Examining Early Initiation of Sexual Intercourse Among Sexually Active Urban Refugee Adolescent Girls and Young Women Living in the Slums of Kampala, Uganda

Background and purpose: Early initiation of sexual intercourse—having sex before the age of 15years has adverse sexual and reproductive health outcomes such as unintended pregnancy and sexually transmitted infections (STIs), including HIV. Uganda has an HIV incidence rate of 6.5%— with adolescent girls and young women (AGYW) over-represented compared to their male counterparts. Uganda hosts over 1million refugees with most urban refugees living in Kampala slums were STI incidence is 37.2%. Understanding factors associated with early sexual initiation is a critical issue especially among refugees who are vulnerable to HIV and other STIs due in part to conflict-related sexual violence (e.g. rape, sexual slavery, forced prostitution, forced pregnancy, forced abortion, and any other form of sexual violence) and mobility. The current study uses a resilience framework (risk and protective factors) to examine early initiation of sexual intercourse among sexually active urban refugee AGYW in Kampala, Uganda.

Methods: Data for this study were drawn from a cross-sectional tablet-based sample of sexually active urban refugee adolescent girls and young women (AGYW) living in five slums of Kampala, Uganda (n=189). Participants were recruited using respondent driven sampling method, known to be effective in engaging hard to reach populations in research. The dependent variable was early initiation of sexual intercourse, measured by responses to whether AGYW had sex before the age of 15. We conducted univariate and multivariate logistic regression to assess the relationship between early sexual debut and risk factors (adverse childhood experiences, dating violence, community violence, family structure, alcohol use, social-economic variables) and protective factors (access to sexual and reproductive health (SRH) information and social support).

Results: Ages of the study participants ranged from 16 to 24 years (M=20.23 years, SD=2.55, Median = 20.00). Approximately half of the sample (51.9%) had experienced sexual initiation before the age 15 years. Nearly 16% of the respondents experienced childhood sexual abuse, while 28% reported childhood physical abuse. Over half reported dating sexual violence and one third reported dating physical violence. Almost 15% reported access to SRH information. In multivariate logistic regression analysis, we found that experiencing childhood sexual violence (AOR: 7.24; 95 % CI 1.80–29.30), intimate partner sexual violence (AOR: 1.79; 95 % CI 1.19–2.68), age (AOR: 1.33; 95 % CI 1.02–1.73), alcohol use (AOR: 3.35; 95 % CI 1.16–9.71) and completion of secondary education (AOR: 11.50; 95 % CI 3.68–35.93) were associated with early initiation of sexual intercourse. Access to SRH information (AOR: 0.17; 95 % CI 0.04–0.76) was a protective factor for early initiation of sexual intercourse.

Conclusion: Early initiation of sexual intercourse is alarmingly high among urban refugee AGYW living in Kampala slums, Uganda. With Uganda hosting refugees escaping conflicts in the DR Congo, Burundi and Southern Sudan, some AGYW's might have experienced involuntary early initiation of sexual intercourse. This finding highlights the importance of social worker practitioners to include screening for sexual violence as part of sexual health interventions among refugee AGYW. There is need for novel and gender-specific SRH interventions tailored to increase maladaptive coping strategies among urban refugees AGYW.