Associations between early sexual debut and use of health services: results from a cohort study in urban South Africa

Early sexual debut is associated with increased risk of HIV and other negative sexual health outcomes. This indicates a need for early use of health services among this group. This study investigated whether early sexual debut was associated with lower usage of health services during adolescence in urban South Africa. Health-seeking behaviour data was collected from the Birth-to-Twenty cohort at 13, 15 and 17 years of age. Early sexual debut, defined as <15 years of age, was based on annual, self-completed questionnaires. Multivariate random effects regression models were used to test the association between healthcare use and frequency of healthcare use during adolescence with early sexual debut. Data was available on 1783 adolescents, 19% of whom had early sexual debut. Adolescents’ healthcare usage was low, declined through adolescence (23% at 13 years, 18% at 15 years and 17% at 17 years) and was significantly lower among adolescents with early sexual debut (adjusted OR 0.77, 95% CI 0.59-0.99, p 0.041). There was no evidence of an association between early sexual debut and frequency of adolescents’ healthcare usage (adjusted IRR 0.86, 95% CI 0.70-1.04, p 0.116). Better linkages between health services and youth programs may help reach vulnerable adolescents with health services.