8 to 8.0) women seroconverted. Highest seroconversion rate was observed among women who had reported to have had sex 15 years or younger (12.0 per 100 person-years, 95% CI 8.0 to 18.0). Overall, impact of risk factors considered in this study was associated with considerable potential reductions in HIV prevalence and incidence rates (population attributable risk: 85%, 95% CI 84% to 87% and population attributable risk: 77%, 95% CI 72% to 82%, respectively).

Conclusions

The association of HIV status with younger age at sexual debut may likely due to an increased number of lifetime partners. This increase could result from longer duration of sexual life. Prevention of HIV infection should include efforts to delay age at first sex in young women.

Trial registration number

NCT00121459.

Article summary

Article focus

• Early sexual debut may increase women's vulnerability to HIV infection.

• Early sexual debut has been associated with increased sexual risk-taking behaviour, such as having multiple partners.

• Delaying sexual debut may have been one of the key changes in behaviour, which lead to a decline in HIV infection in the past.

Key messages

• Our results showed that women who initiated sexual activity early were more likely to engage in risky sexual behaviours.

• A clear trend observed indicating that early onset sexual activity was associated with increased HIV seroprevalence and incidence.

• Comprehensive sexual education programmes should reach out-of-school youth, who may be at heightened vulnerability, should be identified as well.

Strengths and limitations of this study

• We cannot rule out the effects of unmeasured characteristics such as multiple or concurrent sex partners and commercial sex on our findings. No data concerning migration, socioeconomic status at the time of sexual debut or sexual behaviour data from male partners.

• Nevertheless, current study used the data from the region where the HIV epidemic is severely high among particularly young women.