What Works for Women and Girls

especially young women, have their first sexual experience before the age of 15. DHS data from60 developing countries show that 25% of girls and boys had sexual intercourse before age 15(DHS 2007 cited in IWHC, 2007). Data collected in 2006 from 26 countries in all regions ofthe world found that individuals who had not planned their first sexual experience were 75%less likely than those who had planned it to use condoms at first sex (Roach and Fontes, 2008).Ensuring that young people have the appropriate information to plan to protect themselves—before their first sexual experience—is therefore vitally important.Young women have limited power in sexual relations and many young women experiencesexual coercion, often from older partners. For example, a 2008 study interviewed pregnantand never-pregnant women under the age of 17—twenty-four in rural Rakai District, Ugandaand thirty-two in urban Jamaica—about their sexual experiences and found that many youngwomen were pressured to have sex at an early age, did not make a conscious decision to doso, and later regretted it. In Jamaica, all of the interviewed young women indicated that they“should have been older the first time they had sex” (Geary et al., 2008: 18). In Uganda, where9 of the 24 interviewees first had sex at age 14 or younger, half described coercion during firstsex. Many Ugandan girls believed that men are entitled to demand sex, especially in marriage.As a married 17-year-old Ugandan indicated, “sex is ‘an obligation because you are married.’”(Geary et al., 2008: 22). Delayed sexual debut is associated with girls’ education, which may playa crucial role in improving their self-esteem and options, enabling them to say no to unwantedsex. [See also Chapter 11E. Strengthening the Enabling Environment: Advancing Education]In addition to those in Chapter 3. Prevention for Women, interventions that work specificallyfor adolescents can be broken down into two main categories:5A. Prevention for Young People:Encouraging Behavior Change“Adolescents’ high risk forHIV infection [is] due to highfrequency of sex and rate ofpartner change, short duration ofsexual relationships, risk-takingbehavior, low perceptions ofHIV/STI risk and limited accessto contraception.”(Mantell et al., 2005: 324).Ideally, young women should be able to decide when theyare ready to have sex and have the information they needto make informed decisions about protecting themselveswhen they do decide to become sexually active. A number ofinterventions have been successful in encouraging youngpeople to do just that, but many interventions have notchanged behavior and many challenges and gaps remain.114 CHAPTER 5 PREVENTION FOR YOUNG PEOPLE