Submission ID 130605
| Issue/Objective | Early age at first sex has been associated with adverse mental health, sexual health and HIV outcomes. These early experiences shape lifelong risk profiles. This study explores the relationships between early age at first sex and later vulnerabilities among adolescent girls and young women (AGYW) in post conflict Northern Uganda. |
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| Methodology/Approach | The Cango Lyec project is an Acoli governed open cohort involving conflict affected populations across four districts (Amuru, Gulu, Nwoya, and Omoro) in Northern Uganda. Between December 2020 and March 2023, 424 consenting sexually active AGYW aged 13-24 were enrolled and completed interviewer-administered questionnaires on trauma, depression, sources of strength, sociodemographic and behavioural characteristics. Venous blood was collected for HIV, HBV, and syphilis serology. Multivariable logistic regression models adjusted for age and district of residence were used to assess factors associated early age (<15) at first sex. |
| Results | HIV prevalence was 4.2% overall. Among those who had sex before the age of 15 HIV prevalence was 12.5% (7/56) compared to 2.9% (11/368) among those with later age at first sex. Having been married more than once (OR=3.93;p=0.002) and each additional pregnancy (OR=1.45;p=0.007) was associated with an increased likelihood of early age at first sex. Ever attempting suicide (OR=2.67;p=0.019), ever been strangled by an intimate partner (OR=3.46;p=0.036), and having experienced sexual assault in the context of war (OR=2.41;p=0.044) were significantly associated with early age at first sex. In addition, experiencing ill health without medical care (OR=1.91;p=0.044), living with HIV (OR=4.51;p=0.004), and having syphilis (OR=3.24;p=0.044) were associated with an increased likelihood of early age at first sex. Importantly, ever having attended school (OR=0.21;p=0.036), secondary or higher education (OR=0.33;p=0.002), older age at first pregnancy (OR=0.85;p<0.001), and having used a condom at first sex (OR=0.50;p=0.019) were associated with increased likelihood of later age at first sex. |
| Discussion/Conclusion | The ongoing legacies of war, especially gender violence, are linked to early age at first sex among AGYW in Northern Uganda. Culturally-safe wholistic approaches supporting AGYW that integrate mental health and education are urgently required. |
| Presenters and Affiliations | Samuel Malamba Uganda Virus Research Institute (UVRI) - HIV Reference Laboratory Program David Zamar BC Children's Hospital Research Institute Herbert Muyinda Makerere University, Child Health Development Center Riley Bizzotto The University of British Columbia Achilles Katamba Makerere University, College of Health Sciences Stella Atim The Cango Lyec Project Tonny Odongping The Cango Lyec Project Martin Omello The Cango Lyec Project Nelson Sewankambo Makerere University, College of Health Sciences Martin Schechter The University of British Columbia Patricia Spittal The University of British Columbia D. Martin Ogwang St Mary's Hospital - Lacor and Northern Uganda Program on Health |
