The HIV epidemic in South Africa is severe

The HIV epidemic in South Africa is severe. In 1991, only 1% of pregnant women attending antenatal clinics in the country were HIV-positive, but by 2006, the prevalence of HIV among pregnant women was 29%.¹ Among young people, females are at particularly high risk: In 2003, a nationally representative household survey of nearly 12,000 15–24-year-old South Africans found that 16% of young women and 5% of young men were infected with HIV.²

Early coital debut may increase the risk of HIV infection.^3–5 In places where the prevalence of HIV is high, such as South Africa, coital debut confers a substantial risk of sexual exposure to HIV. Furthermore, sexual behaviors at the time of early coital debut (e.g., nonuse of condoms) may set a precedent for future behaviors that elevate HIV risk. In addition, early debut is associated with increased risks of other STIs and pregnancy among young people.^6–9

Although the prevalence of early sexual debut is often assumed to be particularly high in Sub-Saharan Africa, age at first sex is fairly consistent worldwide; for most young women in Africa, sexual debut occurs at ages 17–20.¹⁰ The mean age at first sex among young men and women in South Africa ranges from 16 to 18 years, depending on the age and type of sample.^11–14

First sexual experiences are part of the transition to adulthood, and they are influenced by the environment, context and culture in which young people develop.^15,16 Studies conducted among South African adolescents in the 1990s and early 2000s described gender norms that defined successful masculinity as having multiple sex partners, and that deemed using physical and sexual violence to establish control over female partners as acceptable behavior.^17–22 Moreover, social norms dictated that intercourse and condom use be initiated by men;^17,19,20,23 young women reported that they avoided discussing condom use for fear of violent reactions from their partners.^17,19 This research clearly documents how inequities in gender power shape young women's first and subsequent sexual experiences and make many of these encounters risky.

Given the potential role of first sexual experiences in increasing the risk of HIV infection, improved understanding of the context of these events is needed to enhance behavioral intervention programs. In this article, we describe the first sexual experiences of a nationally representative sample of South African youth, and we examine the relationship between early coital debut and sexual behaviors occurring at first sex. Specifically, we examine, separately by gender and age-group, the associations between partner age differences and ever having been forced to have sex by one's first partner in relation to early coital debut, and between early coital debut and condom use at first sex. This is the first paper to describe South African youths' first sexual experiences using nationally representative data, and to use multivariable methods to explore the relationships among partner age, early debut and condom use at first sex among these youth .