Individual- and Community-Level Influences on the Timing of Sexual Debut Among Youth in Nyanza, Kenya

摘要

CONTEXT: Delaying sexual debut is an important HIV prevention strategy, yet few studies have examined associations between both community- and individual-level characteristics and sexual debut among youth in Sub-Saharan Africa.METHODS: Cross-sectional survey data collected from 8,183 youth aged 11-17 in 160 schools in Nyanza, Kenya, were used to examine the relationships between individual and community measures and the timing of sexual debut. Multilevel discrete-time hazard models were used to identify bivariate and multivariate associations.RESULTS: At the individual level, youth were more likely to have initiated sex (or had done so at an earlier age) if they had felt pressure to engage in sex from a greater number of sources (odds ratios, 1.3-1.8); perceived that they had a small or (among females) moderate chance, rather than no chance, of contracting HIV (1.2-1.3); or endorsed a greater number of HIV transmission myths (1.1 for both sexes). In addition, males with higher abstinence self-efficacy had a reduced risk of sexual debut (0.95). At the community level, males and females had a reduced risk of sexual debut if they lived in a community where AIDS deaths were publicly acknowledged (0.6-0.8) or the Primary School Action for Better Health program had been implemented (0.8-0.95); risk was also reduced among young men who lived in communities where HIV was discussed at a greater number of parent-teacher association meetings (0.9) or where abstinence was the primary AIDS prevention message conveyed to youth (0.9).CONCLUSION: Community-level variables are frequently associated with sexual debut and should be included in future research.