Background: A variety of studies identified early sexual debut as a significant risk factor for HIV
infection, particularly among young African women. However, little is known about this
relationship in Central Africa.
Methods: This study was based on a cross-sectional analysis of Demographic and Health
Surveys data drawn from four central African countries, Cameroon and Gabon with high HIV
prevalence levels, Democratic Republic of Congo and Congo with low HIV prevalence levels.
Relationship between sexual activity initiated before age 15 and HIV sero-status was examined
in men and women aged 15-24 years, to determine potential differences in this relationship
across countries. Logistic regression was used to build a standard multivariate analysis model
allowing for comparison between countries while controlling for sociodemographic, economic,
behavioral, most recent partner characteristics, and HIV prevention knowledge.
Results: HIV prevalences were significantly higher among women from high HIV prevalence
countries compared to women living in lower HIV prevalence countries (p<.0001), and among
women compared to men: 3.7%, 2.7%, 0.9%, and 2% for women and 0.8%, 0.7%, 0.2%, 0.7%
for men from Cameroon, Gabon, Democratic Republic of Congo, and Congo respectively. The
median age at first intercourse varied between 15 and 16 years in all four countries. Significant
associations were found between early sexual debut and HIV-positive status among females in
Cameroon (OR, 2.52; 95% CI, 1.57-4.01; p=.0001) and Democratic Republic of Congo (OR, 3.92;
95%CI, 1.71-9.48; p=.002) after controlling for age, marital status, education, religion, economic
status, lifetime number of sexual partners, condom use, relationship with most recent sex
partner, and knowledge of condom and fidelity as HIV prevention methods. Multivariate
analyses also showed that being older (OR, 1.88; 95% CI, 1.13-3.22; p=.02), and having more
than one lifetime sexual partners (OR, 3.05; 95%CI, 1.77-5.61; p=.0001) remained significantly
associated with a positive HIV test among female Cameroonians whereas in Democratic
Republic of Congo, women having a low economic status were significantly less likely to be
seropositive (OR, 0.16; 95%CI, 0.04-0.5; p=.004) compared to those from wealthier families.
Conclusion: Decline in heterosexual transmission of HIV in Central Africa will necessitate that
behavioral interventions targeting young African women encourage delaying sexual debut and
not engaging in other risky sexual behaviors.