Determinants and generational patterns of age at sexual debut among men and women in South Africa: Evidence from the SADHS 2016

BACKGROUND: Early sexual initiation is a public health concern in South Africa and increases the risks of HIV, unintended pregnancy, and adverse reproductive outcomes. Nationally representative, gender-differentiated analyses remain limited. Analyses that examine debut patterns across the full reproductive age range to provide cohort-level generational evidence are particularly lacking. AIM: This study examined the socio-demographic determinants and generational patterns of age at sexual debut among men and women in South Africa, using nationally representative data from the 2016 South African Demographic and Health Survey (SADHS). METHODS: Using the 2016 SADHS data, we analysed 7 476 sexually active women (15 to 49 years) and 3 183 men (15 to 59 years). Early sexual debut was defined as the first intercourse before age 18 years. Descriptive statistics and chi-square tests examined bivariate associations, and logistic regression identified independent predictors, applying survey weights for national representativeness. RESULTS: Early debut affected 53.0% of women and 62.4% of men. For women, lower education and poverty increased odds, while higher education was protective. Provincial variation was observed. Among men, younger age strongly predicted early debut, while marriage or cohabitation reduced it. Education, residence, and province were not significant predictors for men. CONCLUSION: Early sexual debut remains highly prevalent with gender-specific determinants. Interventions should promote education and economic support for women, and age-appropriate, masculinity-sensitive sexual health programmes for men, addressing social and structural drivers to reduce HIV and reproductive health burdens.