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The longitudinal data available in ACDIS provide an opportunity to examine AFS and its determinants, ensuring temporality of the determinants relative to first sex as well as permitting the updating of these factors during the time that an individual remained at risk of sexual debut. We found no association of AFS with grade-for-age among women. For both sexes, periurban residence versus rural , ever use of alcohol and knowing someone who had HIV were associated with earlier AFS. Similarly, Hallett et al found that the median AFS for women was 18 years and for men was 19 years in rural Zimbabwe in In contrast, median AFS estimates in a South African nationally representative survey by Pettifor et al 3 16 years for men and 17 years for women may have been underestimated, given that AFS was estimated among 15—year-olds who had ever had sex at the time of the cross-sectional survey. The additional suggestion that being behind in school has a protective effect for men warrants further investigation. We found several factors significantly associated with AFS in men and women, with the majority being important for one sex but not the other. For time-varying characteristics it is based on person-years and one individual could contribute to different categories during the study period. Other factors significantly associated with AFS were important for one gender only, including maternal death for women and paternal death for men. During person-years of follow-up, reported sexual debut. Our estimate is, however, similar to the median AFS of 18 years for both sexes reported from the Nelson Mandela HSRC national survey , based on a larger age group of 15—year-olds. Furthermore, living in a more rural rather than a periurban area was associated with later AFS in men and women. The data do not specify whether alcohol was used at the time of first sex. In contrast, both school attendance and being behind in terms of grade-for-age were significantly associated with a later AFS for young men. The association of alcohol use with earlier AFS has been observed in some non-African populations. The periurban area is densely, often informally, settled.
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