Assessing the effect of age at sexual debut on HIV acquisition among Adolescents Girls and Young Women in Malawi: Evidence from Malawi Population-based HIV Impact Assessment

Abstract Background Adolescent girls and young women (AGYW) constitute the highest proportion of all new HIV infections in sub-Saharan Africa. Age at sexual debut is one of the sexual behavior factors that predict HIV among AGYW. We aim to assess the effect of age at sexual debut on HIV acquisition among AGYW in Malawi using 2016 Malawi population-based HIV impact assessment (MPHIA). Methods We analyzed HIV data on 1,921 AGYW from the 2016 MPHIA. Associations between HIV infection and predictor variables were assessed using both univariate and multivariate logistic regression. The effect of age at sexual debut on HIV acquisition was assessed using binary logistic regression model with random adjustment of standard errors. Results The weighted HIV prevalence among AGYW was estimated at 4.7%. The prevalence was high for AGYW from southern region (7.8%) compared to the central (2.3%) and the northern region (2.1%). AGYW from urban areas had twice as much the prevalence of HIV compared to those from rural areas (9.1% versus 3.7% for urban and rural respectively). This study has identified 9 behavior and contextual factors that are associated with HIV infection among AGYW, and these are: region (p < 0.001), residence (p < 0.001), age (p = 0.008), age at first sex (p = 0.001), age at marriage (p0.0131), marital status (p < 0.001), education (p = 0.002), wealth quintile (p = 0.05) and partner at last sex (p < 0.001). AGYW who started sex before the age of 15 were more than two times (OR 2.47, 95% CI 1.52–4.05) likely to be test HIV positive compared to those who started after the age of 15. Conclusion This study concludes that early sexual debut occurring before the age of 15 significantly predict HIV among AGYW in Malawi. To reduce their risk to acquiring HIV, such AGYW should be linked to HIV PreP services to minimize risk of HIV transmission.