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Abstract BACKGROUND: Although household illness and death are believed to be risk factors for unsafe sexual behaviors among adolescents in developing countries—particularly girls—few studies document the relationship. Many existing studies are anecdotal in nature. METHODS: Using a cross-sectional population-based survey of 4,000 14–24-year-olds in KwaZulu-Natal, South Africa, a multivariate hazard model is utilized to assess the effects of household illness and death in the two years preceding the survey on adolescent sexual debut. Standard errors are corrected for the two-stage sampling design, and sampling weights are applied. RESULTS: After controlling for the effects of various individual-, household-, and community-level factors, adolescents residing in households that experienced a health shock in the two years before the survey were more likely to have sexually debuted than same-age adolescents in households that had not experienced such recent shocks. Adolescents in households that experienced a recent death were 20 percent more likely to have debuted (p<0.01), while those in households that experienced a recent severe illness were 13 percent more likely to have debuted (p<0.05). Disaggregating by gender reveals that a recent death increases female and male chances of debut by 20 percent (p<0.03) and 24 percent (p<0.03), respectively. A recent severe illness in the household had less statistically significant effects, increasing both female and male chances of debut by 13 percent (p<0.11 and p<0.13, respectively). The study also indicates that residing in a poor household was a statistically significant predictor of debut for females (p<0.01) but not males (p<0.86). CONCLUSIONS: Household health shocks, especially death, are risk factors for sexual debut among both female and male adolescents in KwaZulu-Natal, South Africa. Poverty also increases female but not male chances of debut. This page updated |
