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Try out PMC Labs and tell us what you think. Learn More. The aim of this study was to establish the prevalence and risk factors for intergenerational IG -sex in females aged 15—19 residing in Barbados. This cross sectional cluster survey was conducted in a 2. The prevalence of age at first sex was analyzed using a life table approach and risk factors for IG sex defined as sexual relations with a male 10 or more years older were analyzed by logistic regression, adjusting for age. Most insightful is that risk of IG-sex nearly halved for every year at which first sex was delayed.

A high proportion of coerced sex was reported at first sexual experience and this was linked to poor condom use. Affirmative prevention approaches are recommended to boost self-acclamation of adolescent women within less coercive relationships, especially during their first sexual encounter. The Caribbean region has the second highest prevalence of HIV worldwide, behind sub-Saharan Africa, and is one of two regions the other being Africa where the proportion of young women living with HIV in the 15—24 age group outs males [ 1 , 2 ].

In Barbados the overall prevalence of HIV remains higher in men, but in the age group 10—19 it is more prevalent in women [ 2 ]. This ifies a major shift for a disease originally concentrated within the male population. Inter-generational IG -sex is generally defined in the literature as heterosexual intercourse with a non-marital partner ten or more years older [ 6 - 8 ].

In sub-Saharan Africa, adolescent women aged 15—24 were between 2 to 4 times more likely to be infected than their male contemporaries [ 11 ], while research by Kelly et al. A study of adolescent women aged 15—24 in rural Zimbabwe concluded that each one-year increase in age difference between partners was associated with a 4 percent increase in risk of HIV infection [ 13 ]. These relationships, commonly intergenerational, are linked with reduced condom use [ 4 , 6 ]. Despite high levels of HIV awareness and education in the Caribbean, levels of reported condom use remain inconsistent [ 5 , 20 - 23 ].

As in other parts of the world, the ability to exercise condom use by young females is impacted by entrenched gender stereotypes, cultural attitudes towards sex, asymmetric power distribution within relationships, sexual violence, and unequal access to resources [ 4 , 17 , 24 - 27 ]. Information on IG-sex is quite sparse for the Caribbean. However, Demographic Health Surveys and KABP studies have estimated IG-sex prevalence among sexually active females aged 15—19 years within the preceding 12 months ranging from 3. A series of Demographic Health Surveys in African countries revealed a range of IG-sex prevalence in 15—19 year olds from 3.

The transactional element that often characterizes these types of relationship is a strong motivating factor, not only through accruing material or social benefits but also by affirmation of self-worth [ 7 , 36 - 38 ]. Indeed, the meaning of transactional sex within a given cultural context remains the subject of debate [ 38 , 39 ].

Our survey therefore sought to measure prevalence of IG-sex as a primary outcome measure in a nationally representative survey, conducted in adolescent females aged 15—19 residing in Barbados. Determinants examined for IG-sex included transactional sex, age, age at first sex, religious worship, and psycho-social measures of self-esteem, sense of personal power, and peer pressure.

The findings were contrasted with the determinants for sex with any age partner in the same survey population. The study was completed among adolescent females aged 15 to 19 years, who were sampled from multiple polling districts chosen with a probability proportional to size to achieve a target 3. The sample de was a two-stage random sample of girls aged between 15 and Stage 1 consisted of selecting polling districts with probability proportional to size.

The second stage of sampling was done by interviewers within each polling district, who selected every fifth household for inclusion after a randomly chosen start. All eligible girls within each household were selected for inclusion in the survey. All surveys were conducted with informed consent and IRB approval, in accordance with the principles of the Declaration of Helsinki as revised in The survey was interviewer-administered with Youth Commissioners of the Youth Department selected on the basis of experience in fieldwork and working with young people.

Validated instruments included scales for peer pressure, personal power, and self-esteem [ 40 - 43 ]. A pre-test of the survey instrument was conducted on a similar population to the respondent population with the aim of identifying any weaknesses in questionnaire de and providing practice for fieldworkers. Double data entry was performed to minimize transcription error. The primary outcome measure was inter-generational sex. The UNAIDS definition of inter-generational relationships also referred to as cross-generational was used to guide the survey [ 8 ].

IG Sex was therefore defined as heterosexual intercourse with an unmarried male partner 10 or more years older. IG prevalence was measured using 3 items: respondent self-reports of sexual intercourse with a male partner 10 or more years older at the first sexual encounter; sexual intercourse within the past 12 months with a male partner 10 or more years older; and ever having had sexual intercourse with a male partner 10 or more years older. Transactional sex is the exchange of money, food and other items for sex [ 10 , 14 , 15 , 38 ].

The survey asked respondents if they had ever exchanged sex in exchange for money or gifts, and the question was repeated for same-age and older partners. Several predictors of IG sex were incorporated into the survey, some of which were based on individual items: age at first sexual encounter; age of first sexual partner; religious service attendance; and psychosocial variables of self-esteem, sense of personal power and peer pressure.

Such survey des inflate the standard errors of any point estimates, and a Taylor linearization was used for all variance estimation. To calculate the age at first sex a life table approach was used, which calculated the cumulative proportion having sex at each year of age up to The technique allowed for those adolescents who had never had sex to be censored at their current age. The average item non-response rate was minimal 5. The sexual history of females who responded to this item is shown in Table 1.

Respondents were stratified according to age and type of sex engaged in i. Table 1 also categorizes responses to questions on perceived financial distress and religious worship attendance, stratified according to sexual history. Religious worship attendance revealed Respondents were Christian Selected characteristics of Barbadian females aged 15 to 19, stratified by sexual history never had sex, had sex but not inter-generational sex, had inter-generational sex. The age at first sex is illustrated in Figure 1. In this group of adolescent females aged 15 to 19 at the time of interview, 7.

Age at first sex among Barbadian females aged 15— The distribution of age at first sex was generated from censored observations by survival analysis. The input data were age of the respondent, whether or not they ever had sex and if applicable recalled age at first sex. The key outcome measure of this survey was the prevalence of IG-sex, reported in Table 2.

Overall, As a proportion of females who had ever had sex, IG-sex was reported at the first sexual encounter by The age difference of the male partner at the first sexual encounter was examined in further detail: the age difference was reported to be 10 or more years older in Zero percent of girls in the survey reported a younger partner at first sex. Money or gifts were equally likely to be received from a same-age versus an IG partner.

Condom use was strongly related to willingness to have sex. Multiple partnering in sexually active females showed that Sexual history among Barbadian females aged 15 to 19, and selected sexual characteristics among Barbadian females who have had sex at least once. This was due to three participants without known age. A range of demographic, economic, and psycho-social factors were examined for their relationship with the likelihood of having had sex any-age partner in this adolescent female population.

As expected, age was a strong predictor of having had sex, with the odds increasing by 1. All other factors were therefore pre-adjusted for age and are presented on the right of Table 3. We could not demonstrate a link between financial security and the likelihood of having had sex, despite the evidence for perceived financial distress captured in Table 1. Religious service attendance was strongly related to having had sex, with those adolescent females not attending church reporting an almost three times greater chance of having had sex odds ratio 2.

Finally, a constellation of psycho-social factors, including self-esteem, sense of personal power, and peer-pressure, were examined for their association with having had sex in this adolescent female population. Given the statistically ificant effects of peer pressure and religious service attendance on the probability of having had sex, the relationship between peer pressure and religious service attendance was examined as a post-hoc analysis. Unadjusted and age-adjusted odds of reporting IG-sex are shown in Table 4.

The unadjusted odds ratio of reporting IG-sex rose by 1. More insightful was that the chance of IG-sex decreased as age at first sex increased age-adjusted odds ratio 0. This amounts to almost a halving of risk for every additional year of age at which the first sexual encounter occurred. Of the psychosocial factors, we could not demonstrate a link between peer-pressure or sense of personal power with IG-sex. However, self-esteem was statistically ificantly associated with IG-sex: i. Having more than one partner in the past 12 months was associated with IG-sex age adjusted odds ratio 3.

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