Association between early sexual debut and HIV infection among adolescent girls and young women in Cameroon: does motherhood modify the relationship?

Abstract Background In Cameroon, where HIV prevalence among Adolescent girls and young women (AGYW) remains nearly double that of their male peers, limited evidence exists on how early sexual debut and motherhood jointly shape HIV risk. This study examines the association between early sexual debut and HIV infection among AGYW and assesses whether motherhood modifies this relationship. Methods We analysed data from 4,825 AGYW aged 15–24 years from the 2017–2018 Cameroon Population-based HIV Impact Assessment (CamPHIA). Early sexual debut was defined as first sexual intercourse before age 15. Weighted descriptive statistics, univariable and multivariable logistic regression analyses were conducted to assess factors associated with HIV infection. An interaction term between motherhood status and early sexual debut was included to assess whether motherhood modified the association between early sexual debut and HIV infection. Adjusted predicted probabilities were subsequently generated. Results Overall, HIV prevalence was 2%, 10.5% reported early sexual debut, and 36% were mothers. Early sexual debut was associated with higher odds of HIV infection (AOR = 1.86, 95% CI: 1.08–3.20). AGYW aged 20–24 had higher odds of HIV infection than those aged 15–19 (AOR = 1.95, 95% CI: 1.04–3.64), while being neither in school nor employed was also associated with higher odds of HIV infection (AOR = 2.02, 95% CI: 1.03–3.96). There was evidence that the association between early sexual debut and HIV infection differed by motherhood status (interaction AOR = 9.78, 95% CI: 4.52–21.26). Adjusted predicted probabilities were highest among mothers who had experienced early sexual debut (4.05%), compared with mothers without early sexual debut (1.69%) and nulliparous AGYW with early sexual debut (0.39%). The association with early sexual debut was attenuated in sensitivity analyses, whereas evidence of interaction with motherhood persisted. Conclusion Early sexual debut was associated with HIV infection among AGYW in Cameroon, and there was evidence that this association differed by motherhood status. The findings highlight the need for integrated HIV and sexual and reproductive health interventions that address the intersecting vulnerabilities experienced by AGYW, particularly young mothers, while supporting continued education and economic participation.