Sexual experiences among early adolescents aged 12-14 Years in four districts of Rwanda: a cross-sectional study

Background Globally, early adolescents (10-14 years) represent 8% of the world population, and Africa accounts for 25% of them. Although a minority of early adolescents have initiated sexual intercourse, their sexual curiosity results in the exploration and understanding of sexuality. Early sexual intercourse may lead to sexually transmitted infections, HIV/AIDS, early pregnancy or fatherhood, and early marriage. Early sexual activity is associated with high rates of unplanned pregnancy, multiple sexual partners, and other forms of risky sexual behaviours. Understanding sexual activity among early adolescents can contribute to designing interventions that adequately address their needs. However, there is limited information about early adolescents’ sexual activity and the social-ecological factors associated with their sexual experiences. This study aimed to determine the prevalence of sexual activity and the social-ecological factors associated with sexual experiences among early adolescents (12-14 years) in Rwanda. Methods We conducted a cross-sectional study among early adolescents (12-14 years) from four districts and 16 secondary schools between November and December 2020. A multistage sampling technique was used to select 56 participants from each school, including 28 males and females from grades one and two, who were randomly selected. We used an adapted version of the Illustrative Questionnaire for Interview - Surveys with Young People. Questions focused on nonpenetrative and penetrative sexual experiences in addition to sociodemographic and other social-ecological characteristics. Ethical clearance was obtained from the University of Rwanda and the University of the Witwatersrand, Johannesburg. Written parental or legal guardian consent and participants’ assent were obtained. We conducted the data analysis in Stata 14.2 and used descriptive statistics (frequencies and proportions) and bivariate and multivariate logistic regression analyses with 95% confidence intervals (CIs) and a significance level of p-value <0.05. Results The study included 811 participants, 55.1% of whom were aged 14, 30.5% were aged 13, and 14.4% were aged 12. Most participants (n=539, 73.5%) lived with both parents, and 48.8% (n=395) described the socioeconomic status of their households as well-off. Nearly 81% (n=658) of the participants indicated that they had experienced non-penetrative sex, and 53 of 759 participants (7%) reported that they had experienced penetrative sex. The social-ecological factors significantly associated with nonpenetrative sexual experiences were attending parties (AOR=6.8, 95% CI= 1.6-29.2), internet use (AOR=1.9, 95% CI= 1.1-3.3) (individual level), and their fathers’ low education (primary: AOR=2.6, 95% CI= 1.4-5.0; secondary: AOR=1.9, 95%CI: 1.0-3.8) (family level). Individual level factors such as male sex (AOR: 4.6, 95% CI= 1.8-12.4), alcohol consumption (AOR=3.5, 95% CI= 1.4-8.8), watching pornography (3-4 times: AOR=7.5, 95% CI= 1.6-34.9, ≥ five times: AOR= 5.1, 95% CI= 1.7-15.0), being a double orphan (AOR:17.8, 95% CI= 1.9-170.2), discussing sex matters often with one’s father (AOR=6.5, 95% CI= 1.8-23.2) (family and relationship level), and forced sexual intercourse (AOR=8.2, 95% CI= 2.7-25.4) (community level) were social-ecological factors associated with penetrative sexual experience. Conclusion Nonpenetrative sexual experience was common, with few participants reporting penetrative sexual experience. The social-ecological factors associated with sexual experiences among early adolescents are modifiable and can assist in planning healthy sexual interventions for this age group. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement Yes ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutional Review Board at University of Rwanda Human Research Ethics Committee (HREC)-Medical at University of the Witwatersrand, Johannesburg. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All relevant data are within the manuscript.