Abstract
Introduction
Although early sexual debut is highly prevalent in Botswana, its link to sexual risk practices has not been explored at the national level. The aim of this paper was to investigate the association between age-at-first-sex, experience of sexual coercion and subsequent sexual practices.
Methods
We used data derived from the 2013 Botswana AIDS Impact Survey (BAISIV)—a fourth and latest in a number of nationally representative, population-based surveys meant to measure the sociodemographic and other effects of the HIV/AIDS epidemic in Botswana. A sample of 3796 adolescents in ages 10–24 years who had successfully completed BAISIV individual questionnaire were selected and included for analysis. Data was analyzed using descriptive and multivariate statistical methods. All comparisons were considered statistically significant at p < 0.05.
Results
Mean age at first sex for the sampled adolescents was 17.9 years. Using binary logistic regression analysis, results indicate that females (AOR1.16, CI = 1.08–1.63), adolescents who did not belong to any religious affiliation (AOR = 1.71, CI = 1.03–2.86) and those who started sexual activity earlier (AOR = 1.53, CI = 1.02–2.56) were more likely to report to have experienced sexual coercion. Moreover, the odds of reporting multiple sexual partnerships were significantly high among adolescents who started sexual activity earlier (AOR = 1.71, CI = 1.03–2.86) and those who resided in cities/towns (AOR = 1.61, CI = 1.08–2.38).
Conclusions
There is need for adolescent HIV policies and programs to address circumstances around young people’s initiation into sexual intercourse, as well as the psychosocial, and cultural norms pertaining to initiation of sex.
Similar content being viewed by others
Notes
Ethical statement was adapted from, Statistics Botswana (2014) Botswana AIDS Impact Survey IV Report, Government Printers, Gaborone.
References
Agardh, A., Odberg-Pettersson, K., & Ostergren, P. O. (2011). Experience of sexual coercion and risky sexual behavior among Ugandan university students. BMC Public Health, 11, 527. https://doi.org/10.1186/1471-2458-11-527.
Alexander, K. A., Volpe, E. M., Abboud, S., & Campbell, J. C. (2016). Reproductive coercion, sexual risk behaviours and mental health symptoms among young low-income behaviourally bisexual women: implications for nursing practice. Journal of Clinical Nursing, 25(23–24), 3533–3544. https://doi.org/10.1111/jocn.13238.
Aoife, M. D., Mavedzenge, S. N., Plummer, M. L., & Ross, D. A. (2012). The sexual behaviour of adolescents in sub-Saharan Africa: patterns and trends from national surveys. Tropical Medicine & International Health, 17(7), 796–807. https://doi.org/10.1111/j.1365-3156.2012.03005.x.
Ayankogbe, O. O., Odusote, K., Omoegun, M. O., Ofoha, V., Adedokun, A., & Abiola, K. O. (2011). Determinants of young people's sexual behaviour concerning HIV and AIDS in the practice population of a university health centre in Lagos, Nigeria. African Journal of Primary Health Care & Family Medicine, 3(1), 219. https://doi.org/10.4102/phcfm.v3i1.219.
Beguy, D., Kabiru, C. W., Nderu, E. N., & Ngware, M. W. (2009). Inconsistencies in self-reporting of sexual activity among young people in Nairobi, Kenya. The Journal of Adolescent Health, 45(1), 595–601.
Catania, J. A., Gibson, D. R., Chitwood, D. D., & Coates, T. J. (1990). Methodological problems in AIDS behavioral research: influences on measurement error and participation bias in studies of sexual behavior. Psychological Bulletin, 108(1), 339–362.
Conduct Problems Prevention Research Group. (2014). Trajectories of risk for early sexual activity and early substance use in the Fast Track prevention program. Prevention science : the official journal of the Society for Prevention Research, 15(Suppl 1) (0 1), S33–S46. https://doi.org/10.1007/s11121-012-0328-8.
Conroy, A. A., Tsai, A. C., Clark, G. M., Boum, Y., Hatcher, A. M., Kawuma, A., Hunt, P. W., Martin, J. N., Bangsberg, D. R., & Weiser, S. D. (2016). Relationship power and sexual violence among HIV-positive women in rural Uganda. AIDS and Behavior, 20(9), 2045–2053. https://doi.org/10.1007/s10461-016-1385-y.
Dickson, N., Paul, C., Herbison, P., & Silva, P. (1998). First sexual intercourse: age, coercion, and later regrets reported by a birth cohort. BMJ, 316(7124), 29–33. https://doi.org/10.1136/bmj.316.7124.29.
Durowade, K. A., Babatunde, O. A., Omokanye, L. O., Elegbede, O. E., Ayodele, L. M., Adewoye, K. R., Adetokunbo, S., Olomofe, C. O., Fawole, A. A., Adebola, O. E., & Olaniyan, T. O. (2017). Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria. African Health Sciences, 17(3), 614–622. https://doi.org/10.4314/ahs.v17i3.3.
Gender Links (2012). Gender based violence indicators study Botswana: key findings of the Gender Based Violence Indicators Study by the Women's Affairs Department and Gender Links.www.gov.bw • www.genderlinks.org.za.Gaborone.
Ghosh, M., Daniels, J., Pyra, M., Juzumaite, M., Jais, M., & Murphy, K. (2018). Impact of chronic sexual abuse and depression on inflammation and wound healing in the female reproductive tract of HIV-uninfected and HIV-infected women. PLoS One, 13(6), e0198412. https://doi.org/10.1371/journal.pone.0198412.
Hewett, P. C., Mensch, B. S., & Erulkar, A. S. (2004). Consistency in the reporting of sexual behaviour by adolescent girls in Kenya: a comparison of interviewing methods. Sexually Transmitted Infections, 80(1), ii43–ii48. https://doi.org/10.1136/sti.2004.013250.
Keetile, M. (2014). High-risk behaviors among adult men and women in Botswana: implications for HIV/AIDS prevention efforts. SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance, 11(1), 158–166. https://doi.org/10.1080/17290376.2014.960948.
Kelley, M. L., Ehlke, S. J., Lewis, R. J., Braitman, A. L., Bostwick, W., Heron, K. E., & Lau-Barraco, C. (2018). Sexual coercion, drinking to cope motives, and alcohol-related consequences among self-identified bisexual women. Substance Use & Misuse, 53(7), 1146–1157. https://doi.org/10.1080/10826084.2017.1400565.
Kirstin, R., Mitchell, M. C. H., Prah, P., Clifton, S., Tanton, C., Wellings, K., & Copas, A. (2019). Why do men report more opposite-sex sexual partners than women? Analysis of the Gender Discrepancy in a British National Probability Survey, The Journal of Sex Research, 56(1), 1–8. https://doi.org/10.1080/00224499.2018.1481193.
Knopf, A. S., McNealy, K. R., Al-Khattab, H., Carter-Harris, L., Oruche, U. M., Naanyu, V., Draucker, C. B., & Vermund, S. H. (2017). Sexual learning among east African adolescents in the context of generalized HIV epidemics: a systematic qualitative meta-synthesis. PLoS One, 12(3), e0173225. https://doi.org/10.1371/journal.pone.0173225.
Koenig, M. A., Lutalo, T., Zhao, F., Nalugoda, F., Kiwanuka, N., Wabwire-Mangen, F., et al. (2004). Coercive sex in rural Uganda: prevalence and associated risk factors. Social Science & Medicine, 58(4), 787–798. https://doi.org/10.1016/s0277-9536(03)00244-2.
Letamo, G., & Bainame, K. (1997). The socioeconomic and cultural context of the spread of HIV/AIDS in Botswana. Gaborone: Government Printers.
Livingston, J. A., Testa, M., Windle, M., & Bay-Cheng, L. Y. (2015). Sexual risk at first coitus: does alcohol make a difference? Journal of Adolescence, 43(1), 148–158. https://doi.org/10.1016/j.adolescence.2015.05.018.
Maharaj, P., & Munthree, C. (2007). Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa. Journal of Biosocial Science, 39(02), 231–244. https://doi.org/10.1017/s0021932006001325.
Marston, C., & King, E. (2006). Factors that shape young people’s sexual behaviour: a systematic review. Lancet, 368, 1581–1586. https://doi.org/10.1016/S0140-6736(06)69662-1.
Marston, M., Beguy, D., Kabiru, C., & Cleland, J. (2013). Predictors of sexual debut among young adolescents in Nairobi's informal settlements. International Perspectives on Sexual and Reproductive Health, 39(1), 22–31. https://doi.org/10.1363/3902213.
Marthur, S., Okal, J., Musheke, M., Pilgrim, N., Kishor Patel, S., Bhattacharya, R., et al. (2018). High rates of sexual violence by both intimate and non-intimate partners experienced by adolescent girls and young women in Kenya and Zambia: findings around violence and other negative health outcomes. PLoS One, 13(9), e0203929. https://doi.org/10.1371/journal.pone.0203929.
Mercer, C. H. (2014). Sexual behaviour. Medicine (Abingdon, England : UK ed.), 42(6), 291–293. https://doi.org/10.1016/j.mpmed.2014.03.005.
Ministry of Education and Skills Development. (2016). The Botswana youth risk behavioral surveillance survey report. Gaborone: Government Printers.
Mookodi, G. (2004). Male violence against women in Botswana: a discussion of gendered uncertainties in a rapidly changing environment. African Sociological Review / Revue Africaine De Sociologie, 8(1), 118–138 Retrieved from http://www.jstor.org/stable/24487419.
Ohene, S. A., Halcon, L., Ireland, M., Carr, P., & McNeely, C. (2005). Sexual abuse history, risk behavior, and sexually transmitted diseases: the impact of age at abuse. Sexually Transmitted Diseases, 32(6), 358–363.
Plummer, M. L., & Wight, D. (2011). Young People’s lives and sexual relationships in rural Africa: findings from a large qualitative study in Tanzania. Lanham: Lexington Books.
Richter, L., Mabaso, M., Ramjith, J., & Norris, A. (2015). Early sexual debut: voluntary or coerced? Evidence from longitudinal data in South Africa – The birth to twenty plus study. The South African Medical Journal, 105, 304 www.samj.org.za/index.php/samj/article/view/8925/6640.
Seña, A. C., Hsu, K. K., Kellogg, N., Girardet, R., Christian, C. W., Linden, J., Griffith, W., Marchant, A., Jenny, C., & Hammerschlag, M. R. (2015). Sexual assault and sexually transmitted infections in adults, adolescents, and children. Clinical Infectious Diseases, 61(8), S856–S864. https://doi.org/10.1093/cid/civ786.
Sithole, J. (2011). Botswana’s positive adolescents: challenges of living with HIV. Gaborone: University of Botswana Press http://www.bibalex.org/Search4Dev/files/407322/351588.pdf.
Statistics Botswana. (2014). Botswana AIDS impact survey IV report (BAIS IV-report). Gaborone: Government Printers.
Stern, E., & Cooper, C. (2014). Experiences and conceptualizations of sexual debut from the narratives of South African men and women in the context of HIV/AIDS. African Journal of AIDS Research, 13(2), 121–131. https://doi.org/10.2989/16085906.2014.943252.
Svensson, J., Baer, N., & Silva, T. (2019). Adolescents’ level of knowledge of and supportive attitudes to sexual crime in the Swedish context. Journal of Sexual Aggression, 25(2), 75–89.
Tusiime, S., Musinguzi, G., Tinkitina, B., Mwebaza, N., Kisa, R., Anguzu, R., & Kiwanuka, N. (2015). Prevalence of sexual coercion and its association with unwanted pregnancies among young pregnant females in Kampala, Uganda: a facility based cross-sectional study. BMC Women's Health, 15, 79. https://doi.org/10.1186/s12905-015-0235-9.
Underwood, C. R., & Schwandt, H. M. (2015). Assessing girls’ HIV vulnerability: evidence from Botswana, Malawi and Mozambique. Health Policy and Planning, 31(6), 729–735. https://doi.org/10.1093/heapol/czv123.
Viswan, S. P., Ravindran, T., Kandala, N. B., Petzold, M. G., & Fonn, S. (2017). Sexual autonomy and contraceptive use among women in Nigeria: findings from the demographic and health survey data. International Journal of Women's Health, 9(1), 581–590. https://doi.org/10.2147/IJWH.S133760.
Williams, C. M., Brett, K. M., & Abma, J. C. (2009). Coercive first intercourse and unintended first births. Violence and Victims, 24(3), 351–363.
Williams, C. M., Clear, E. R., & L.C. (2014). Sexual coercion and sexual violence at first intercourse associated with sexually transmitted infections. Sexually Transmitted Disorders., 40(10), 771–775. https://doi.org/10.1097/OLQ.0000000000000011.
Yaya, S., & Bishwajit, G. (2018). Age at first sexual intercourse and multiple sexual partnerships among women in Nigeria: a cross-sectional analysis. Frontiers in Medicine, 5, 171. https://doi.org/10.3389/fmed.2018.00171.
Yi, S., Tuot, S., Chhoun, P., Pal, K., Tith, K., Brody, C., & Newman, P. A. (2015). Factors associated with inconsistent condom use among men who have sex with men in Cambodia. PLoS One, 10(8), e0136114. https://doi.org/10.1371/journal.pone.0136114.
Acknowledgments
The authors extend their appreciation to Statistics Botswana for availing the Botswana AIDS Impact Survey IV data used in this study. We also acknowledge University of Botswana, for availing resources used for data analysis in this work.
Author information
Authors and Affiliations
Corresponding author
Additional information
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Appendix
Appendix
Rights and permissions
About this article
Cite this article
Keetile, M., Rakgoasi, S.D. Factors associated with first heterosexual sex; sexual coercion and sexual risk behaviors among adolescents in Botswana. Sex Res Soc Policy 18, 261–270 (2021). https://doi.org/10.1007/s13178-020-00454-w
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13178-020-00454-w