Date of Award

5-17-2019

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor

Shannon Self-Brown

Second Advisor

Monica Swahn

Third Advisor

Francis Annor

Abstract

Introduction: Nigeria is the most populous country in Africa, with over 186 million residents and 62% under age 25. It is plagued by public health problems disproportionately affecting young females, including prevalence rates of HIV/AIDS and unwanted pregnancy among the highest in the world. The purpose of this study was to (1) examine the association between age at first sex and sexual risk-taking behaviors and sexual abuse and (2) determine whether belief in sex-related social norms moderated those relationships. It extended previous research by exploring age at onset as a determinant and identifying targets for prevention activities to help policymakers and stakeholders prioritize limited resources for appropriate response efforts.

Methods: Using data from the Violence Against Children Survey, secondary analysis of 899 Nigerian females aged 13-24 was conducted. The predictor variable of interest was early sexual debut before age 15 (ESD). Outcomes explored were condom use, multiple sex partnership, HIV testing (lifetime and past 12 months), and sexual violence victimization (lifetime and past 12 months). Study covariates included sexual norms, age, marital status, religion, school attendance, ethnicity, and food insecurity. Bivariate and multivariable logistic regression analyses were used to estimate adjusted odds ratios (OR) with 95% confidence intervals (CI).

Results: ESD was positively associated with an increased risk of inconsistent condom use (OR=5.2; 95% CI: 1.2 – 23.1) and lifetime HIV testing (OR=2.1; CI: 1.1 – 4.0). Statistically significant interactions were not observed in any of the six hypothesized relationships.

Conclusions: Using condoms inconsistently and never being tested for HIV were both more likely among those who debuted sexually before age 15. Endorsing at least one traditional sexual norms belief did not have a moderating effect. However, sex norms were independently associated with inconsistent condom use, not having an HIV test in the past 12 months, having experienced sexual abuse in one’s lifetime, and experiencing sexual violence in the past 12 months. Therefore, prevention programs should be designed to alter sociocultural views of what is deemed acceptable/unacceptable behavior for men and women, promote consistent condom use among girls and young women, and improve access to voluntary HIV testing and counseling.

Available for download on Friday, April 23, 2021

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