Starting Young: Sexual Initiation and HIV Prevention in Early Adolescence

Ruth Dixon-Mueller

Disclosures

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

In This Article

Discussion

Boys and girls ages 10-14 constitute a key target group for the investment of global and national AIDS prevention resources. By choice, persuasion or coercion, a substantial minority of young adolescents in many countries has unprotected vaginal, oral or anal sex with peers or older partners before they turn 15. Research on this under-studied age group is urgently needed to provide the evidence base for instituting effective HIV prevention programs and policies early in the life course.

In their recommendations for monitoring sexual behavior and HIV risks in general populations, Cleland et al. (2004:ii3) advise against lowering the 15-24 age boundaries to include 10-14-year-olds on two grounds: first, that young adolescents' reports of their sexual behavior are particularly unreliable; second, that HIV prevalence in this age group is typically very low. These grounds could also be used to justify monitoring young adolescents, however. The unreliability factor derives from gender- and culture-specific social pressures and/or internalized norms that contribute to boys' and girls' tendencies to embellish, conceal, or otherwise misreport certain sexual experiences, and from their sometimes limited understanding of the questions asked. Yet, the analysis of such tendencies is itself highly relevant to HIV prevention efforts. Similarly, the low HIV prevalence factor does not deny that many boys and girls aged 14 or younger have already initiated sexual practices that put them and/or their partners at substantial risk, now or in the future, and that some will already be infected. Others will have already acquired STIs, such as the one-third of sexually experienced primary-school girls who reported having had symptoms in the Tanzanian study noted earlier, and are prime candidates for early HIV infections. Routine epidemiological monitoring of STIs/HIV among young adolescents -- at least among 12-14-year-olds -- as well as behavioral monitoring of their knowledge, attitudes, penetrative and non-penetrative sexual practices, partnerships, protective behaviors, and positive and negative sexual experiences would form a useful basis for the design of initiatives to reverse the rising rates of HIV infection among 15-24-year-olds that are so commonly reported.

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