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The main objective of this paper is to understand the role of the family on the sexual experiences of adolescents from urban, disadvantaged settings in Baltimore and Johannesburg. Data were collected as part of the WAVE study, a global study of disadvantaged youth in five cities. Qualitative data were based on key informant interviews, a Photovoice exercise, community mapping, focus groups and in-depth interviews with adolescents. Quantitative data were gathered from an ACASI survey that was administered to approximately 450–500 adolescents per site. Results from the qualitative data revealed that while parents were viewed as important sources of information for sexual and reproductive health, they were often not present in the adolescents’ lives. This lack of parental presence was perceived to result in adolescents feeling an overall lack of adult support and guidance. The impact of parental presence and support on adolescent sexual experience was further examined from the quantitative data and revealed a complex picture. In both Baltimore and Johannesburg, female adolescents who were raised by other relatives were less likely to report having had sex compared to those raised by two biological parents, which was not observed for males. In Johannesburg, female adolescents who were paternal orphans were less likely to have had sex compared to non-orphans; the opposite was true among males. Finally, in both sites, female adolescents who had been exposed to violence were more likely to have had sex compared to those who had not; for males, there was no significant relationship. The study demonstrates the powerful influence of both context and gender for understanding the influences of the family on adolescent sexual behaviors. Programs aiming to reduce adolescent sexual risk behaviors the need to understand the complex influences on risk behaviors in different settings and in particular, the role of mothers and fathers. Prevention strategies need to also understand and incorporate gender-specific messages and interventions in order to address the high risk of sexual behaviors among adolescents in these settings. [ABSTRACT FROM AUTHOR]

Female sex workers are a structurally vulnerable population, including critical insecurity such as having access to food and shelter. This risk may be heightened among individuals who enter sex work as minors. However, the reasons for entering sex work as a minor and the long-term structural risk implications are poorly understood. Here, we investigated the reasons for and long-term impact of trading sex before the age of eighteen on women's structural vulnerability among a cohort of 250 cisgender women involved in street-based sex work in Baltimore City, Maryland, USA. We used logistic regression to explore the role of age of entry on two structural vulnerability outcomes of interest (homelessness and recent food insecurity in the past 3 months). Overall, 73% of women entered the sex trade to get drugs, 36% of women entered to get basic necessities such as food or housing, and 17% of women entered to support their children or family. Of significance, 21% of those aged < 18 years at entry reported being either coerced, threatened, pressured, misled, tricked, or physically forced into trading sex compared to 5% in those who entered at an older age group (p value < 0.001). In adjusted analysis, women who first trade sex before the age of 18 had 4.54 increased odds of experiencing recent homelessness (95% CI 1.92-10.70) and had 3.14 times increased odds of experiencing recent food insecurity (95% CI 1.42-6.94). Those who entered as minors were also more likely to be HIV positive (11.3% vs 3.6%, p value = 0.02). This study highlights that those who trade sex at a younger age experience an ongoing cumulative vulnerability in comparison to those entering over the age of 18. These findings call for additional research into a more detailed understanding of young women's entry into the sex trade and trajectory. A focus on the importance of policy changes and structural interventions that directly alleviate young people's socio-economic disadvantage is needed. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between adverse childhood experiences (ACEs) and early sexual initiation. Methods: We analyzed retrospective data of (n = 241) Black women recruited from public STD clinics in Baltimore, MD. Multinomial logistic and linear regression models estimated associations between ACEs and early sexual initiation; contextual variables at initiation were examined as mediators. Results: Twelve percent of our sample reported very early sexual initiation (11–12 years) and 29% reported early sexual initiation (13–14 years). Each additional ACE reported was associated with greater risk of very early sexual initiation (RRR = 1.49; 95%CI:1.23,1.80). Specifically, emotional abuse (RRR = 3.71; 95%CI:1.55,8.89), physical abuse (RRR = 9.45; 95%CI:3.56,25.12), sexual abuse (RRR = 8.60; 95%CI:3.29,22.51), witnessing maternal abuse (RRR = 5.56; 95%CI:2.13,14.52), and household substance misuse (RRR = 3.21; 95%CI:1.38,7.47) at or before the age of 18 were associated with very early sexual initiation. As for context of initiation, age at sexual initiation was younger if the man at initiation was a non-partner (ß = -0.88; 95%CI:-1.36,-0.40), was ≥3 years older (ß = -1.30; 95%CI:-1.82,-0.77), had pressured or forced sexual intitiation (ß = -1.09; 95%CI:-1.58,-0.59), and was under the influence of drugs/alcohol (ß = -0.97; 95%CI:-1.62,-0.32). Contextual variables at first sex, including being pressured or forced, and the man being ≥3 years older fully mediated the association between ACEs and early sexual initiation. Conclusions: This study highlights the critical need to develop interventions that reduce the impact of ACEs on women’s health and delay age at sexual initiation. Health education efforts are needed for clinicians and parents to identify and prevent childhood abuse and to identify and report sexual coercion and abuse for girls and adolescents. [ABSTRACT FROM AUTHOR]