title: Associations between Forced Sexual Initiation, HIV Status, Sexual Risk Behavior, Life Stressors, and Coping Strategies among Adolescents in Nigeria.
abstract: Some individuals experience their first sexual intercourse through physically forced sex, which affects the way they experience and cope with stress. We examined differences in sexual risk behavior, experience of stressors, and use of stress-coping strategies among adolescents in Nigeria based on their history of forced sexual initiation and HIV status.
  
  
  
  We analyzed data from 436 sexually active 10-19-year-old adolescents recruited through a population-based survey from 12 Nigerian states. Using Lazarus and Folkman's conceptual framework of stress and coping, we assessed if adolescents who reported forced sexual initiation were more likely to report HIV sexual risk practices, to report as stressors events related to social expectations, medical care and body images, and loss and grief, and to use more avoidance than adaptive coping strategies to manage stress. We also assessed if HIV status affected experience of stressors and use of coping strategies.
  
  
  
  Eighty-one adolescents (18.6%) reported a history of forced sexual initiation; these participants were significantly more likely to report anal sex practices (OR: 5.04; 95% CI: 2.14-11.87), and transactional sex (OR: 2.80; 95% CI: 1.56-4.95). Adolescents with no history of forced sexual initiation were more likely to identify as stressors, life events related to social expectations (OR: 1.03; 95% CI: 0.96-1.11) and loss and grief (OR: 1.34; 95% CI: 0.73-2.65), but not those related to medical care and body images (OR: 0.63; 95% CI: 0.34-1.18). They were also more likely to use adaptive responses (OR: 1.48; 95% CI: 0.62-3.50) than avoidance responses (OR: 0.90; 95% CI: 0.49-1.64) to cope with stress, though these differences were not significant. More adolescents with a history of forced sexual initiation who were HIV positive identified as stressors, life events related to medical care and body images (p = 0.03) and loss and grief (p = 0.009). Adolescents reporting forced sexual initiation and HIV-negative status were significantly less likely to use religion as a coping strategy (OR: 0.28; 95% CI: 0.09-0.83).
  
  
  
  History of forced sexual initiation and HIV status affected perception of events as stressors and use of specific coping strategies. Our study findings could inform best practice interventions and policies to prevent and address forced sexual initiation among adolescents in Nigeria and other countries.
authors.affiliation: Institute of Public Health and Department of Child Dental Health, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria.
authors.forename: Morenike Oluwatoyin
authors.initials: MO
authors.lastname: Folayan
authors.affiliation: Department of Behavioral and Social Sciences, School of Public Health, Brown University, Providence, Rhode Island, United States of America.
authors.forename: Abigail
authors.initials: A
authors.lastname: Harrison
authors.affiliation: Division of Clinical Sciences, Center for Healthy Communities, University of California Riverside School of Medicine, Riverside, California, United States of America.
authors.forename: Brandon
authors.initials: B
authors.lastname: Brown
authors.affiliation: Positive Action for Treatment Access, Ikeja, Lagos, Nigeria.
authors.forename: Morolake
authors.initials: M
authors.lastname: Odetoyinbo
authors.affiliation: Division of Global Public Health, Department of Medicine, University of California San Diego, San Diego, California, United States of America.
authors.forename: Jamila K
authors.initials: JK
authors.lastname: Stockman
authors.affiliation: Department of Health Promotion and Education, College of Medicine, University of Ibadan, Ibadan, Oyo State, Nigeria.
authors.forename: Ademola J
authors.initials: AJ
authors.lastname: Ajuwon
authors.affiliation: Center for Interdisciplinary Studies in Sexuality, AIDS and Society, Universidad Peruana Cayetano Heredia, Lima, S.M.P. Lima, Peru.
authors.forename: Carlos F
authors.initials: CF
authors.lastname: Cáceres
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology; D002648:Child; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D000066511:Intimate Partner Violence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D008602:Mental Healing / Q000523:psychology; D009549:Nigeria / Q000453:epidemiology; D012067:Religion; D012307:Risk Factors; D012309:Risk-Taking; D012737:Sex Factors; D012742:Sex Offenses / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data*; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D013315:Stress, Psychological / Q000453:epidemiology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires