(Withdrawn) Vulnerabilities at First Sex and Their Association with Lifetime Gender-Based Violence Among Adolescent Girls and Young Women Living in Kampala Slums, Uganda

Background: Adolescent girls and young women (AGYW)’s vulnerability to sexual violence is a serious public health concern worldwide linked to poor sexual health outcomes, including high rates of sexually transmitted infections and HIV. Yet, despite high sexual violence rates among refugee adolescent girls living in precarious settings, few studies have examined the relationships between forced sex and intimate partner violence perpetration. This study fills this knowledge gap by estimating the prevalence of forced first sexual intercourse and exploring its association with non-partner and recent intimate partner violence experiences among urban refugee AGYW in Kampala.

Methods: We conducted a community-based cross-sectional study among AGYW aged (16-24 years) living in four informal urban settlements (Kabalagala, Rubaga, Kansanga, Katwe, Nsambya) in Uganda in 2018. We identified AGYW who reported the first sexual intercourse and used multivariable logistic regression to explore associations between forced first sexual intercourse and gender-based violence experiences.

Results: Although less than half of the AGYW (35.8%; n=72) reported forced first sexual intercourse, more than half (53.6%; n=52) of those were below 15 years when they had their first sexual intercourse. Additionally, most of the AGYW who reported forced first sexual intercourse 65.8% (n=48) also experienced lifetime non-partner sexual violence, 41.8% (n=59) non-partner physical violence, 41.3% (n=19) intimate partner physical violence, and 40.4% (n=38) intimate partner sexual violence. Forced first sexual intercourse prevalence was associated with increased odds of non-partner lifetime physical violence (aOR 2.88, 95% CI= 1.33, 6.22), non-partner lifetime sexual violence (aOR 13.22, 95% CI= 5.85, 29.88), intimate partner physical violence (aOR 2.56, 95% CI= 1.12, 5.88) and intimate partner sexual violence (aOR 2.31, 95% CI= 1.02, 5.20) than AGYW who did not experience forced first sexual intercourse.

Conclusions: Findings that non-partner and partner sexual and physical violence are associated with vulnerabilities that begin at first sex spotlight that interrelatedness of different forms of violence. Universal and holistic gender-based violence prevention programs should target adolescents before the age of 15years to insulate them from violence experiences. Also, early screening to identify victims/survivors of forced first sex could help with early identification of AGYW who are potentially at risk of ongoing GBV. Also, there is a need for gender transformative, tailored intervention programs that target the needs of adolescents at different developmental stages.