title: Early Sexual Debut: A Risk Factor for STIs/HIV Acquisition Among a Nationally Representative Sample of Adults in Nepal.
abstract: While early sexual debut is highly prevalent in Nepal, its link to sexually transmitted infections (STIs/HIV) risk factors has not been explored at a national level. The objective of this study was to assess potential association between early sexual debut and risk factors for STIs/HIV acquisition, including sexual risk behaviors, sexual violence, and teenage pregnancy among adults in Nepal. Data were taken from the nationally representative Nepal Demographic Health Survey (2011), which employed a two-stage complex design to collect data. A sample of 12,756 adults (ages 15-49 years) were included. Multivariate logistic models were conducted, adjusted for demographic characteristics, to assess the association between early sexual debut and STIs/HIV-related risk factors. The prevalence of early sexual debut in this sample was 39.2%, with a mean age of coital debut at 17.9 years. After adjusting for potential confounders, individuals with early sexual debut were significantly more likely to report a history of STIs (aOR 1.19; 95% CI 1.06-1.35) and had a significantly higher risk profile, including having multiple sex partner (aOR 2.14; 95% CI 1.86-2.47), inconsistent condom use (aOR 0.72; 95% CI 0.61-0.86), paid for sex (aOR 1.61; 95% CI 1.14-2.27), a history of sexual violence (aOR 1.99; 95% CI 1.63-2.43), and teenage pregnancy (aOR 12.87; 95% CI 11.62-14.26). Individuals who have early sexual debut are more likely to engage in risk behaviors that place them at increased risk of STIs/HIV acquisition. STIs/HIV prevention strategies should aim at delaying sexual debut to decrease the disproportionate burden of adverse health outcomes, including STIs/HIV, among individuals in Nepal.
authors.affiliation: Department of Community Medicine and Health Care, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT, 06030, USA. Roman.Shrestha@UConn.edu.|Center for Health, Intervention, and Prevention (CHIP), University of Connecticut, Storrs, CT, 06269, USA. Roman.Shrestha@UConn.edu.
authors.forename: Roman
authors.identifier: http://orcid.org/0000-0003-4340-3101
authors.initials: R
authors.lastname: Shrestha
authors.affiliation: Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA.
authors.forename: Pramila
authors.initials: P
authors.lastname: Karki
authors.affiliation: Center for Health, Intervention, and Prevention (CHIP), University of Connecticut, Storrs, CT, 06269, USA.|Department of Allied Health Sciences, University of Connecticut, Storrs, CT, 06269, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Copenhaver
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009390:Nepal / Q000453:epidemiology; D011247:Pregnancy; D011253:Pregnancy in Adolescence / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012742:Sex Offenses / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology*; D012959:Socioeconomic Factors; D055815:Young Adult
keywords: Early sexual debut; HIV/AIDS; Nepal; Sexual risk behavior; Sexually transmitted infection