142nd APHA Annual Meeting and Exposition

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301825
Influence of ART, Orphanhood, and Education on Trends Over Time in Initiation of Sexual Intercourse among Adolescents, Rakai District, Uganda, 1994-2011

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014 : 1:00 PM - 1:10 PM

John S. Santelli, MD, MPH , Department of Population and Family Health, Columbia University, New York, NY
Inge Holden , Department of Epidemiology, Columbia University, New York, NY
Sanyukta Mathur, DrPH MHS , Department of Population & Family Health, Columbia University, Mailman School of Public Health, New York, NY
Xiaobo Zhong, MS , Department of Biostatistics, Columbia University, New York, NY
Ying Wei, PhD , Department of Biostatistics, Columbia University, New York, NY
Richard Musoke, MHS , Rakai Health Sciences Program, Entebbe, Uganda
Tom Lutalo, MSc , Rakai Health Sciences Program, Uganda Virus Research Institute, Entebbe, Uganda
Zoe Edelstein, PhD , Department of Population & Family Health, Columbia University, NEW YORK, NY
Fred Nalugoda, MHS , Rakai Health Sciences Program, Entebbe, Uganda
Ronald Gray, MD , Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Maria Wawer, MPH, MD , Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
David Serwadda, MBChB, MSc, MMed, MPH , Makerere University School of Public Health, Kampala, Uganda
  
Audio (mp3) recording Recorded Presentation (mp4)
Background:  Initiation of sexual intercourse is a key social developmental transition and an important risk factor for HIV/STIs and unintended pregnancy. Poverty, family factors, educational and occupational opportunities for young people, and prevention programs can influence sexual initiation. We explored risk factors for and time trends in initiation of sex, including rising school enrollment and the decline in orphanhood among youth in rural Uganda. 

Methods:  We examined data from adolescents (15-19 years) in the Rakai Community Cohort Study over 14 rounds of data collection and 43 communities under continual surveillance between 1994 and 2011 (n=33,132 person-rounds of observation). We used logistic regression in GEE to identify factors associated with initiation of sexual intercourse between survey rounds, including linear and quadratic change over time. Analyses were adjusted by single year of age, given changes in population age structure over time. 

Results: Sexual experience rose in the 1990s and then declined after 2003 for adolescent men and women; both linear and quadratic (U-shaped) trends were significant (all p<.0001). In bivariate and multivariate analyses, sexual initiation was associated with having left school, having lost one or both parents, lower SES, and alcohol use in the past 30 days. School enrollment increased steadily from 1994-2011; orphanhood declined after 2004, coinciding with the introduction of ART services in Rakai. School enrollment mediated the relationship between orphanhood and sexual initiation. 

Conclusions: National education policies and the influence of HIV treatment on family survival appear to be key factors influencing adolescent sexual behavior among adolescents in Rakai.

Learning Areas:

Epidemiology
Social and behavioral sciences

Learning Objectives:
Identify two or more risk factors for sexual initiation about adolescents. Describe two factors influencing time trends in sexual initiation among adolescents in Rakai.

Keyword(s): Adolescents, Sexual Risk Behavior

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a Professor of Population and Family Health and Pediatrics at Columbia University and a Senior Fellow at The Guttmacher Institute. I have published original research, commentaries, and book chapters on adolescent reproductive health, clinical and community preventive services, school-based health care, and research ethics. I have been a leader in insuring that adolescents are appropriately included in health research and have access to medically accurate, comprehensive sexuality education.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3274.0: Global perspectives on adolescent sexual and reproductive health