The effects of family environment on sexual vulnerability among adolescent girls, ages 15--19, in Rakai, Uganda

Background: Prevention of HIV infection in adolescent females is a major public health problem in sub-Saharan Africa. This study examines the effects of household family structure and parental presence on sexual vulnerability, defined as early sexual debut, experiencing sexual coercion and having multiple sexual partners, among adolescent girls, ages 15-19, in Rakai, Uganda.;Methods: Using data from the Rakai Community Cohort Study, parametric hazards and discrete- time survival models were used to model baseline structure and longitudinal changes in structure on age of sexual debut, respectively. Modified Poisson regression with robust error variance using generalized estimation equations was used to model the associations between structure and sexual coercion, stratified by marital status. Multinomial logistic regression with the Taylor linearization method was used to model the effects of structure and parental presence on number of sexual partners.;Results: Higher levels of education, being a student and not using alcohol were protective with respect to all three outcomes. Reported approval of intimate partner violence was associated with increased likelihood of experiencing sexual coercion. A number of household family structures were associated with increased risk of some or all outcomes. Residing with stepfathers was associated with higher risk of all three outcomes compared to residing with a biological father, with or without the presence of a mother. Conversely, living with a single mother was protective against sexual coercion. Living with siblings or alone was associated with increased risk of having multiple sexual partners. The absence of both parents from the household, due to death or not living in the home, was associated with greater likelihood of early sexual debut but not with having multiple sexual partners.;Conclusion: Research into the family structure of adolescent girls in sub-Saharan Africa, including the roles of fathers, is important in order to better understand vulnerability and protective factors, and potentially, to develop interventions to reduce risk of H1V. Support is needed for adolescent girls when both parents absent from the home, not only those who have lost parents to HIV. Adolescent develop in varying family contexts and programs must take this into consideration.