Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa.

This study examined outcomes associated with early sexual debut in five sub-Saharan African countries for males and females, separately. We employed Violence Against Children Surveys (VACS) from Kenya, Malawi, Nigeria, Tanzania, and Uganda, restricting samples to males and females age 18-24 years. Early sexual debut was defined as having one's first sexual intercourse before 15. Logistic, Ordinary Least Squares, and Poisson regressions were utilised to estimate associations between early sexual debut and outcomes across four ecological domains: individual, family, peer/partner, and community. Regressions were stratified by sex. The prevalence of early sexual debut ranged from 8.6% in Tanzania to 17.7% in Malawi. Males were more likely to report early sexual debut in Kenya (16.3%, compared to 6.7% for females; P < 0.001) and Uganda (15%, compared to 10.4% for females; P = 0.037). In Nigeria, 14.5% of females reported early sexual debut, compared to 5.4% of males (P < 0.001). Early sexual debut was associated with only one outcome in the individual and family domains, and was most consistently associated with outcomes in the peer/partner domain. Differences in these relationships for males and females suggest programs and policies working to reduce early sexual debut and promote healthy sexual relationships among young adolescents should thoughtfully consider framing messaging through a gendered lens.