In addition, studies that did not specify women’s HIV infection status and only mentioned investigating STIs in general as outcomes of interest in the abstract were excluded. In addition to the limitations of the review itself, there are important methodological limitations within the studies included in this review, which may have affected

their findings. Most studies utilised a cross-sectional design, which severely limits their ability to make causal inferences. None of the studies Selleckchem U0126 provided strong longitudinal, prospective information on the relationship between early sexual debut and women’s increased HIV risk, because a few cohort studies included in this review had short follow-up times or only included women in their sample who were already sexually active. In addition, asking women retrospectively about their age at their first sexual intercourse is prone to result in potential recall or response bias, especially given the potential sensitivity of the topic being explored, especially if first sexual debut was with a non-marital sexual

partner.[36] There may also potentially be variations in the quality of the research being presented, with a potential for bias being enhanced if surveys have not met standards of intensive interviewer 3-Methyladenine mw training, careful translation into local languages of terms such as sexual intercourse and sexual partners.[30] Only a few studies included in this review reported implementing strategies or measures to reduce recall and social desirability biases when asking women about their age at their sexual debut.[14] In the review, we were also not able to ensure comparability in the definitions of early sexual debut selleck chemical across studies and instead had to compile evidence from studies that used differing definitions. In practice, the majority of studies reviewed compared rates of HIV infection among women who had started having

sex before the age of 15 to rates among women who had their first sex after the age of 15. However, a few studies also used other age cut-offs, and a number of studies used multiple age categories, which made the comparisons and interpretations difficult. For example, they compared early sexual debut before the age of 15 with first sex after the age of 20 or even 25, while the majority of women in most studies had their first sex between the ages of 16–20. Existing evidence on the developmental stages of adolescents[37] seems to suggest that an age cut-off for early first sex before the age of 15 is the most sensible; however, this should be determined according to the cultural background, as first sex may often coincide with cultural norms or legal marriage age. Whichever cut-off point is chosen, it should be accompanied by a justification, which was rarely given in the reviewed studies.