Associations between forced non-consensual first-sex and HIV among sexually active women in the Kingdom of Eswatini

ABSTRACT

Studies continue to underscore the profound impact of sexual violence on women’s health. Yet, little is known about the impact, via a complex matrix of behavioural and social factors, of first intercourse, namely forced non-consensual on HIV status, particularly among sexually active women (SAW) in low-income countries where HIV prevalence remains high. Using a national sample from Eswatini, we employed multivariate logistic regression modelling to estimate the associations between forced first-sex (FFS), subsequent sexual behaviour and HIV status among 3555 SAW aged from 15 years to 49 years. The results found that women who experienced FFS had a greater number of sexual partners compared to those who had never experienced FFS (aOR = 2.79, p < .01), although there were no significant differences in condom use, early sexual debut and casual sex involvement between these two groups. FFS remained significantly associated with a higher risk of having HIV (aOR = 1.70, p < .05) even after controlling for risky sexual behaviours and various other factors. These findings further reinforce the relationship between FFS and HIV, and suggest that addressing sexual violence is a critical component of HIV prevention among women in low-income countries.

KEYWORDS:

• HIV
• forced first-sex
• sexual behaviour
• sexually active women
• Eswatini

Acknowledgements

The authors acknowledge the Population Based HIV Impact Assessment Project (PHIA) for conducting the national survey and giving permission for us to use the second Swaziland HIV Incident Measurement Survey (SHIMS2) carried out in 2016 to conduct this study. The conclusions herein are those of the authors and do not represent the viewpoint of the Ministry. No funding bodies had any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the Ministry of Science and Technology in Taiwan under grant 111-2314-B-A49-016.