Assessing the Effect of Age at Sexual Debut on HIV Acquisition among Adolescents Girls and Young Women in Malawi: Evidence from Malawi Population-based HIV Impact Assessment

Abstract

Abstract Background: Adolescent girls and young women (AGYW) constitute the highest proportion of all new HIV infections in sub-Saharan Africa (SSA). Age at sexual debut is one of the sexual behavior factors that predict HIV in AGYW. This study aimed at assessing the effect of age at sexual debut on HIV acquisition among AGYW in Malawi using the 2016 Malawi Population-based HIV Impact Assessment (MPHIA). Methods: We analyzed HIV related data on 1,921 AGYW from the 2015/16 MPHIA. Associations between HIV infection and predictor variables were assessed using both univariate and multivariate logistic regression. The effect of age at sexual debut on HIV acquisition was assessed using binary logistic regression model. Results: The weighted HIV prevalence among AGYW was 4.7%. The prevalence was high for AGYW from southern region (7.8%) compared to the central (2.3%) and the northern region (2.1%). AGYW from urban areas had more than twice the prevalence compared to those from rural areas (9.1% versus 3.7% for urban and rural areas respectively). This study has identified 9 behavioral and contextual factors that are associated with HIV infection among AGYW, and these are: Region (p<0.001), Residence (p<0.001), Age (p=0.008), Age at first sex (p=0.001), Age at marriage (p0.0131), Marital status (p<0.001), Education (p=0.002), Wealth quintile (p=0.05) and Partner at last sex (p<0.001). AGYW who started sex before the age of 15 were more than two times more likely (OR 2.47, 95% CI 1.52 – 4.05) to test HIV positive compared to those who started after the age of 15. Conclusion: We conclude that early sexual debut occurring before the age of 15, significantly predict HIV among AGYW in Malawi. To reduce their risk to acquiring HIV, such AGYW should be linked to HIV preventions services such to HIV pre-exposure prophylaxis services in order to minimize their risk of HIV transmission.