Adolescent girls and young women in Kenya are highly vulnerable to HIV during their first sexual encounter, according to study results published in the Journal of Acquired Immune Deficiency Syndromes.
“The aim of this study was to understand early risk and vulnerabilities for HIV among adolescent girls and young women in Kenya,” Marissa Becker, MD, MSc (Public Health), FRCPC, an associate professor in the University of Manitoba’s Centre for Global Public Health, told Infectious Diseases in Children. “The reason to do so was because many HIV prevention programs for key populations, such as female sex workers, reach young sex workers several years after they have already experienced high-risk encounters, which is too late.”
Becker and colleagues noted that Eastern and Southern Africa have a high HIV prevalence, and women aged 15 to 24 years comprise 10% of the adult population yet accounted for 26% of new HIV infections in 2016.
The researchers conducted a cross-sectional biological and behavioral survey between April and November 2015 of sexually active AGYW aged 14 to 24 years in Mombasa, Kenya. They used logistic regression to identify age-adjusted associations between first sex vulnerabilities and outcomes, including gender-based violence (GBV) and HIV in AGYW who identified themselves as engaging in sex work (n = 408), transactional sex outside of formal sex work — defined as sex in which there was an expectation and receipt of money or goods in return for sex but the price was not pre-negotiated (n = 177) — or casual sex (n = 714).
The median age at first sexual encounter among the AGYW was 16 years, with 27.8% of participants reporting that they were aged younger than 15 years at their first sexual encounter. Thirty-nine percent of participants reported first sex before or within 1 year of menarche (median age of menarche, 14 years).
A total of 43.6% of AGYW reported receiving money at first sex, 41.2% reported being coerced into first sex and 11.2% reported being forced into first sex. AGYW in sex work were more likely to have first sex vulnerabilities.
The researchers reported an association between GBV (prevalence, 23.8%) and HIV (prevalence, 5.6%) with first sex before age 15 years (GBV adjusted OR = 1.4; 95% CI, 1-1.9; HIV aOR = 1.9; 95% CI, 1.1-3.3), before or within 1 year of menarche (GBV aOR = 1.3; 95% CI, 1-1.7; HIV aOR = 2.1; 95% CI, 1.3-3.6) or receiving money (GBV aOR = 1.9%; 95% CI, 1.4-2.5; HIV aOR = 2; 95% CI, 1.2-3.4).
“The prevalence of first sex vulnerabilities was high across AGYW irrespective of their engagement in sex work, transactional sex or casual sex; suggesting considerable overlap in early HIV risk across subsets in Kenya,” Becker and colleagues wrote.
The researchers noted that up to 40% of AGYW who engaged in casual sex reported the exchange of gifts or money at first sex.
“We hope the findings of this research can assist HIV prevention programs to adapt their strategies to reach vulnerable young women and teenaged girls at a younger age and intervene on risks early on — in Kenya and globally,” Becker said. – by Bruce Thiel
Disclosures: The authors report no relevant financial disclosures.