Trends in age at first sex in Uganda: evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai

Slaymaker, Emma; Bwanika, John Baptist; Kasamba, Ivan; Lutalo, Tom; Maher, Dermot; Todd, Jim

doi:10.1136/sti.2008.034009

Cited by 33 publications

(35 citation statements)

References 22 publications

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“…Increased HIV awareness and knowledge of preventive behaviors may in part be responsible for this modest shift away from premarital sexual activity, although further analysis is needed to draw such a conclusion. Similar patterns have been observed in Kenya and Ghana (Zaba et al, 2004), and in Uganda, where the youngest cohort of women had a lower rate of premarital intercourse compared to earlier cohorts despite a delay in the age of marriage (Mensch et al, 2006, Slaymaker et al, 2009, Zaba et al, 2004). In a study of DHS data from southern and eastern Africa, Harwood-Lejeune also found that adolescent pre-marital sexual activity was declining (Harwood-Lejeune, 2001).…”

Section: Discussionsupporting

confidence: 78%

Recent trends in the timing of first sex and marriage among young women in Ethiopia

Reda

Lindstrom

2014

APS

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Context Ethiopia has been characterized by high population growth. Recent social and economic developments have the potential to alter reproductive patterns in the country. Some of these developments include sustained economic growth, urbanization, rapid growth in school enrollments, expansion of primary health care, and a rise in contraceptive access and use. In other national contexts, these developments have been associated with a gradual decoupling of the transition into sexual activity and marriage among young women. We investigate recent trends in the transition into first sex and marriage among three cohorts of Ethiopian women. Methods Using data from the 2000, 2005, and 2011 Ethiopia Demographic and Health Surveys (DHS) we estimate survival curves and discrete-time hazards models to examine recent trends in age at first sex and first marriage among women ages 20–29. Results Across the three survey years the median age at first sex has remained relatively stable at 17 years, although the median age at marriage has increased from 17 to 18 years between the 2005 and 2011 surveys. Net of the effects of education and place of residence, there is evidence of a slight trend away from premarital first sex to sexual initiation in the context of marriage. However, among the most educated women and women living in urban areas (who are a small minority of women), there is a much greater tendency to initiate sexual activity outside of marriage compared to women with little schooling and women living in rural areas, and once they have begun sexual activity they tend to wait longer before they get married. We also find evidence in the most recent survey that women who have first sexual intercourse before marriage are delaying marriage more than was the case among earlier cohorts.

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Section: Discussionsupporting

confidence: 78%

Recent trends in the timing of first sex and marriage among young women in Ethiopia

Reda

Lindstrom

2014

APS

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“…The median age at first sex for women is about 5 years younger than for men in Uganda and Umkhanyakude. 23 24 However, by the age of 25 years, over 90% of both men and women reported having a sexual partner during the past 12 months and can be said to be sexually active. In older women (>40 years), a decline in the proportion that is sexually active was observed in all sites.…”

Section: Discussionmentioning

confidence: 99%

Reported number of sexual partners: comparison of data from four African longitudinal studies

Todd

Cremin

McGrath

et al. 2009

Sexually Transmitted Infections

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Objective: To compare reported numbers of sexual partners in Eastern and Southern Africa. Methods: Sexual partnership data from four longitudinal population-based surveys (1998)(1999)(2000)(2001)(2002)(2003)(2004)(2005)(2006)(2007) in Zimbabwe, Uganda and South Africa were aggregated and overall proportions reporting more than one lifetime sexual partner calculated. A lexis-style table was used to illustrate the average lifetime sexual partners by site, sex, age group and birth cohort. The male-to-female ratio of mean number of partnerships in the last 12 months was calculated by site and survey. For each single year of age, the proportion sexually active in the past year, the mean number of partners in the past year and the proportion with more than one partner in the past year were calculated. Results: Over 90% of men and women between 25 and 45 years of age reported being sexually active during the past 12 months, with most reporting at least one sexual partner. Overall, men reported higher numbers of lifetime sexual partners and partners in the last year than women. The male-to-female ratio of mean partnerships in the last year ranged from 1.41 to 1.86. In southern African cohorts, individuals in later birth cohorts reported fewer sexual partners and a lower proportion reported multiple partnerships compared with earlier birth cohorts, whereas these behavioural changes were not observed in the Ugandan cohorts. Across the four sites, reports of sexual partnerships followed a similar pattern for each sex. Conclusions: The longitudinal results show that reductions in the number of partnerships were more evident in southern Africa than in Uganda.

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“…Kyamulibwa, run by the UK Medical Research Council/Uganda Virus Research Institute, is located within Kalungu District and began collecting demographic and health data on the population in 1989 [12]. Rakai, run by the Rakai Health Sciences Program, is located within Rakai District and began its open-community cohort for 15–49 year olds in 1994 [12]. Background characteristics of the two sites are displayed in Table 1.…”

Section: Methodsmentioning

confidence: 99%

HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews

et al. 2017

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BackgroundSuccessful HIV testing, care and treatment policy implementation is essential for realising the reductions in morbidity and mortality those policies are designed to target. While adoption of new HIV policies is rapid, less is known about the facility-level implementation of new policies and the factors influencing this.MethodsWe assessed implementation of national policies about HIV testing, treatment and retention at health facilities serving two health and demographic surveillance sites (HDSS) (10 in Kyamulibwa, 14 in Rakai). Ugandan Ministry of Health HIV policy documents were reviewed in 2013, and pre-determined indicators were extracted relating to the content and nature of guidance on HIV service provision. Facility-level policy implementation was assessed via a structured questionnaire administered to in-charge staff from each health facility. Implementation of policies was classified as wide (≥75% facilities), partial (26–74% facilities) or minimal (≤25% facilities). Semi-structured interviews were conducted with key informants (policy-makers, implementers, researchers) to identify factors influencing implementation; data were analysed using the Framework Method of thematic analysis.ResultsMost policies were widely implemented in both HDSS (free testing, free antiretroviral treatment (ART), WHO first-line regimen as standard, Option B+). Both had notable implementation gaps for policies relating to retention on treatment (availability of nutritional supplements, support groups or isoniazid preventive therapy). Rakai implemented more policies relating to provision of antiretroviral treatment than Kyamulibwa and performed better on quality of care indicators, such as frequency of stock-outs. Factors facilitating implementation were donor investment and support, strong scientific evidence, low policy complexity, phased implementation and effective planning. Limited human resources, infrastructure and health management information systems were perceived as major barriers to effective implementation.ConclusionsMost HIV policies were widely implemented in the two settings; however, gaps in implementation coverage prevail and the value of ensuring complete coverage of existing policies should be considered against the adoption of new policies in regard to resource needs and health benefits.

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Trends in age at first sex in Uganda: evidence from Demographic and Health Survey data and longitudinal cohorts in Masaka and Rakai

Cited by 33 publications

References 22 publications

Recent trends in the timing of first sex and marriage among young women in Ethiopia

Recent trends in the timing of first sex and marriage among young women in Ethiopia

Reported number of sexual partners: comparison of data from four African longitudinal studies

HIV policy implementation in two health and demographic surveillance sites in Uganda: findings from a national policy review, health facility surveys and key informant interviews

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