Forced Sexual Initiation and Early Sexual Debut and Associated Risk Factors and Health Problems Among Adolescent Girls and Young Women — Violence Against Children and Youth Surveys, Nine PEPFAR Countries, 2007–2018

Abstract

Adolescent girls and young women aged 13-24 years are disproportionately affected by HIV in sub-Saharan Africa (1), resulting from biologic, behavioral, and structural* factors, including violence.Girls in sub-Saharan Africa also experience sexual violence at higher rates than do boys (2), and women who experience intimate partner violence have 1.3-2.0times the odds of acquiring HIV infection, compared with those who do not (3).Violence Against Children and Youth Survey (VACS) data during 2007-2018 from nine countries funded by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) were analyzed to estimate prevalence and assess factors associated with early sexual debut and forced sexual initiation. Among adolescent girls and young women aged 13-24 years who ever had sex, the prevalence of lifetime sexual violence ranged from 12.5% to 49.3%, and forced sexual initiation ranged from 14.7% to 38.9%; early sexual debut among adolescent girls and young women aged 16-24 years ranged from 14.4% to 40.1%.In multiple logistic regression models, forced sexual initiation was associated with being unmarried, violence victimization, risky sexual behaviors, sexually transmitted infections (STIs), and poor mental health.Early sexual debut was associated with lower education, marriage, ever witnessing parental intimate partner violence during childhood, risky sexual behaviors, poor mental health, and less HIV testing.Comprehensive violence and HIV prevention programming is needed to delay sexual debut and protect adolescent girls and young women from forced sex.VACS are nationally representative, multistage cluster household surveys of persons aged 13-24 years.All study protocols included oral informed consent, parental consent * Structural factors include gender-based violence, child sexual abuse, orphanhood, low education level, spousal separation, harmful gender and societal norms, gender inequity, and unequal power. Detailed information about individual country survey partners, methodology, sampling design, samples, and response rates is available in VACS country reports.https://www.cdc.gov/violenceprevention/childabuseandneglect/vacs/ reports.htmlfor minors, safeguards to protect privacy and confidentiality of participants, and referrals to postviolence care as needed. CDC and in-country Institutional Review Boards approved study protocols. This report examines lifetime experiences of sexual violence, early sexual debut, and forced sexual initiation among adolescent girls and young women aged 13-24 years in Eswatini,** Haiti, Kenya, Malawi, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe, using 2007-2018 data from VACS. Lifetime sexual violence included ever experiencing 1) unwanted sexual touching, 2) unwanted attempted sex, 3) pressured or coerced sex, or 4) physically forced sex.Early sexual debut was defined as first sexual intercourse at or before age 15 years among adolescent girls and young women aged 16-24 years who had ever had sex with or without violence.Forced sexual initiation was defined as pressured, coerced, or physically forced first sex among adolescent girls or young women aged 13-24 years who had ever had sex.Orphan status was defined as having one or both parents deceased before the 18th birthday.Weighted prevalences of lifetime sexual violence, early sexual debut, and forced sexual initiation were estimated for each country using SAS (version 9.4; SAS Institute); prevalences were weighted to the most recent census or population projections to account for the multistage cluster design and nonresponse.Multiple logistic regression models were fit to the data combined across all countries to examine the odds of forced sexual initiation and early sexual debut by demographic characteristics and childhood experiences and health problems and behaviors.These models included a fixed https://www.cdc.gov/violenceprevention/pdf/vacs/VACS-trainingwhitepaper.pdf This activity was reviewed by CDC and was conducted consistent with applicable federal law and CDC policy (45 C.F.R. part 46.102(l)(2), 21 C.F.R.

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