Regional HIV Stigma and Adolescents' Sexual Debut in Sub-Saharan African Countries

• In Event: Putting Sociology to Work for a More Equitable Global Health

Abstract

HIV stigma remains a persistent structural barrier in sub-Saharan Africa despite decades of policy efforts to reduce discrimination. While prior research shows that stigmatizing beliefs are associated with riskier sexual behaviors, less is known about whether living in high-stigma social contexts shapes the timing of adolescents’ sexual debut, and whether such effects are gendered. We examine whether regional HIV stigma predicts early sexual debut among adolescents, with particular attention to gendered power dynamics.
Drawing on two waves of the Demographic and Health Surveys (2003–2007; 2013–2017), we construct regional HIV stigma measures from earlier survey waves and link them to adolescents’ retrospectively reported age at first sex. Stigma is measured using three widely used indicators of instrumental stigma and modeled via item response theory before aggregation to the regional level. We estimate discrete-time hazard models with complementary log-log specifications, incorporating region-level frailty and country fixed effects.
Results show that higher regional HIV stigma is associated with an increased risk of early sexual debut among girls, but not among boys. Moreover, this association is driven primarily by men’s regional stigma rather than women’s. Girls residing in regions where men express more conservative HIV stigma norms experience a significantly accelerated transition into first sex.
These findings suggest that early sexual debut among girls may reflect constrained responses to gendered power asymmetries within stigma-laden social environments, rather than autonomous sexual decision-making. By highlighting the contextual and gendered dimensions of HIV stigma, this study advances understanding of how cultural norms shape sexual inequality beyond individual attitudes and behaviors.

Authors

• Chanki Yoo, University of Massachusetts-Amherst

• David A. Cort, University of Massachusetts-Amherst