The purpose of the study was to identify risk factors and
time trends for sexual experience and sexual debut in rural Uganda.
Using population-based, longitudinal data from 15- to
19-year olds in Rakai, Uganda, we examined temporal trends in the prevalence of
sexual experience and potential risk factors for sexual experience (n =
31,517 person-round observations) using logistic regression. We then identified
factors associated with initiation of sex between survey rounds, using Poisson regression
to estimate incidence rate ratios (IRR; n = 5,126 person-year
observations).
Sexual experience was more common among adolescent women
than men. The prevalence of sexual experience rose for most age-gender groups
after 1994 and then declined after 2002. Factors associated with higher
prevalence of sexual experience (without adjustment for other factors) included
age, not enrolled in school, orphanhood, lower socioeconomic status, and
drinking alcohol in the past 30 days; similar factors were associated with
initiation of sex. Factors independently associated with initiation of sex
included older age, nonenrollment in school (IRR = 1.7 for women and 1.8
for men), alcohol use (IRR = 1.3 for women and men), and being a double
orphan among men (IRR = 1.2). Sexual experience began to decline around
2000, whereas increases in school enrollment began as early as 1994 and
declines in orphanhood occurred after 2004 (as antiretroviral therapy became
available).
Sexual experience among youth in Rakai was associated with
social factors particularly school enrollment. Changes in these social factors
also appear to influence change over time in sexual experience.
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By:
- 1Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York. Electronic address: Js2637@columbia.edu.
- 2Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York; Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
- 3Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York.
- 4Heilbrunn Department of Population & Family Health, Mailman School of Public Health, Columbia University, New York, New York.
- 5Department of Biostatistics, Mailman School of Public Health, Columbia University, New York, New York.
- 6Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda.
- 7Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland.
- 8Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda; Makerere University school of Public Health, Kampala, Uganda.
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