15th International AIDS Conference Bangkok, Thailand — July 11-July 16, 2004

Int Conf AIDS. 2004 Jul 11-16;15:Abstract No. LbOrC22

H Vandenhoudt¹, PN Amornkul², F Odhiambo³, P Nasokho³, N Otwoma³, D Mwaengo², J Vulule³, A Misore⁴, A Buve¹, C Vitek⁵, A Greenberg⁵, L Slutsker², E Marum⁶, K De Cock^6
1Institute of Tropical Medicine, Antwerp, Belgium; ²Centers for Disease Control and Prevention, Kisumu, Kenya; ³Kenya Medical Research Institute, Kisumu, Kenya; ⁴Ministry of Health, Nairobi, Kenya; ⁵CDC, Atlanta, United States; ⁶CDC, Nairobi, Kenya

BACKGROUND: Before starting a youth intervention program, we conducted a baseline survey in Asembo, a rural area with high HIV prevalence in Western Kenya. We describe circumstances around first sexual intercourse, potential exposure to HIV and pregnancy among women aged 13-19 years.

METHODS: A random sample was taken of Asembo residents aged 13-34 years. Informed consent was obtained from adults and mature minors. Non-mature minors needed to assent and have parent/guardian informed consent before enrolling. Study participants were interviewed about sexual behavior, including age of sexual partners, and tested for HIV, HSV-2 and other sexually transmitted infections.

RESULTS: Of 540 women <20 years, 226 (42%) reported having ever had sexual intercourse, of whom 195 (82%) had never married. Median age at first sex was 16.5 years; 7.6% of women had their sexual debut before age 13 and 15% before menarche. Of 195 sexually active, never married women 24 (13%) were pregnant; 153 (78%) reported their first sexual intercourse was consensual, 26 (13%) felt pressured into sex and 16 (8%) were physically forced. The majority (>80%) had their sexual debut with a man age <20 years. Frequency of sexual intercourse was low: 77% reported <5 episodes with the first partner. Only 27% reported condom use during first sexual intercourse. Of 106 sexually active, never married women who reported 1 lifetime sex partner, the HIV prevalence was 4.7%(95% CI 0.7-8.7); HSV-2 prevalence was 12.5%(95% CI 6.1-18.9). Using the reported age of the partners and the age-specific HIV and HSV-2 prevalence rates in men, we estimated that among first-time partners, HIV prevalence was 1.9-3.3% and HSV-2 prevalence was 11.5-14%.

CONCLUSIONS: Many young women in Asembo have their first sexual experience at an immature age. From the time of sexual initiation, women are exposed to high rates of HIV and other STIs in their partners. Prevention efforts should target pre-teens before they become sexually active.

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