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

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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.

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Most cited references 50

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Sexual behaviour in context: a global perspective.

Kaye Wellings, Martine Collumbien, Emma Slaymaker … (2006)

Research aimed at investigating sexual behaviour and assessing interventions to improve sexual health has increased in recent decades. The resulting data, despite regional differences in quantity and quality, provide a historically unique opportunity to describe patterns of sexual behaviour and their implications for attempts to protect sexual health at the beginning of the 21st century. In this paper we present original analyses of sexual behaviour data from 59 countries for which they were available. The data show substantial diversity in sexual behaviour by region and sex. No universal trend towards earlier sexual intercourse has occurred, but the shift towards later marriage in most countries has led to an increase in premarital sex, the prevalence of which is generally higher in developed countries than in developing countries, and is higher in men than in women. Monogamy is the dominant pattern everywhere, but having had two or more sexual partners in the past year is more common in men than in women, and reported rates are higher in industrialised than in non-industrialised countries. Condom use has increased in prevalence almost everywhere, but rates remain low in many developing countries. The huge regional variation indicates mainly social and economic determinants of sexual behaviour, which have implications for intervention. Although individual behaviour change is central to improving sexual health, efforts are also needed to address the broader determinants of sexual behaviour, particularly those that relate to the social context. The evidence from behavioural interventions is that no general approach to sexual-health promotion will work everywhere and no single-component intervention will work anywhere. Comprehensive behavioural interventions are needed that take account of the social context in mounting individual-level programmes, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour.

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Intimate partner violence and HIV infection among women: a systematic review and meta-analysis

Ying Li, Caitlin M Marshall, Hilary C Rees … (2014)

Introduction To assess evidence of an association between intimate partner violence (IPV) and HIV infection among women. Methods Medline/PubMed, Embase, Web of Science, EBSCO, Ovid, Cochrane HIV/AIDS Group's Specialized Register and Cochrane Central Register of Controlled Trials were searched up to 20 May 2013 to identify studies that examined the association between IPV and HIV infection in women. We included studies on women aged ≥15 years, in any form of sexually intimate relationship with a male partner. Results Twenty-eight studies [(19 cross-sectional, 5 cohorts and 4 case-control studies) involving 331,468 individuals in 16 countries – the US (eight studies), South Africa (four studies), East Africa (10 studies), India (three studies), Brazil (one study) and multiple low-income countries (two studies)] were included. Results were pooled using RevMan 5.0. To moderate effect estimates, we analyzed all data using the random effects model, irrespective of heterogeneity level. Pooled results of cohort studies indicated that physical IPV [pooled RR (95% CI): 1.22 (1.01, 1.46)] and any type of IPV [pooled RR (95% CI): 1.28 (1.00, 1.64)] were significantly associated with HIV infection among women. Results of cross-sectional studies demonstrated significant associations of physical IPV with HIV infection among women [pooled OR (95% CI): 1.44 (1.10, 1.87)]. Similarly, results of cross-sectional studies indicated that combination of physical and sexual IPV [pooled OR (95% CI): 2.00 (1.24, 3.22) and any type of IPV [pooled OR (95% CI): 1.41 (1.16, 1.73)] were significantly associated with HIV infection among women. Conclusions Available evidence suggests a moderate statistically significant association between IPV and HIV infection among women. To further elucidate the strength of the association between IPV and HIV infection among women, there is a need for high-quality follow-up studies conducted in different geographical regions of the world, and among individuals of diverse racial/cultural backgrounds and varying levels of HIV risks.

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Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability.

Suzanne Leclerc (2008)

This paper reviews the current state of knowledge on age-disparate sexual relationships in the context of the southern African HIV/AIDS hyperepidemic. Disproportionately high HIV infection rates among young women aged 15-24 years have been attributed to their greater involvement in relationships with older-aged partners. Whereas early studies emphasized economic concerns in the context of poverty as driving girls to accept or seek the attentions of older employed men, close-grained studies reveal a complex interplay of meanings and motives that prompt both men and women across socioeconomic strata to engage in intergenerational sex. Studies have revealed that age-disparate relationships are meaningful and perceived as beneficial at a number of levels, including social, physical, psychological, as well as economic and symbolic. In the context of growing economic inequalities and cultural expectations for men to give and women to receive a compensation for sex, relationships with older men are a common and readily available way through which young women gain materially, affirm self-worth, achieve social goals, increase longer-term life chances, or otherwise add value and enjoyment to life. Awareness of HIV risks in these relationships remains low. HIV prevention policies and programmes need to start from an understanding of how those engaged in risky behaviour perceive their sexual relationships and conceptualize the choices they make and the strategies they use. A more comprehensive policy on women and girls with better integration of communities in assessing and addressing issues, and an expansion of campaigns and programmes on the role of men as protectors and supporters of women are recommended.

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Author and article information

Journal

Journal ID (nlm-ta): J Acquir Immune Defic Syndr

Journal ID (iso-abbrev): J. Acquir. Immune Defic. Syndr

Journal ID (publisher-id): qai

Title: Journal of Acquired Immune Deficiency Syndromes (1999)

Publisher: JAIDS Journal of Acquired Immune Deficiency Syndromes

ISSN (Print): 1525-4135

ISSN (Electronic): 1944-7884

Publication date (Print): 1 November 2018

Publication date (Electronic): 10 August 2018

Volume: 79

Issue: 3

Pages: 296-304

Affiliations

[* ]Center for Global Public Health, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB, Canada;

[† ]Technical Support Unit, Partnership for Health and Development in Africa, Nairobi, Kenya;

[‡ ]India Health Action Trust, Bangalore, India;

[§ ]National AIDS and STI Control Programme, Nairobi, Kenya;

[║ ]International Center for Reproductive Health Kenya, Mombasa, Kenya;

[¶ ]Centers for Disease Control and Prevention, Atlanta, GA;

[# ]Retrovirology Laboratory, JC Wilt National HIV, Winnipeg, WB, Canada;

[** ]Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada; and

[†† ]Division of Infectious Disease, Department of Medicine, University of Toronto, Toronto, ON, Canada.

Author notes

Correspondence to: Marissa L. Becker, MD, MSc, Rady Faculty of Health Sciences, Center for Global Public Health, University of Manitoba, R070 Med Rehab Bldg, 771 McDermot Avenue, Winnipeg, MB R3E 0T6, Canada (e-mail: marissa.becker@ 123456umanitoba.ca ).

Article

Publisher ID: QAIV18893 Accession ID: 00003

DOI: 10.1097/QAI.0000000000001826

PMC ID: 6203425

PubMed ID: 30113403

SO-VID: 96a90f4f-3e12-455e-85b0-1b1eacade214

License:

This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 05 March 2018

Date accepted : 18 June 2018

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Keywords: adolescent girls and young women,female sex workers,transactional sex,hiv,violence,kenya

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Keywords: adolescent girls and young women, female sex workers, transactional sex, hiv, violence, kenya

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

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Most cited references 50

Sexual behaviour in context: a global perspective.

Intimate partner violence and HIV infection among women: a systematic review and meta-analysis

Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability.

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