title: Age differences at sexual debut and subsequent reproductive health: Is there a link?
abstract: BACKGROUND
  Experiences at sexual debut may be linked to reproductive health later in life. Additionally, young women with older sexual partners may be at greater risk for HIV and sexually transmitted infections. This study examines sexual debut with an older partner and subsequent reproductive health outcomes among 599 sexually experienced women aged 15-24 who utilized voluntary counseling and testing or reproductive health services in Port-au-Prince, Haiti.
  
  
  METHODS
  Logistic regression models, controlling for socioeconomic and demographic factors, examined whether age differences at first sex were significantly associated with STI diagnosis in the previous 12 months and family planning method use at last intercourse.
  
  
  RESULTS
  Sixty-five percent of women reported sexual initiation with a partner younger or less than 5 years older, 28% with a partner 5 to 10 years older, and 7% with a partner 10 or more years older. There was a trend towards decreased likelihood of recent use of family planning methods in women who had first sexual intercourse with a partner 5 to 9 years older compared to women with partners who were younger or less than 5 years older. Age differences were not linked to recent STI diagnosis.
  
  
  CONCLUSIONS
  Programs focusing on delaying sexual debut should consider age and gender-based power differentials between younger women and older men. Future research should examine whether wide age differences at sexual debut are predictive of continued involvement in cross-generational relationships and risky sexual behaviors and explore the mechanisms by which cross-generational first sex and subsequent reproductive health may be connected.
authors.affiliation: Department of Maternal and Child Health, University of North Carolina at Chapel Hill, 27599-7599, USA. agomez@unc.edu
authors.forename: Anu Manchikanti
authors.initials: AM
authors.lastname: Gómez
authors.forename: Ilene S
authors.initials: IS
authors.lastname: Speizer
authors.forename: Heidi
authors.initials: H
authors.lastname: Reynolds
authors.forename: Nancy
authors.initials: N
authors.lastname: Murray
authors.forename: Harry
authors.initials: H
authors.lastname: Beauvais