Available online 14 April 2023
Author links open overlay panel, , , , , , , AbstractIntroductionUnderstanding the timing of sexual debut is critical for informing sexual and reproductive health (SRH) interventions. We investigated sexual behavior and early sexual debut among Rwandan youth.
MethodsWe conducted a cross-sectional analysis of data from a cluster-randomized trial with 6,079 students ages 12-19 years in Rwanda. We examined timing of first sex using Cox models to estimate adjusted hazard ratios (aHR) and predictors of early sexual debut (<15 years) using logistic regression to estimate adjusted odds ratios (aOR). Interpretations of sex were also explored.
ResultsParticipants were 15 years and 51.5% female on average; 1,723 (28.3%) reported sexual activity. Among 1,320 who provided an age of sexual debut, 51.4% reported sex at 12 years and 75.7% at <15 years. Males were more likely to report early sexual debut (aOR: 2.48; 95% CI: 2.05, 2.98) and younger age at first sex than females (aHR: 1.92; 95% CI: 1.19, 1.51). One-third of participants considered “sexual intercourse” to include kissing/touching, or masturbation.
ConclusionsSex at 12 years was frequently reported, indicating that interventions facilitating access to youth-friendly SRH services are necessary before age 12. Validation studies are needed to evaluate how interpretations of sexual intercourse influence assessment of sexual activity.
AbbreviationsSRHsexual and reproductive health
aORadjusted odds ratio(s)
aHRadjusted hazard ratio(s)
FP/RHfamily planning and reproductive health
S1school level secondary 1
S2school level secondary 2
PDprevalence difference(s)
USAIDUnited States Agency for International Development
KeywordsSexual debut
first sex
youth sexual health
© 2023 The Author(s). Published by Elsevier Inc.
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