ABSTRACT Background: A variety of studies identified early sexual debut as a significant risk factor for HIV infection, particularly among young African women. However, little is known about this relationship in Central Africa. Methods: This study was based on a cross-sectional analysis of Demographic and Health Surveys data drawn from four central African countries, Cameroon and Gabon with high HIV prevalence levels, Democratic Republic of Congo and Congo with low HIV prevalence levels. Relationship between sexual activity initiated before age 15 and HIV sero-status was examined in men and women aged 15-24 years, to determine potential differences in this relationship across countries. Logistic regression was used to build a standard multivariate analysis model allowing for comparison between countries while controlling for sociodemographic, economic, behavioral, most recent partner characteristics, and HIV prevention knowledge. Results: HIV prevalences were significantly higher among women from high HIV prevalence countries compared to women living in lower HIV prevalence countries (p Conclusion: Decline in heterosexual transmission of HIV in Central Africa will necessitate that behavioral interventions targeting young African women encourage delaying sexual debut and not engaging in other risky sexual behaviors.

This longitudinal study investigates whether the timing of sexual debut (early, on-time, or late, compared to one’s peers) is associated with young adult romantic relationship quality (i.e., overt and relational victimization, relational aggression, dating worries, and positive dating experiences) either directly or indirectly by moderating the relationship between trajectories of individual factors (internalizing symptoms, externalizing symptoms, and alcohol use) young adult romantic relationship quality. Participants were from a large, six-wave longitudinal study (N = 662, 48% males, M age at T1 = 15.5 years, SD = 1.9 years). I use multi-step regression models to estimate how sexual debut group moderates the association between individual factors and young adult romantic relationship experiences by estimating slopes and intercepts for individual factors and creating interaction terms to test the moderating effect of timing of sexual debut on the slopes and intercepts of individual factors. Gender differences are also investigated. Results indicate that early sexual debut is associated with higher baseline levels of individual factors and directly predicts negative relationship experiences in young adulthood. Early sexual debut moderates the relationship between baseline internalizing symptoms and negative dating experiences and dating worries in young adulthood. Findings also show that early sexual debut moderates the relationship between steeper increases in externalizing symptoms and negative dating experiences and dating worries. The results provide a better understanding of the longitudinal impacts of adolescent experiences on young adult relationship outcomes. / Graduate

Guided by the limited previous literature of adolescent sexual debut and father behaviors, this study examined the influence of father warmth, involvement, and monitoring on adolescent age of sexual debut and likelihood of sexual debut before age 16. Participants and measures were drawn from the Flourishing Families Project and included 346 families and variables from measures completed by adolescents and their parents. A zero-inflated Poisson model was used to test the relationship between father variables and adolescent sexual debut. Gender differences were also analyzed. The findings indicate that an increase in father warmth correlates with a decreased age of sexual debut for adolescent sons and daughters. Results also suggest that an increase in father engagement is related to an increase in the age of debut. However, this variable was also associated with increasing the likelihood of debut for adolescent sons. No significance was found between father monitoring and the age or likelihood of debut. Findings suggest that father variables, independent of mother behaviors, uniquely influence adolescent sexual debut; these effects seem to be protective in some circumstances, while increasing risk in other instances. Implications for future research is considered.

This dissertation tests if a young adult’s social location determines what type of information he or she will receive about sexual health from parents and formal sexual education programs. I also test whether sexual education mediates direct associations between social location and 4 protective sexual health behaviors: condom communication, consistent condom use, delaying sexual debut, and reducing the number of lifetime sexual partners. Using the 2011-2013 wave of the National Survey of Family Growth, I look for differences in sexual education and engaging in protective sexual health behaviors among white, Hispanic, and African American men and women ages 15-24. I find that communication about sex from parents and formal sex education programs varies by race and gender. I also find that direct associations exist between social location, parental communication, formal sexual education, and protective sexual health behaviors. However, all of these operate independently from one another, and I find that parental communication and formal sexual education does little to mediate the direct associations between social location and protective sexual behaviors. Policy implications, limitations, and directions for future research are also discussed.

Introduction: Sexually Transmitted Diseases, including HIV/AIDS, continue to be a major burden in the United States. Sexual partnering behaviors contribute to the spread of STDs. Sexual concurrency has been shown to exponentially increase STD prevalence in populations. Serial monogamy with short periods between sexual partners also introduces risk. Methods: We identified sexually active men and women from the 2006-2010 National Survey of Family Growth (NSFG) and used sub sets for each particular study. Sexual partnering was defined as being concurrent, serially monogamous or monogamous in the previous year. Polytomous logistic regression models were developed to evaluate the associations between age of sexual debut among adult men, age of menarche and discordant heterosexual identity and behavior among all women and sexual partnering patterns. Descriptive, mediation, subpopulation and stratified analyses were also conducted. Results: Sexual debut < 15 and 15-17 years was associated with concurrency (adjusted odds ratio (aOR)<15: 2.19; 95% Confidence Interval (CI): 1.36-3.55; aOR 15-17: 1.69; 95% CI: 1.04-2.75). This association was mediated by lifetime number of partners (further adjusted for lifetime partners: OR<15: 1.26; 95% CI: 0.74-2.22; OR15-17: 1.13; 95% CI: 0.67-1.92). Age of menarche was not associated with subsequent concurrent sexual partnering (adjusted odds ratio (aOR)early: 1.09; 95% Confidence Interval (CI): 0.57-2.09; aORaverage: 1.13; 95% CI: 0.64-1.99) or serial monogamy (aORearly: 0.75; 95% CI: 0.41-1.38; aORaverage: 0.71; 95% CI: 0.39-1.29). A subanalysis among currently unmarried women did not alter this relationship. Heterosexually discordant women who had both male and female partners in the previous year were 5.5 times as likely to report having a concurrent relationship (95% CI: 2.77-11.09) and 2.43 times as likely to report engaging in serially monogamous relationships (95% CI: 1.19-4.97) with their male partners than concordant women. Conclusions: Sexual partnering behaviors are potentially modifiable and reducing risky partnerships will contribute to a decrease in STD acquisition and transmission. Our findings have important implications. Clinically, they support the provision of comprehensive services, regardless of sexual identity. For policy, they confirm the need for early, inclusive and thorough sexual and reproductive health programming for our youth, in particular focusing on the benefits of lifetime partner reduction.

Background: Adverse childhood experiences (ACEs) are a major public health problem in the US, and have been linked to risky sexual behavior and psychopathology. However, studies examining the link between the wide range of ACEs and sexual health outcomes and behaviors, and the associated mediational role of psychopathology are lacking. Objectives: The main objectives of this dissertation project were: 1) To determine the association between ACEs and sexual health outcomes and behaviors (early sexual debut, intimate partner violence (IPV) perpetration, and HIV/STIs); 2) To examine the disparities among selected populations; and 3) To assess the mediational role of psychopathology in the association between ACEs and sexual health. Methods: Data were obtained from Wave 2 (2004-2005) of the National Epidemiologic Survey on Alcohol and Related Conditions. Logistic and linear regression models were used to determine the association between ACEs (neglect, physical/psychological abuse, sexual abuse, witnessing parental violence, and parental incarceration/psychopathology) and early age at sexual debut by sex and sexual orientation. Structural equation modeling (SEM) was used to determine the mediational role of psychopathology (PTSD, substance abuse, and depression) in the association between ACE constructs and IPV perpetration, and the role of psychopathology, early sexual debut and IPV perpetration in the association between ACEs and HIV/STIs. Results: The association between ACEs and early sexual debut was generally stronger for women and sexual minorities. Among men, PTSD mediated the association between sexual abuse and IPV perpetration (z=0.004, p = 0.018). However, among men and women, substance abuse mediated the association between physical/psychological abuse and IPV perpetration: z=0.011, p=0.036 and z=0.008, p=0.049, respectively. Among men, PTSD mediated abuse (physical/psychological, and sexual) and parental incarceration/psychopathology; substance abuse mediated abuse and neglect; depression and early sexual debut mediated abuse; and IPV perpetration mediated sexual abuse, and HIV/STIs. Among women, substance abuse mediated neglect and physical/psychological abuse, and depression mediated physical/psychological abuse and HIV/STIs. Conclusions: Intervention and prevention programs geared towards preventing sexual health outcomes and behaviors should employ a life course approach and address ACEs. Treatment components addressing PTSD, substance abuse, and depression should also be added to IPV perpetration and HIV/STI prevention programs.

<p>The present study predicted that gender, relationship status, sexual orientation, and sexual debut would have an impact on number of sexual partners, which would then affect self-esteem, sexual satisfaction, and sexual self-efficacy. Through an online survey, participants anonymously responded to statements related to these concepts in order to test relationships among demographics and the number of sexual partners as well as among the number of sexual partners and self-esteem, sexual satisfaction, and sexual self-efficacy. Overall, men were much more influenced by their relationship status and number of sexual partners than women, implying that the men are still affected by the sexual double standard through the praise they receive for having many sexual partners.</p>

Youth are having sexual intercourse at an early age and as such, are engaging in risky behaviors that are associated with adverse health outcomes, including HIV infection. Little research has been undertaken to examine the influence of contextual factors on youth intentions to delay sexual involvement. To address that gap, this study aimed to examine the influence of age, gender, race, immigration status, HIV knowledge, HIV-related stigma, concern about HIV, direct exposure to HIV/AIDS, peer pressure, and religious influence on youth intentions to delay sexual involvement. Delayed sexual involvement was conceptualized as youth attitudes towards abstaining from sex, their knowledge of the consequences of sexual involvement, and perceived parent or peer disapproval of the behavior. The theory of reasoned action was used as a framework to guide the study. The cross-sectional study involved secondary data analysis of baseline data pooled from a program evaluation. The sample included 536 urban low-income African American and Latino youth aged 11 to 16 years at high risk of HIV/AIDS. Multiple linear regression analyses revealed that the weighed combination of the predictor variables, age, gender, race, immigration status, HIV knowledge, direct exposure to HIV/AIDS, peer pressure, and religious influence explained the greatest variance of intention to delay sexual involvement (R2 = .246, p < .05). Also observed was a significant relationship between age, gender, and sexual intentions across the regression models. These findings can enhance HIV prevention and social change initiatives because of the potential to impact youth early sexual debut, reduce risky sexual behavior, and consequently decrease the rates of HIV infection among youth.

Thesis (MPhil)--Stellenbosch University, 2015. / ENGLISH ABSTRACT: Introduction: There is an increase in the prevalence of HIV among young females compared to their male counterparts in South Africa (Shisana, 2012). Previous studies have shown early sexual debut is one of the contributing factors to acquiring HIV. Early sexual debut being defined as first sexual intercourse below the age of 15 years as illustrated in the literature (Aji et al., 2013). The aim of the study is to determine the contributing factors to early sexual debut by female adolescents in the ages between 13-19 attending Town-Two Clinic. To establish the knowledge of adolescent females about HIV & STI transmission, to evaluate what sexual and reproductive health education and management is required by adolescents attending the clinic, and to provide guidelines to deal with the concerns and needs of female adolescents attending Town-Two Clinic as well as reproductive health education. Methods: This is an exploratory qualitative study. Twenty female adolescents between the ages 13-19 attending Town Two Clinic for family planning were voluntarily recruited. Data collection was done by means of a 20 minute interview; two participants were interviewed a day. The interview was semi-structured using open-ended questions. Socio-demographic data was obtained by means of a questionnaire; linked to the interviewee by means of a study code to maintain anonymity. Data analysis was done using inductive analysis and creative synthesis, which analyses the details of the information collected to discover important patterns, themes and interrelationships (Larry, 2014). Results: The average age of the participants was 16 years. The youngest and eldest was 13 and 19 years old respectively; average grade was grade10. Majority of participants resided with their mothers (35%), 20% lived with both parents, 20% with their elder siblings, 15% with grandparents and 5% with other relatives. Participants (45%) reported they were sexually active; average age at first sexual intercourse was 14 years. The participants’ acceptable age for sexual debut was 18yrs. Reasons contributing to early sexual debut were identified as: peer pressure, easy access to alcohol, transaction and cross-generational sex, media and social networks, crowded living conditions, sexual abuse and lack of parental supervision and communication with children. The participants (95%) said they received sex education at school;. (65%) reported they were taught about safe sex practices and using a condom every time they have sex. Knowledge gaps; (60%) of the participants reporting they would like to receive more information and teaching about STI’s, as they knew very little about them. Conclusion: The study demonstrates the contributing factors to early sexual debut amongst female adolescents as: Peer pressure, easy access to alcohol, transaction and cross-generational sex, media and social networks, crowded living conditions, sexual abuse and lack of parental supervision and communication with children, and its risk to HIV infection. Appropriate and current sex education with regards HIV, STI prevention, testing and treatment is crucial. Parents play a vital role in educating their own children and need to overcome their socio-cultural views about sex. Interdisciplinary collaboration is needed between the health sector, education, law enforcement, church youth groups, media and social networks in developing effective programs for educating youth on HIV prevention, reproductive health and dangers of substance abuse. / AFRIKAANSE OPSOMMING: Nie beskikbaar