Gender difference in timing of sexual initiation and fertility desire among youth born with HIV: a case-control study in Thailand

In countries heavily affected by HIV, large cohorts of youth living with perinatal HIV (YLHIV) are reaching adulthood. They encounter new HIV-related challenges, particularly those related to sexual and reproductive health (SRH). This study aimed to compare the SRH of young adults living with perinatal HIV to that of their peers in the general population. This is a case-control study conducted in 2018–2019 in Thailand, comparing YLHIV aged 19–26 years with their controls from the general population, matched on sex, age and living location. We compared SRH characteristics between groups using univariable tests and estimated the cumulative incidence of sexual initiation using Kaplan-Meier test. We performed a logistic regression to assess the independent factors associated with sexual initiation and fertility desire. 272 YLHIVs and their 272 controls participated, 165 women and 107 men (median age 22 years). Among women living with perinatal HIV, 64% were sexually initiated and 62% had a desire for a child in the future, there was no difference with their controls. Among men living with perinatal HIV, 38% were sexually initiated versus 67% in controls (p < 0.001), 52% desired a child versus 75% in controls (p < 0.001). At the age of 20 years, the cumulative incidence of sexual initiation was 41% in men living with perinatal HIV compared to 61% in controls (p < 0.001). Our study indicates that in Thailand young men experience a significant delay in sexual initiation compared with their peers in the general population, whereas this is not the case for young women. Further studies should examine the reasons for this delay.