Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Low education levels are associated with early age of sexual debut, drug use and risky sexual behaviours among young Indigenous Australians

Handan Wand A G , Joanne Bryant C , Heather Worth D , Marian Pitts E , John M. Kaldor A , Dea Delaney-Thiele F and James Ward B
+ Author Affiliations
- Author Affiliations

A Kirby Institute, UNSW Australia, Sydney, NSW 2052, Australia.

B South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia.

C Centre for Social Research in Health, UNSW Australia, Sydney, NSW 2052, Australia.

D School of Public Health and Community Medicine, UNSW Australia, Sydney, NSW 2052, Australia.

E Australian Research Centre in Sex, Health and Society, LaTrobe University, Melbourne, Vic. 3000, Australia.

F Aboriginal Medical Service Western Sydney, Mount Druitt, NSW 2770, Australia.

G Corresponding author. Email: hwand@kirby.unsw.edu.au

Sexual Health 15(1) 68-75 https://doi.org/10.1071/SH17039
Submitted: 25 February 2017  Accepted: 9 August 2017   Published: 14 November 2017

Abstract

Background: Earlier age at sexual debut is associated with drug and alcohol use, risky sexual behaviours and sexually transmissible infections (STI). Methods: In the present study, 2320 young Indigenous Australians were surveyed. Results: Most study participants had sex for the first time when they were 14 years or younger (79% and 67% for males and females respectively). More than 80% of participants were categorised as being in the high-risk category for the combined sexual risk factors (i.e. not using condoms, drunk or high at last sexual act, or three or more sexual partners in the past year). There was a linear decreasing trend between the proportion of males and females who had less than high school education and age at first sex (Ptrend < 0.001). Compared with the highest quintile of age at first sexual debut (≥18 years), those in the bottom quintile (<15 years) were less likely to have completed high school (63% vs 32% respectively for males; 68% vs 26% respectively for females; Ptrend < 0.001 for both). Conclusions: The findings of the present study suggest that sex education and STI prevention should start early when targeting Indigenous young people, with age-appropriate messages. Sex education should be comprehensive and address individual risk behaviours, sexual agency and societal vulnerability to not only delay sexual debut, but also to emphasise the importance of STI prevention through condom use, which clearly already works to a certain extent with this group.

Additional keyword: high-risk sexual behaviours.


References

[1]  Aboriginal Surveillance Report of HIV, viral hepatitis, STIs 2015. Sydney: The Kirby Institute, UNSW Australia. 2016. Available online at: http://kirby.unsw.edu.au/surveillance/2015-aboriginal-surveillance-report-hiv-viral-hepatitis-stis [verified 25 February 2017].

[2]  Wand H, Ward J, Bryant J, Delaney-Thiele D, Worth H, Pitts M, Kaldor JM. Individual and population level impacts of illicit drug use, sexual risk behaviours on sexually transmitted infections among young Aboriginal and Torres Strait Islander people: results from the GOANNA survey. BMC Public Health 2016; 16 600
Individual and population level impacts of illicit drug use, sexual risk behaviours on sexually transmitted infections among young Aboriginal and Torres Strait Islander people: results from the GOANNA survey.Crossref | GoogleScholarGoogle Scholar |

[3]  Ward J, Bryant J, Wand H, Kaldor J, Delaney-Thiele D, Worth H, Pitts M. Methods of a national survey of young Aboriginal and Torres Strait Islander people regarding sexually transmissible infections and bloodborne viruses. Aust N Z J Public Health 2016; 40 S96–101.
Methods of a national survey of young Aboriginal and Torres Strait Islander people regarding sexually transmissible infections and bloodborne viruses.Crossref | GoogleScholarGoogle Scholar |

[4]  Moss GB, Clemetson D, D’Costa L, Plummer FA, Ndinya-Achola JO, Reilly M, Holmes KK, Piot P, Maitha GM, Hillier SL, Kiviat NC, Cameron CW, Wamola IA, Kreiss JK. Association of cervical ectopy with heterosexual transmission of human immunodeficiency virus: results of a study of couples in Nairobi, Kenya. J Infect Dis 1991; 164 588–91.
Association of cervical ectopy with heterosexual transmission of human immunodeficiency virus: results of a study of couples in Nairobi, Kenya.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3Mzjt1CrtQ%3D%3D&md5=9ecf59db859d1c8fc02dab185280d6c9CAS |

[5]  Coombs RW, Reichelderfer PS, Landay AL. Recent observations on HIV type-1 infection in the genital tract of men and women. AIDS 2003; 17 455–80.
Recent observations on HIV type-1 infection in the genital tract of men and women.Crossref | GoogleScholarGoogle Scholar |

[6]  Wand H, Ramjee G. The relationship between age of coital debut and HIV seroprevalence among women in Durban, South Africa: a cohort study. BMJ Open 2012; 2 e000285
The relationship between age of coital debut and HIV seroprevalence among women in Durban, South Africa: a cohort study.Crossref | GoogleScholarGoogle Scholar |

[7]  Gregson S, Nyamukapa CA, Garnett GP, Mason PR, Zhuwau T, Caraël M, Chandiwana SK, Anderson RM. Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet 2002; 359 1896–903.
Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe.Crossref | GoogleScholarGoogle Scholar |

[8]  Greenberg J, Magder L, Aral S. Age at first coitus. A marker for risky sexual behavior in women. Sex Transm Dis 1992; 19 331–4.
Age at first coitus. A marker for risky sexual behavior in women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3s7ltVersw%3D%3D&md5=c445a4bed08d777f2c602a8f6c879292CAS |

[9]  Glynn JR, Kayuni N, Floyd S, Banda E, Francis-Chizororo M, Tanton C, Molesworth A, Hemmings J, Crampin AC, French N. Age at menarche, schooling, and sexual debut in northern Malawi. PLoS One 2010; 5 e15334
Age at menarche, schooling, and sexual debut in northern Malawi.Crossref | GoogleScholarGoogle Scholar |

[10]  Cohen M, Hoffman I, Royce RA, Kazembe P, Dyer JR, Daly CC, Zimba D, Vernazza PL, Maida M, Fiscus SA, Eron JJ. Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1. Lancet 1997; 349 1868–73.
Reduction of concentration of HIV-1 in semen after treatment of urethritis: implications for prevention of sexual transmission of HIV-1.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2szmtVOqtw%3D%3D&md5=8cffd5f19771b1f46505b76992211d24CAS |

[11]  Coovadia H, Jewkes R, Barron P, Sanders D, McIntyre D. The health and health system of South Africa: historical roots of current public health challenges. Lancet 2009; 374 817–34.
The health and health system of South Africa: historical roots of current public health challenges.Crossref | GoogleScholarGoogle Scholar |

[12]  Laga M, Schwärtlander B, Pisani E, Sow PS, Caraël M. To stem HIV in Africa, prevent transmission to young women. AIDS 2001; 15 931–4.
To stem HIV in Africa, prevent transmission to young women.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3MzjtVClug%3D%3D&md5=5c49dce149738e37e4bae7cb97d54310CAS |

[13]  Rissel CE, Richters J, Grulich AE, de Visser RO, Smith AMA. Sex in Australia: selected characteristics of regular sexual relationships. Aust N Z J Public Health 2003; 27 131–7.
Sex in Australia: selected characteristics of regular sexual relationships.Crossref | GoogleScholarGoogle Scholar |

[14]  Savage J. Aboriginal adolescent sexual and reproductive health programs: A review of their effectiveness and cultural acceptability. 2009. Available online at: http://www.health.nsw.gov.au/research/Documents/11-aboriginal-adolescent-sexual-and-reproductive-health-prog.pdf [verified 25 February 2017].

[15]  Larkins SL, Page RP, Panaretto KS, Scott R, Mitchell MR, Alberts V, Veitch PC, McGinty S. Attitudes and behaviours of young Indigenous people in Townsville concerning relationships, sex and contraception: the ‘U Mob Yarn Up’ project. Med J Aust 2007; 186 513–18.

[16]  Maharaj P, Munthree C. Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa. J Biosoc Sci 2007; 39 231–44.
Coerced first sexual intercourse and selected reproductive health outcomes among young women in KwaZulu-Natal, South Africa.Crossref | GoogleScholarGoogle Scholar |

[17]  Manning WD, Longmore MA, Giordano PC. The relationship context of contraceptive use at first intercourse. Fam Plann Perspect 2000; 32 104–10.
The relationship context of contraceptive use at first intercourse.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3M%2FhsFehsw%3D%3D&md5=1c12b4515ef4ab9ebb38465f369ec758CAS |

[18]  Purdie N, Buckley S. School attendance and retention of Indigenous Australian students. 2010. Available online at: http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2010/ctg-ip01. pdf [verified 25 February 2017].

[19]  Helme S, Lamb S. Closing the school completion gap for Indigenous students. 2011. Available online at: http://www.aihw.gov.au/uploadedFiles/ClosingTheGap/Content/Publications/2011/ctgc-rs06.pdf [verified 25 February 2017].

[20]  Gray J, Partington G. School attendance and non-attendance. In Beresford Q, Partington G, editors. Resistance and reform: Aboriginal youth and education. Perth: UWA Press; 2002. pp. 263–303.

[21]  Schvaneveldt PL, Miller BC, Berry EH, Lee TR. Academic goals, achievement, and age at first sexual intercourse: longitudinal, bidirectional influences. Adolescence 2001; 36 767–87.
| 1:STN:280:DC%2BD387psFOjtw%3D%3D&md5=4a03281fe06202fde8e06c145d0d1ca8CAS |

[22]  Mårdh PA, Creatsas G, Guaschino S, Hellberg D, Henry-Suchet J. Correlation between an early sexual debut, and reproductive health and behavioral factors: a multinational European study. Eur J Contracept Reprod Health Care 2000; 5 177–82.
Correlation between an early sexual debut, and reproductive health and behavioral factors: a multinational European study.Crossref | GoogleScholarGoogle Scholar |

[23]  Wand H, Ramjee G. Combined impact of sexual risk behaviors for HIV seroconversion among women in Durban, South Africa: Implications for prevention policy and planning. AIDS Behav 2011; 15 479–86.
Combined impact of sexual risk behaviors for HIV seroconversion among women in Durban, South Africa: Implications for prevention policy and planning.Crossref | GoogleScholarGoogle Scholar |

[24]  Zimmer-Gembeck MJ, Helfand M. Ten years of longitudinal research on U.S. adolescent sexual behavior: developmental correlates of sexual intercourse, and the importance of age, gender and ethnic background. Dev Rev 2008; 28 153–224.
Ten years of longitudinal research on U.S. adolescent sexual behavior: developmental correlates of sexual intercourse, and the importance of age, gender and ethnic background.Crossref | GoogleScholarGoogle Scholar |

[25]  Safron DJ, Schulenberg JE, Bachman JG. Part-time work and hurried adolescence: the links among work intensity, social activities, health behaviors, and substance use. J Health Soc Behav 2001; 42 425–49.
Part-time work and hurried adolescence: the links among work intensity, social activities, health behaviors, and substance use.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD387gtV2isg%3D%3D&md5=f03c127a052c0e9a5a27e5ae0561cfa5CAS |

[26]  Meier AM. Adolescent first sex and subsequent mental health. Am J Sociol 2007; 112 1811–47.
Adolescent first sex and subsequent mental health.Crossref | GoogleScholarGoogle Scholar |

[27]  Grimm KJ. Multivariate longitudinal methods for studying developmental relationships between depression and academic achievement. Int J Behav Dev 2007; 31 328–39.
Multivariate longitudinal methods for studying developmental relationships between depression and academic achievement.Crossref | GoogleScholarGoogle Scholar |

[28]  Templeton DJ, Tyson BA, Meharg JP, Habgood KE, Bullen PM, Malek S, McLean R. Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility. Sex Health 2010; 7 44–8.
Aboriginal health worker screening for sexually transmissible infections and blood-borne viruses in a rural Australian juvenile correctional facility.Crossref | GoogleScholarGoogle Scholar |

[29]  Swartzendruber A, Zenilman JM, Niccolai LM, Kershaw TS, Brown JL, DiClemente RJ, Sales JM. It takes two: partner attributes associated with sexually transmitted infections among adolescent. Sex Transm Dis 2013; 40 372–8.
It takes two: partner attributes associated with sexually transmitted infections among adolescent.Crossref | GoogleScholarGoogle Scholar |

[30]  Cooper ML, Peirce RS, Huselid RF. Substance use and sexual risk taking among Black adolescents and White adolescents. Health Psychol 1994; 13 251–62.
Substance use and sexual risk taking among Black adolescents and White adolescents.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2czjtlaktA%3D%3D&md5=0fd3b3f06d6ae820cb14024f00b6060cCAS |

[31]  Cornelius JR, Clark DB, Reynolds M, Kirisci L, Tarter R. Early age of first sexual intercourse and affiliation with deviant peers predict development of SUD: a prospective longitudinal study. Addict Behav 2007; 32 850–4.
Early age of first sexual intercourse and affiliation with deviant peers predict development of SUD: a prospective longitudinal study.Crossref | GoogleScholarGoogle Scholar |

[32]  Cuffee JJ, Hallfors DD, Waller MW. Racial and gender differences in adolescent sexual attitudes and longitudinal associations with coital debut. J Adolesc Health 2007; 41 19–26.
Racial and gender differences in adolescent sexual attitudes and longitudinal associations with coital debut.Crossref | GoogleScholarGoogle Scholar |

[33]  Bellis MA, Hughes K, Calafat A, Juan M, Ramon A, Rodriguez JA, Mendes F, Schnitzer S, Phillips-Howard P. Sexual uses of alcohol and drugs and the associated health risks: a cross sectional study of young people in nine European cities. BMC Public Health 2008; 8 155
Sexual uses of alcohol and drugs and the associated health risks: a cross sectional study of young people in nine European cities.Crossref | GoogleScholarGoogle Scholar |

[34]  Sabia JJ. Early adolescent sex and diminished school attachment: selection or spillovers? South Econ J 2007; 74 239–68.

[35]  Sabia JJ. Reading, writing, and sex: the effect of losing virginity on academic performance. Econ Inq 2007; 45 647–70.
Reading, writing, and sex: the effect of losing virginity on academic performance.Crossref | GoogleScholarGoogle Scholar |

[36]  Dickson N, Paul C, Herbison P, Silva P. First sexual intercourse: age, coercion, and later regrets reported by a birth cohort. BMJ 1998; 316 29–33.
First sexual intercourse: age, coercion, and later regrets reported by a birth cohort.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7htlSqsQ%3D%3D&md5=15e5870fc3e710c89c197ef3589a29beCAS |

[37]  Australian Institute of Health and Welfare (AIHW). Indigenous child safety. 2014. http://www.aihw.gov.au/publication-detail/?id=60129547839 [verified 1 June 2017].

[38]  Creative Spirits. Aboriginal sexual abuse. Available online at: https://www.creativespirits.info/aboriginalculture/health/aboriginal-sexual-abuse#ixzz4hwDUo8P3 [verified 5 September 2017].