Stöckl, H., Kalra, N., Jacobi, J., et al. American Journal of Reproductive Immunology (February 2013), Vol. 69 Suppl. 1, pp. 27-40
The authors conducted a systematic review to summarize evidence on the association between early sexual debut and women's risk of HIV in sub-Saharan Africa. The review found mixed results in all published evidence. Twenty-five studies met the inclusion criteria; the majority were cross-sectional studies. Among high-quality studies with large sample sizes, there was a consistent finding of bivariate association between early sex and HIV risk, which remained after controlling for socio-demographic factors and other confounders. Yet there were mixed results regarding the association, controlling for later high risk behavior. Half of the studies suggested that increased HIV risk was related to later engagement in sexual risk behaviors, as opposed to the age of sexual debut. Risk may also be related to biological factors. Because of methodological limitations, the review findings need to be interpreted with caution. The authors state that the findings highlight the need for additional research to improve understanding of the determining factors and implications of women's early sexual debut, associations with HIV risk, and areas for intervention.