Starting Young: Sexual Initiation and HIV Prevention in Early Adolescence

Ruth Dixon-Mueller


AIDS and Behavior. 2009;13(1):100-109. 

In This Article

The Strategic Value of Investing in 10-14-Year-Olds

The benefits of investing in the health and development of very young adolescents have been stressed in a number of documents (e.g., Bruce and Joyce 2006; Chong et al. 2006; Lloyd 2005; UNICEF et al. 2002). Relatively little is known about the sexual and reproductive knowledge, attitudes, and practices of young adolescents, however, or about the prevalence of HIV and other sexually transmitted infections (STIs) within this age group. Behavioral data are often reported for 15-19-year-olds, while estimates of HIV prevalence among young people typically refer to ages 15-24. Yet, 10-14-year-old boys and (especially) girls in many developing countries -- particularly those who live in communities where epidemics are generalized among young people -- are at considerable risk of acquiring STIs, including HIV, as soon as they become sexually active (Global Health Council 2007; UNICEF et al. 2002).

Early, unprotected sexual initiation can trigger a succession of harmful physical, emotional and social outcomes, especially for girls (Brown et al. 2001; Jejeebhoy et al. 2005; Zabin and Kiragu 1998). The physiological vulnerability that places adult women at higher risk than men of acquiring STIs/HIV from an infected partner during a single act of vaginal intercourse is heightened among young adolescent girls, especially when intercourse is initiated before menarche or soon after (Duncan et al. 1990; Glynn et al. 2001). In addition, younger adolescents are more likely than older adolescents to report that their sexual initiation was involuntary or coerced, and girls are far more likely to say so (including young brides in forced marriages) than boys (Alan Guttmacher Institute 2006; Brown et al. 2001; Jejeebhoy et al. 2005; Matasha et al. 1998; WHO 2005). In provincial Tanzania, 43% of girls whose sexual initiation took place at age 14 or younger said they were forced, compared with 18% who first had intercourse at ages 15-17 and 12% at age 18 and over; comparable figures for Peru are 41, 28 and 17%; Bangladesh, 36, 28 and 21%; and Thailand, 20, 7 and 4% (WHO 2005:14). Forced intercourse is associated with abrasion, tearing, and bleeding of the immature vagina or rectum; non-use of protection; and other characteristics such as alcohol or drug use; multiple partnerships; repeated episodes of abuse; and heightened probabilities of being infected with STIs/HIV (Jejeebhoy et al. 2005; Jewkes et al. 2006).

Young adolescents who have consensual sex with age-mates or older partners are also in jeopardy, however. Compared with older teens, they are less likely to have the foresight, skills, cognitive maturity, information and supplies they need for their or and their partners' protection from pregnancy and STIs/HIV (Bankole et al. 2007; Blanc and Way 1998; Breinbauer and Maddaleno 2005; Eggleston et al. 1999; Patton and Viner 2007). Among sexually active boys in low-income neighborhoods of Recife, Brazil, for example, only 11% of 13-15-year-olds regularly used contraceptives with their casual or steady partners compared with 45% of 18-19-year-olds (Juarez and Castro Mart\0xEDn 2006:65). Research is needed in a variety of socioeconomic and geographical settings to identify key points of intervention aimed at preventing the initiation of (and vulnerability to) unsafe behaviors among young female and male adolescents; reducing their harmful effects; and promoting healthy sexual choices.


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