Important note: Information in this article was accurate in 2006. The state of the art may have changed since the publication date.
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New Vision (Kampala) - November 29, 2006
Cathy Watson
In the 1980s and 1990s young Ugandans started sex later in response to the threat of HIV. This is one reason why HIV declined.
Will Uganda be able to push the age of first sex higher and get further gains against HIV? Currently the Technical Working Group on Prevention at the Uganda AIDS Commission is pondering this very serious question.
The UN stipulates "increased age of first sex" as a goal all countries must aim for. It is Uganda's new National Strategic Plan on HIV/AIDS that will have to pronounce to what age first sex should move.
Demographic and Health Surveys in 1995 and 2000-1 and the HIV/AIDS Sero-behavioural Survey of 2004-5 showed that median age for first sex has indeed risen.
For girls, it moved from about 15.9 years in the 1980s to about 16.3 years in 1995. It again moved from 17.3 years in 2000 to 17.9 years in 2005. With this increase of two years, the girls have done well, proving that they do have some control over their lives.
For boys the median age of first sex rose from about 17.5 years in the 1980s to 17.7 years in 1995. It also rose from 18.3 years in 2000 to 19.1 years in 2005. Therefore, boys have also made smart strides.
However, it may be hard to raise the age of first sex much more for girls since the median age of marriage for girls is also 17.9 years. Girls have little premarital sex: most of their sex is in marriage. And they are not likely to marry later unless they can stay in school longer.
By 19, only 12 per cent of girls are still in school: 60 percent are having sex in marriage; 20 percent are abstaining; and 24 per cent are having premarital sex.
The picture for boys is strikingly different. They stay in school much longer, marry much later at about 22 years and have a lot of sex before marriage. By 19, about 50 per cent of boys are still in school. Just six percent are having sex in marriage; 35 per cent are abstaining and 59 per cent are having premarital sex.
So for boys there looks to be plenty of room for increasing the age of first sex. But here arises a problem. The 2004-5 Sero-Survey found that males who delay first sex until after the age of 20 are at increased risk of HIV.
Men aged 15-49 who started sex at 20 or above had an HIV prevalence of 6.6 per cent compared to 6.2 per cent in men who had started sex between the age of 18 and 19. Perhaps boys who start later are less skilled at choosing partners or negotiating sex. Whatever the reason, it might be unwise as a public health measure to push boys as a group to abstain much past 20, although it can be an excellent strategy for individual boys.
What clearly needs a strong public health intervention is early sex before the age of 15. This is currently increasing in boys (from just 10 per cent of males now aged 23-24 to 18 per cent of boys now aged 15-17) but decreasing in girls.
The above statistics may seem dry but they represent millions of personal dramas as young people become sexually active in an environment with a heavy disease burden.
Who becomes sexually active, why and with who is part of the social construction of sex. After the successes of the late 1980s and early 1990s, changing the contours of sex and the HIV epidemic may now not be so easy.
Hopefully, Universal Secondary Education (USE) will gradually help girls to postpone first sex.
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