Top

Published in:

Open Access 01-12-2013 | Research article

Prevalence and risk factors for inter-generational Sex: a cross-sectional cluster survey of Barbadian females aged 15–19

Authors: Nicole Drakes, Clarissa Perks, Alok Kumar, Kim Quimby, Colin Clarke, Rajul Patel, Ian R Hambleton, R Clive Landis

Published in: BMC Women's Health | Issue 1/2013

Abstract

Background

The aim of this study was to establish the prevalence and risk factors for intergenerational (IG)-sex in females aged 15–19 residing in Barbados.

Methods

This cross sectional cluster survey was conducted in a 2.6% national sample in the age range (n = 261) recruited from multiple polling districts chosen with a probability proportional to size. Consent was obtained from participants aged ≥18 years or from parents/guardians of participants <18 years, with participant assent. The prevalence of age at first sex was analyzed using a life table approach and risk factors for IG sex (defined as sexual relations with a male 10 or more years older) were analyzed by logistic regression, adjusting for age.

Results

51.0% of adolescent females in the survey reported ever having had sex, among whom prevalence of IG-sex was 13.2% (95% CI: 6.7-19.8) at first sex, 29.0% (22.3-35.7) within the preceding twelve months, and 34.8% (24.3-45.4) ever. Condom use at first sex was positively related to willingness to have sex (F statistic = 9.8, p = 0.001). The strongest determinant for IG-sex was age of sexual debut (age adjusted Odds Ratio [95% CI]: 0.58[0.41-0.83]), followed by money or gifts received from the partner (2.91[1.17-7.23] and self-esteem (0.33[0.11-0.95]).

Conclusions

The survey establishes a high rate of IG-sex in Barbados, a ‘high income’ country. Most insightful is that risk of IG-sex nearly halved for every year at which first sex was delayed. A high proportion of coerced sex was reported at first sexual experience and this was linked to poor condom use. Affirmative prevention approaches are recommended to boost self-acclamation of adolescent women within less coercive relationships, especially during their first sexual encounter.

Available only for authorised users

UNAIDS World AIDS Day Report. 2011, http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/JC2216_WorldAIDSday_report_2011_en.pdf. Accessed May 16 2012. 12-1-2011

The Barbados HIV/AIDS Surveillance Report 2010. 2011, Barbados: HIV AIDS Programme, Ministry of Health

Caribbean AIDS epidemic update 2008. 2012, http://data.unaids.org/pub/Report/2008/jc1528_epibriefs_caribbean_en.pdf accessed 20/04/2012

Bombereau G, Allen CF: Social and cultural factors driving the HIV epidemic in the Caribbean: a literature review. 2008, St. Augustine, Trinidad and Tobago: Caribbean Health Research Council, Accessed at: http://www.academia.edu/1811440/Social_and_cultural_factors_driving_the_HIV_epidemic_in_the_Caribbean

Ogunnaike-Cooke S, Kabore I, Bombereau G, Espeut D, O'Neil C, Hirnschall G: Behavioural Surveillance Surveys in Six Countries of the Organisation of Eastern Caribbean States (2005–2006). 2007, Port of Spain, Trinidad and Tobago: US Agency for International Development, Family Health International, Caribbean Epdemiology Centre and the Pan American Health Organisation

Hope R: Addressing Cross-Generational Sex: A Desk Review of Research and Programs. 2007, Interagency Gender Working Group (IGWG) and the Interagency Youth Working Group (IYWG), Available at: http://www.iywg.org/sites/iywg/files/CrossGenSex.pdf

Luke N: Age and economic asymmetries in the sexual relationships of adolescent girls in sub-Saharan Africa. Stud Fam Plann. 2003, 34: 67-86. 10.1111/j.1728-4465.2003.00067.x.CrossRefPubMed

UNAIDS Terminology Guidelines (October 2011). Accessed at: http://www.unaids.org/en/media/unaids/contentassets/documents/unaidspublication/2011/JC2118_terminology-guidelines_en.pdf. UNAIDS. 10-1-2011

Luke N: Confronting the ‘sugar daddy’ stereotype: age and economic asymmetries and risky sexual behavior in urban Kenya. Int Fam Plan Perspect. 2005, 31: 6-14. 10.1363/3100605.CrossRefPubMed

10.

Chatterji M, Murray N, London D, Anglewicz P: The factors influencing transactional sex among young men and women in 12 sub-Saharan African countries. Soc Biol. 2005, 52: 56-72.PubMed

11.

Bearinger LH, Sieving RE, Ferguson J, Sharma V: Global perspectives on the sexual and reproductive health of adolescents: patterns, prevention, and potential. Lancet. 2007, 369: 1220-1231. 10.1016/S0140-6736(07)60367-5.CrossRefPubMed

12.

Kelly RJ, Gray RH, Sewankambo NK, Serwadda D, Wabwire-Mangen F, Lutalo T, et al: Age differences in sexual partners and risk of HIV-1 infection in rural Uganda. J Acquir Immune Defic Syndr. 2003, 32: 446-451. 10.1097/00126334-200304010-00016.CrossRefPubMed

13.

Gregson S, Nyamukapa CA, Garnett GP, Mason PR, Zhuwau T, Carael M, et al: Sexual mixing patterns and sex-differentials in teenage exposure to HIV infection in rural Zimbabwe. Lancet. 2002, 359: 1896-1903. 10.1016/S0140-6736(02)08780-9.CrossRefPubMed

14.

Kurz K, Luke N: Cross-generational and Transactional Sexual Relations in Sub-Saharan Africa: Prevalence of Behavior and Implications for Negotiating Safer Sexual Practices. Sep 2002, International Center for Research on Women/Population Services International, Available at: http://www.icrw.org/files/publications/Cross-generational-and-Transactional-Sexual-Relations-in-Sub-Saharan-Africa-Prevalence-of-Behavior-and-Implications-for-Negotiating-Safer-Sexual-Practices.pdf

15.

Dunkle KL, Jewkes R, Nduna M, Jama N, Levin J, Sikweyiya Y, et al: Transactional sex with casual and main partners among young South African men in the rural Eastern Cape: prevalence, predictors, and associations with gender-based violence. Soc Sci Med. 2007, 65: 1235-1248. 10.1016/j.socscimed.2007.04.029.CrossRefPubMedPubMedCentral

16.

Maganja RK, Maman S, Groves A, Mbwambo JK: Skinning the goat and pulling the load: transactional sex among youth in Dar es Salaam, Tanzania. AIDS Care. 2007, 19: 974-981. 10.1080/09540120701294286.CrossRefPubMed

17.

Luke N, Goldberg RE, Mberu BU, Zulu EM: Social Exchange and Sexual Behavior in Young Women’s Premarital Relationships in Kenya. J Marriage Fam. 2011, 73: 1048-1064. 10.1111/j.1741-3737.2011.00863.x.CrossRefPubMedPubMedCentral

18.

Allen CF, Edwards M, Williamson LM, Kitson-Piggott W, Wagner HU, Camara B, et al: Sexually transmitted infection service use and risk factors for HIV infection among female sex workers in Georgetown, Guyana. J Acquir Immune Defic Syndr. 2006, 43: 96-101. 10.1097/01.qai.0000226794.23840.80.CrossRefPubMed

19.

Jones A: The Transactional Sexual Abuse of Children in the Caribbean. Accessed at: http://eprints.hud.ac.uk/9608/

20.

Organisation of Eastern Caribbean States and Health Economics Unit, Knowledge, Attitudes, Beliefs and Practices (KABP) Surveys on HIV/AIDS in Antigua and Barbuda, St. Kitts and Nevis, Dominica and Grenada: Synthesized Report. O.E.C.S.HIV/AIDS Programme Unit. 2011, St. Augustine, Trinidad and Tobago: Health Economics Unit, Centre for Health Economics, University of the West Indies

21.

USAID Caribbean: HIV/AIDS Health Profile. 2007, USAID, Accessed at: http://www.old.msmgf.org/documents/Caribbean/NonGovernment/USAIDCaribbeanPrfile.pdf

22.

Report on the Barbados National Youth KABP Survey on HIV/AIDS 2005–2006. 2007, Bridgetown, Barbados: Ministry of Education, Youth Affairs and Sports

23.

Report on National Knowledge, Attitudes, Behaviour & Practices (KABP) Survey Year 2004: Ministry of Health. Report on National Knowledge, Attitudes, Behaviour & Practices (KABP) Survey Year 2004. 2005, Kingston, Jamaica: Hope Enterprises Ltd, Accessed at: http://www.jamaica-nap.org/nationalKABPreport_2004%20Final.pdf

24.

Anderson H, Marcovici K, Taylor K: The UNGASS, Gender and Women’s Vulnerability to HIV/AIDS in Latin America and the Caribbean. Pan-American Health Organization. 2002, Accessed at: http://www.paho.org/English/ad/ge/GenderandHIV-revised0904.pdf

25.

Kempadoo K, Taitt A: Gender, Sexuality and Implications for HIV/AIDS in the Caribbean: A Review of Literature and Programmes. 2006, UNIFEM/IDRC: Prepared for

26.

LeFranc E, Samms-Vaughan M, Hambleton I, Fox K, Brown D: Interpersonal violence in three Caribbean countries: Barbados, Jamaica, and Trinidad and Tobago. Rev Panam Salud Publica. 2008, 24: 409-421.

27.

Gage AJ, Hutchinson PL: Power, control, and intimate partner sexual violence in Haiti. Arch Sex Behav. 2006, 35: 11-24. 10.1007/s10508-006-8991-0.CrossRefPubMed

28.

HIV/AIDS Survey Indicators Database: Measure DHS Online Tools. 2012, Accessed at: http://www.measuredhs.com/hivdata/

29.

Wood EB, Hutchinson MK, Kahwa E, Hewitt H, Waldron N: Jamaican adolescent girls with older male sexual partners. J Nurs Scholarsh. 2011, 43: 396-404. 10.1111/j.1547-5069.2011.01418.x.CrossRefPubMed

30.

Tureski K, O'Connor Anderson K, Rogers S, Cushnie A: Cross-Generational Relationships: Perceived Norms and Practices in Jamaica. 2012, Washington DC: C-Change/ FHI 360, Accessed at: http://www.pancap.org/attachments/article/1015/Cross-Generational-Relationships-Jamaica.pdf

31.

Nigeria: ORC Macro. Demographic and Health Survey 2003. 2004, Abuja, Nigeria: National Population Commission, Accessed at: http://pdf.usaid.gov/pdf_docs/Pnacx579.pdf

32.

Uganda Demographic and Health Survey 2006. 2007, Kampala, Uganda: Uganda Burea of Statistics, accessed at: http://www.ubos.org/onlinefiles/uploads/ubos/pdf%20documents/Uganda%20DHS%202006%20Final%20%20Report.pdf

33.

Tanzania Demographic and Health Survey 2004: ORC Macro. 2005, Dar es Salaam, Tanzania: National Bureau of Statistics, Accessed at: http://www.measuredhs.com/pubs/pdf/FR173/FR173-TZ04-05.pdf

34.

Malawi Demographic and Health Survey 2004: ORC Macro. 2004, Zomba, Malawi: National Statistical Office, Accessed at: http://www.measuredhs.com/pubs/pdf/FR175/FR-175-MW04.pdf

35.

Ghana Demographic and Health Survey 2003: ORC Macro. 2004, Accra, Ghana: Ghana Statistical Service, Accessed at: http://www.measuredhs.com/pubs/pdf/FR152/FR152.pdf

36.

Leclerc-Madlala S: Age-disparate and intergenerational sex in southern Africa: the dynamics of hypervulnerability. AIDS. 2008, 22 (Suppl 4): S17-S25. 10.1097/01.aids.0000341774.86500.53.CrossRefPubMed

37.

Cremin I, Mushati P, Hallett T, Mupambireyi Z, Nyamukapa C, Garnett GP, et al: Measuring trends in age at first sex and age at marriage in Manicaland, Zimbabwe. Sex Transm Infect. 2009, 85 (Suppl 1): i34-i40. 10.1136/sti.2008.033431.CrossRefPubMedPubMedCentral

38.

Wamoyi J, Fenwick A, Urassa M, Zaba B, Stones W: “Women’s bodies are shops”: beliefs about transactional sex and implications for understanding gender power and HIV prevention in Tanzania. Arch Sex Behav. 2011, 40: 5-15. 10.1007/s10508-010-9646-8.CrossRefPubMed

39.

Nobelius AM, Kalina B, Pool R, Whitworth J, Chesters J, Power R: “You still need to give her a token of appreciation”: the meaning of the exchange of money in the sexual relationships of out-of-school adolescents in rural southwest Uganda. J Sex Res. 2010, 47: 490-503. 10.1080/00224499.2010.494776.CrossRefPubMed

40.

Pulerwitz J, Gortmaker SL, De JW: Measuring Sexual Relationship Power in HIV/STD Research. Sex Roles. 2000, 42 (7/8): 637-660. 10.1023/A:1007051506972.CrossRef

41.

Rosenberg M: Society and the Adolescent Child. 1965, Princeton, NJ: Princeton University Press

42.

Carter R: Social Policy Challenges in the Post Independence Era. 2006, Bridgetown, Barbados

43.

Gutierrez L, Hyun JH, Gillmore MR: Toward an understanding of (em)power(ment) for HIV/IDS prevention with adolescent women. Sex Roles. 2000, 42: 581-611. 10.1023/A:1007047306063.CrossRef

44.

Morokoff PJ, Quina K, Harlow LL, Whitmire L, Grimley DM, Gibson PR, et al: Sexual Assertiveness Scale (SAS) for women: development and validation. J Pers Soc Psychol. 1997, 73: 790-804.CrossRefPubMed

45.

Weiser SD, Leiter K, Bangsberg DR, Butler LM, Percy-de KF, Hlanze Z, et al: Food insufficiency is associated with high-risk sexual behavior among women in Botswana and Swaziland. PLoS Med. 2007, 4: 1589-1597.CrossRefPubMed

46.

Lopman B, Lewis J, Nyamukapa C, Mushati P, Chandiwana S, Gregson S: HIV incidence and poverty in Manicaland, Zimbabwe: is HIV becoming a disease of the poor?. AIDS. 2007, 21 (Suppl 7): S57-S66. 10.1097/01.aids.0000300536.82354.52.CrossRefPubMedPubMedCentral

47.

The World Bank, by Country. Barbados: , Accessed at: http://data.worldbank.org/country/barbados

48.

United Nations Human Development Index: United Nations Development Program. 5-17-2012. 2012, Accessed at: http://hdrstats.undp.org/en/countries/profiles/BRB.html

49.

Bombereau G: Systematic review related to HIV risk behaviours in the Caribbean among children, young adults and vulnerable populations. 2007, Port of Spain, Trinidad and Tobago: Caribbean Epidemiology Centre

50.

Halcon L, Blum RW, Beuhring T, Pate E, Campbell-Forrester S, Venema A: Adolescent health in the Caribbean: a regional portrait. Am J Public Health. 2003, 93: 1851-1857. 10.2105/AJPH.93.11.1851.CrossRefPubMedPubMedCentral

51.

Gomez AM, Speizer IS, Beauvais H: Sexual violence and reproductive health among youth in Port-au-Prince, Haiti. J Adolesc Health. 2009, 44: 508-510. 10.1016/j.jadohealth.2008.09.012.CrossRefPubMed

52.

Bailey W, Le Franc E, Blanche C: Partnering and violence. Caribbean Dialogue: A policy bulletin of Caribbean affairs. 1998, 4 (2): 11-18.

53.

Jones A, Trotman-Jemmott E: Perceptions of, attitudes to and opinions on child sexual abuse in the Eastern Caribbean. 2009, http://www.unicef.org/infobycountry/files/Child_Sexual_Abuse_in_the_Eastern_Caribbean_Final_9_Nov.pdf.

54.

Kurtz SP, Douglas KG, Lugo Y: Sexual risks and concerns about AIDS among adolescents in Anguilla. AIDS Care. 2005, 17 (Suppl 1): S36-S44.CrossRefPubMed

55.

Stallworth J, Roofe M, Clark LF, Ehiri JE, Mukherjee S, Person S, et al: Predictors of sexual involvement among adolescents in rural Jamaica. Int J Adolesc Med Health. 2004, 16: 165-178.CrossRefPubMed

56.

Smikle MF, Dowe G, Hylton-Kong T, Williams E, Baum M: Risky behaviour in Jamaican adolescent patients attending a sexually transmitted disease clinic. West Indian Med J. 2000, 49: 327-330.PubMed

57.

Zaba B, Pisani E, Slaymaker E, Boerma JT: Age at first sex: understanding recent trends in African demographic surveys. Sex Transm Infect. 2004, 80 (Suppl 2): ii28-ii35.PubMedPubMedCentral

58.

Ohene SA, Ireland M, Blum RW: The clustering of risk behaviors among Caribbean youth. Matern Child Health J. 2005, 9: 91-100. 10.1007/s10995-005-2452-6.CrossRefPubMed

59.

Baumgartner JN, Waszak GC, Tucker H, Wedderburn M: The influence of early sexual debut and sexual violence on adolescent pregnancy: a matched case–control study in Jamaica. Int Perspect Sex Reprod Health. 2009, 35: 21-28. 10.1363/3502109.CrossRefPubMed

60.

Zaba B, Isingo R, Wringe A, Marston M, Slaymaker E, Urassa M: Influence of timing of sexual debut and first marriage on sexual behaviour in later life: findings from four survey rounds in the Kisesa cohort in northern Tanzania. Sex Transm Infect. 2009, 85 (Suppl 1): i20-i26. 10.1136/sti.2008.033704.CrossRefPubMedPubMedCentral

61.

Hallett TB, Lewis JJ, Lopman BA, Nyamukapa CA, Mushati P, Wambe M, et al: Age at first sex and HIV infection in rural Zimbabwe. Stud Fam Plann. 2007, 38: 1-10. 10.1111/j.1728-4465.2007.00111.x.CrossRefPubMed

62.

Glynn JR, Kayuni N, Floyd S, Banda E, Francis-Chizororo M, Tanton C, et al: Age at menarche, schooling, and sexual debut in northern Malawi. PLoS One. 2010, 5: e15334-10.1371/journal.pone.0015334.CrossRefPubMedPubMedCentral

63.

Ohene SA, Ireland M, Blum RW: Sexually-inexperienced Caribbean youth: Correlates of delayed sexual debut. Adolesc Fam Health. 2003, 3: 177-184.

64.

Bombereau G: HIV/AIDS prevention in the Caribbean: between religious cultures and sexual behaviours. 2005, Canada: University of Chicoutimi

65.

Blum RW, Halcon L, Beuhring T, Pate E, Campell-Forrester S, Venema A: Adolescent health in the Caribbean: risk and protective factors. Am J Public Health. 2003, 93: 456-460. 10.2105/AJPH.93.3.456.CrossRefPubMedPubMedCentral

66.

McBride DC, Freier MC, Hopkins GL, Babikian T, Richardson L, Helm H, et al: Quality of parent–child relationship and adolescent HIV risk behaviour in St. Maarten. AIDS Care. 2005, 17 Suppl 1: S45-S54.CrossRefPubMed

67.

Nduna M, Jewkes RK, Dunkle KL, Shai NP, Colman I: Associations between depressive symptoms, sexual behaviour and relationship characteristics: a prospective cohort study of young women and men in the Eastern Cape. South Africa. J Int AIDS Soc. 2010, 13: 44.CrossRefPubMed

68.

Blum RW, Ireland M: Reducing risk, increasing protective factors: findings from the Caribbean Youth Health Survey. J Adolesc Health. 2004, 35: 493-500.CrossRefPubMed

69.

Research Sub-Committee NHAC: Towards a sexual health policy balancing positive prevention strategies with risk reduction. 2012, Barbados: National HIV/AIDS Commission

The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6874/13/53/prepub

Title: Prevalence and risk factors for inter-generational Sex: a cross-sectional cluster survey of Barbadian females aged 15–19
Authors: Nicole Drakes
Clarissa Perks
Alok Kumar
Kim Quimby
Colin Clarke
Rajul Patel
Ian R Hambleton
R Clive Landis
Publication date: 01-12-2013
Publisher: BioMed Central
Published in: BMC Women's Health / Issue 1/2013
Electronic ISSN: 1472-6874
DOI: https://doi.org/10.1186/1472-6874-13-53

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prevalence and risk factors for inter-generational Sex: a cross-sectional cluster survey of Barbadian females aged 15–19

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2013

Annual acknowledgement of reviewers

Use of emergency department services by women victims of violence in Lazio region, Italy

Knowledge, perception about antiretroviral therapy (ART) and prevention of mother-to-child-transmission (PMTCT) and adherence to ART among HIV positive women in the Ashanti Region, Ghana: a cross-sectional study

Trends and determinants of mortality in women of reproductive age in rural Guinea-Bissau, West Africa – a cohort study

Associations between oral contraceptive use and risks of hypertension and prehypertension in a cross-sectional study of Korean women

Ultrasound mapping of pelvic endometriosis: does the location and number of lesions affect the diagnostic accuracy? a multicentre diagnostic accuracy study