Top 5 Takeaways

1. High Prevalence of Early Sexual Debut: Between 14.4% and 40.1% of adolescent girls and young women in the nine PEPFAR countries had early sexual debut.
2. Increased Risky Behaviors: Those with early sexual debut had higher odds of engaging in risky sexual behaviors and lower odds of having been tested for HIV.
3. Forced Sexual Initiation: Forced sexual initiation was associated with being unmarried, experiencing violence, risky sexual behaviors, STIs, and poor mental health.
4. Impact on Mental Health: Both forced sexual initiation and early sexual debut were linked to increased mental distress, suicidal thoughts, and attempts.
5. Need for Comprehensive Programs: Comprehensive violence and HIV prevention programs are essential to delay sexual debut and protect adolescent girls and young women from forced sex.

Original Article Author and Citation

Corresponding Author

Pragna Patel, plp3@cdc.gov

Suggested Citation

Howard AL, Pals S, Walker B, et al. 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. MMWR Morb Mortal Wkly Rep 2021;70:1629–1634. DOI: http://dx.doi.org/10.15585/mmwr.mm7047a2

Summary

This study analyzed data from the Violence Against Children and Youth Surveys (VACS) conducted in nine PEPFAR countries between 2007 and 2018. It examined the prevalence and associated factors of early sexual debut and forced sexual initiation among adolescent girls and young women aged 13–24 years. The findings revealed high rates of early sexual debut and forced sexual initiation, which were linked to increased risky sexual behaviors, lower HIV testing rates, and significant mental health issues.

Methods

VACS are nationally representative, multistage cluster household surveys of persons aged 13–24 years. The study included oral informed consent, parental consent for minors, privacy safeguards, and referrals to postviolence care. Data from Eswatini, Haiti, Kenya, Malawi, Nigeria, Tanzania, Uganda, Zambia, and Zimbabwe were analyzed. Weighted prevalences and multiple logistic regression models were used to estimate and assess the odds of forced sexual initiation and early sexual debut by various factors.

Discussion

The study found that sexual violence, forced sexual initiation, and early sexual debut were prevalent among adolescent girls and young women in the nine countries. These experiences were associated with increased risky sexual behaviors and mental health issues, highlighting the need for comprehensive violence and HIV prevention programs. The findings support previous research linking sexual violence and early sexual experiences to higher HIV risk and poor mental health outcomes.

Conclusion

Preventing sexual violence and delaying sexual debut are critical components of HIV prevention efforts. Targeted interventions are needed for adolescent girls and young women, particularly those who are in school, never married, or have experienced violence. Comprehensive programs should include education, mental health services, and community support to reduce the risk of HIV and improve overall well-being.

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