Conditions of first sexual encounter can be indicators of future HIV risk and gender-based violence

Adolescent girls and young women in Mombasa, Kenya are more likely to experience higher risks of HIV and gender-based violence when they are involved with sex work venues or have sexual experiences at a young age, suggests a study co-led by St. Michael's Hospital and the University of Manitoba in Canada.

Published in the Journal of Acquired Immune Deficiency Syndromes (JAIDS), the research suggests that the conditions of a first sexual encounter, such as a woman's age, the man's age, use of condoms, and whether or not the encounter is consensual can be indicators of future risk of HIV infection and gender-based violence.

The research team found that adolescent girls and young women in Mombasa, Kenya, who are forced or coerced in their first sexual experience, are four to five times more likely to face ongoing gender-based violence throughout their lifetime. This research also showed that one in four participants experience gender-based violence after their first sexual experience, with 37.5 per cent prevalence amongst those involved in sex work.

Dr. Sharmistha Mishra, a scientist at the Li Ka Shing Knowledge Institute of St. Michael's Hospital and one of the study's lead authors, and her team found that women who experienced their first sexual encounter before the age of 15 were two times more likely to be at risk of HIV acquisition. This was especially prevalent for those in the sex work industry and those who frequented sex work venues.

"We wanted to understand early risk and vulnerabilities for HIV because many prevention programs for key populations reach young sex workers several years after they have already experienced high-risk encounters," Dr. Mishra said. "There are vulnerabilities that appear in the first few years of becoming sexually active and entering sex work more formally."

The study's results were drawn from a cross-sectional biological and behavioural survey conducted among sexually active adolescent girls and young women in Mombasa, Kenya. Community organizations, including past and current female sex workers working with the International Centre for Reproductive Health Kenya, identified participants at local sex work hotspots who then participated in interviews and HIV testing. Participants were referred to HIV prevention and care programs in Mombasa.

"Global health partnerships are strongest when there is a generation of new knowledge that informs programs led on the ground," said Dr. Mishra, speaking of this work's partnership between St. Michael's Hospital, the University of Toronto, the University of Manitoba, and the National AIDS and STI Control Programme in Kenya.

This research is part of a multi-component study designed to count how many young women are involved in sex work in Mombasa, Kenya; measure early HIV risks through a representative survey; and conduct mathematical modelling to understand the impact of not accounting for the early risk many young women face.

"We've identified a need to provide HIV prevention and treatment plans for adolescent girls and young women at an earlier age," Dr. Marissa Becker, associate professor at the University of Manitoba and co-lead of the study. "We hope the findings of this research can assist HIV prevention programs to adapt their strategies to reach vulnerable young women and teenaged girls at a younger age and intervene on risks early on."

Dr. Becker, Dr. Mishra and their team are continuing to conduct programmatic and mathematical modeling studies in this area, with a hope to implement and evaluate new programs and interventions. They are also looking at how their findings in Kenya are applicable to other countries.

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