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Protection at First Sexual Intercourse Among Adolescent Girls and Young Women in Kenya

Archives of Sexual Behavior volume 50, pages 219–227 (2021)Cite this article

A Correction to this article was published on 04 September 2020

This article has been updated

Abstract

Adolescent girls and young women (AGYW) are at high risk of HIV and other sexually transmitted infections (STIs), including at first sexual intercourse. The literature is scarce on factors influencing use of protective strategies at this critical time. We conducted 20 in-depth interviews and five focus group discussions with purposively sampled AGYW aged 16–20 years who reported first sex while enrolled in a larger cohort study and willing to participate. All AGYW were counseled on HIV prevention and had access to reproductive health information and services. Data collected were transcribed, translated and analyzed thematically. We identified two approaches to first sex. In one approach, the AGYW facilitated protection use, and those AGYW reported intention and preparation to initiate sexual activity and ability to request condom use, as well as their male partner’s willingness to use and provide condoms. In another approach, AGYW experienced first sexual intercourse without agency (the feeling of control over actions and their consequences [Moore, 2016]) and described lack of prior intentions and planning, discomfort with discussions about sex and condom use, and desire to experience sexual pleasure as reported by peers. No AGYW mentioned parents/adults as playing any role as facilitators of protection use at first sex, highlighting the need for further research on the missing gap. The AGYW were trusting of verbal reports by male partners describing themselves as having never engaged in sex, HIV negative, and free of STIs. We found that some AGYW were empowered to plan, discuss, and request protection at first sex, and others did not take agency. First sex is a time of vulnerability where innovative strategies are needed to strengthen AGYW’s agency and promote condom use and other HIV/STI prevention methods.

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Acknowledgements

The authors thank the AGYW who participated in this study and the study teams at the KEMRI_CCR (PHRD) Thika, Kenya study site and at the University of Washington Coordinating Centre for work on data collection and management.

Funding

This study was funded by the National Institutes of Health (NIH), Grant Number 5R01HD091996 and P01 AI030731.

Author information

Affiliations

  1. Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya

    Edinah Casmir, Fernandos Ongolly, Nicholas Thuo, Lynda Oluoch, Catherine Kiptinness & Nelly Rwamba Mugo

  2. Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Afkera Kesete Daniel

  3. Department of Global Health, University of Washington, Seattle, WA, USA

    Nelly Rwamba Mugo & Alison C. Roxby

  4. Department of Medicine, University of Washington, Seattle, WA, USA

    Anna Wald & Alison C. Roxby

  5. Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya

    Kenneth Ngure

  6. Department of Epidemiology, University of Washington, Seattle, WA, USA

    Anna Wald

  7. Department of Laboratory Medicine, University of Washington, Seattle, WA, USA

    Anna Wald

  8. Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    Anna Wald

Authors
  1. Edinah Casmir
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  2. Afkera Kesete Daniel
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  3. Fernandos Ongolly
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  4. Nicholas Thuo
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  5. Lynda Oluoch
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  6. Catherine Kiptinness
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  7. Anna Wald
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  8. Nelly Rwamba Mugo
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  9. Alison C. Roxby
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  10. Kenneth Ngure
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Corresponding author

Correspondence to Edinah Casmir.

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Conflict of interest

All authors have no conflicts of interest to declare.

Ethics Approval

Ethical clearance for the study was obtained from the Kenya Medical Research Institute’s Scientific and Ethics Review Unit (SERU) as well as the University of Washington Institutional Review Board.

Informed Consent

All participants aged > 18 gave written informed consent to participate; participants aged < 18 gave assent and had parental written consent to participate. However, the interviews were conducted without parental presence.

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The original version of this article was revised: The name of coauthor Afkera Kesete Daniel was incorrectly given as Afkera Kasete in the article as originally published.

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Casmir, E., Daniel, A.K., Ongolly, F. et al. Protection at First Sexual Intercourse Among Adolescent Girls and Young Women in Kenya. Arch Sex Behav 50, 219–227 (2021). https://doi.org/10.1007/s10508-020-01785-w

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  • DOI: https://doi.org/10.1007/s10508-020-01785-w

Keywords

  • Protection use
  • First sexual intercourse
  • HIV prevention
  • Adolescent girls and young women
  • Kenya