Risk and Protective Factors and Trends over Time in Initiation of Sexual Intercourse among Adolescents, Rakai District, Uganda, 1994-2011

John Santelli, Columbia University
Inge K. Holden, Columbia University
Xiaobo Zhong, Columbia University
Ying Wei, Columbia University
Richard Musoke, Johns Hopkins University

Initiation of sexual intercourse places young people at immediate risk of HIV, other STIs, and unintended pregnancy. We examined data from adolescents (15-19 years) in the Rakai Community Cohort Study, Uganda, using logistic regression to assess factors associated with ever having sexual intercourse. Sexual experience rose for young men in the 1990s and then declined after 2003 for adolescent men and women (quadratic trend, p<.0001 for adolescent men adjusted for age). Sexual initiation was associated with not being enrolled in school, being a single or double orphan, alcohol use in the past 30 days, and religious affiliation. Over time, dramatic increases occurred in school enrollment and sizeable declines were found for entrance into marriage and in single and double orphanhood. Trends in sexual initiation among youth in Rakai appears to be strongly influenced by social factors such as increasing access to education and declining orphanhood.