Coerced and forced sexual initiation and its association with negative health outcomes among youth: Results from the Nigeria, Uganda, and Zambia Violence Against Children Surveys

Abstract

Introduction: Coerced and forced sexual initiation (FSI) can have detrimental effects on children and youth. Understanding health outcomes that are associated with experiences of FSI is important for developing appropriate strategies for prevention and treatment of FSI and its consequences. Methods: The Violence Against Children Surveys were conducted in Nigeria, Uganda, and Zambia in 2014 and 2015. We examined the prevalence of FSI and its consequences (sexual high-risk behaviors, violence experiences, mental health outcomes, and sexually transmitted infections (STI)) associated with FSI among youth aged 13–24 years in three countries in sub-Saharan Africa. Results: Over one in ten youth aged 13–24 years who had ever had sex experienced FSI in Nigeria, Uganda, and Zambia. In multivariable logistic regression, FSI was significantly associated with infrequent condom use (OR = 1.4, 95%CI = 1.1–2.1), recent experiences of sexual violence (OR = 1.6, 95%CI: 1.1–2.3), physical violence (OR = 2.2, 95%CI: 1.6–3.0), and emotional violence (OR = 2.0, 95%CI: 1.3–2.9), moderate/serious mental distress (OR = 1.5, 95%CI: 1.1–2.0), hurting oneself (OR = 2.0, 95%CI: 1.3–3.1), and thoughts of suicide (OR = 1.5, 95%CI: 1.1–2.3), after controlling for demographic characteristics. FSI was not statistically associated with engaging in transactional sex, having multiple sex partners, or having a STI. Conclusion: FSI is associated with infrequent condom use, recent experiences of violence and mental health outcomes among youth in sub-Saharan Africa, which may increase the risk for HIV and other consequences. Developing strategies for prevention is important for reducing the prevalence of FSI and its effects on children and youth.

Associations of physical partner violence and sexual violence victimization on health risk behaviours and mental health among university students from 25 countries

“…Consistent with findings of various previous studies [2][3][4][5][10][11][12], this study found among men and women that physical IPV and/or sexual violence victimization was associated with sexual risk behaviour (having had multiple sexual partners, alcohol use in the context of sex, diagnosed with HIV and pregnancy), and violence related behaviour (been in a physical fight and carried a weapon). In agreement with previous findings [2,5,6,[8][9][10][11][12][13][16][17][18][19][20], physical IPV and/or sexual violence victimization was overall and among women associated with all 5 mental health indicators (depression, loneliness, PTSD, sleeping problem and short sleep) and among men 2 poor mental health indicators (PTSD and sleeping problem), and overall victimization was associated with 3 addictive behaviours (alcohol, tobacco and drug use), among women 2 addictive behaviours (binge drinking and tobacco use) and among men 2 addictive behaviours (tobacco use and drug use).…”

“…Various studies have identified that a history physical IPV and/or sexual violence victimization among male and/or female adolescents or emerging adults is associated with sexual risk behaviours, violence related behaviours, poor mental health, substance use, other health risk behaviours, poor health status and poor academic performance. Sexual risk behaviour among adolescents and emerging adults may include, multiple sexual partners [2][3][4], unprotected sex [5][6][7][8][9], pregnancy [4][5][6][7]10], and sexually transmitted infections including HIV [5,[10][11][12][13].…”

“…Violence-related behaviours among adolescents and emerging adults may include in a physical fight [2,14], carried a weapon [2], handgun access [15], and injury [5,10]. Poor mental health as a consequence of physical IPV and/or sexual violence victimization among adolescents and emerging adults may include depression [5,9,11,12,[16][17][18][19][20], posttraumatic stress [5,11,12,16], anxiety [5,9,16,19], psychological distress [8,21], suicidal behaviour [2,14,17,20], sleep disorders [5,12,13], and disordered eating [5,10]. Several studies found that a history of physical IPV and/or sexual violence victimization among adolescents and emerging adults increased the odds for substance use, such as alcohol use or binge drinking [2,5,9,10,13], tobacco use [5,6], drug use [2,5,6,9,10,<...>…”

Polygyny and intimate partner violence in sub-Saharan Africa: Evidence from 16 cross-sectional demographic and health surveys

“…Some of the wide range of negative consequences of IPV for women include loss of pregnancy, through stillbirths and miscarriages, and contraction of sexually transmitted infections ( Durevall & Lindskog, 2015 ). Women who suffer from IPV are also more likely to report high levels of depression, post-traumatic stress disorder, psychological distress, as well as suicidal thoughts ( Mason & Lodrick, 2013 ; Nguyen et al, 2019 ; Ogunwale & Oshiname, 2017 ).…”

Can sexual health interventions make community-based health systems more responsive to adolescents? A realist informed study in rural Zambia

“…Data from sub-Saharan Africa suggest that, while a significant number of adolescents have their first sexual experience at an early age (ranging from 2.0 to 27.0% of adolescents under age 15) [2], in many cases they do not use any form of protection to prevent pregnancy or sexually transmitted infections [3,4]. In addition, not all sexual experiences among adolescents are consensual, since the prevalence of coerced sex and sexual abuse at this age remains high (approximately 16% in Zambia) [5,6].…”