Is Early Sexual Debut a Risk Factor for HIV Infection Among Women in Sub-Saharan Africa? A Systematic Review
Version of Record online: 26 NOV 2012
© 2012 John Wiley & Sons A/S
American Journal of Reproductive Immunology
Special Issue: Sexual Violence and HIV Transmission
Volume 69, Issue Supplement s1, pages 27–40, February 2013
How to Cite
Is early sexual debut a risk factor for hiv infection among women in sub-Saharan Africa? A systematic review. Am J Reprod Immunol 2012, , , .
- Issue online: 6 FEB 2013
- Version of Record online: 26 NOV 2012
- Manuscript Accepted: 22 OCT 2012
- Manuscript Received: 29 AUG 2012
- Early sexual debut;
- HIV ;
- sub-Saharan Africa;
- systematic review
In Africa, adolescent girls have high HIV risk. Early sexual debut may be a risk factor, although evidence has not been systematically compiled.
A systematic review was conducted. Quantitative studies from sub-Saharan Africa with biologically confirmed HIV infection measures were included.
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.
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.