This study estimated the prevalence of sexual intercourse among EAWAPTSI using the RDS method. We found that the prevalence of sexual intercourse was higher among those with the following characteristics: older age, male, enrolled in school, under the care of their mother, low parental education, less discussion of sexuality with their parents, and agreed with this behavior at their age. Most of them also intended to perform this behavior again in the future. The importance of this finding is that we identify the prevalence of sexual intercourse among early adolescents, which can be used as a basis for consideration for interventions. The RDS method should be used rather than regular surveys to reach adolescents who have already had sexual intercourse because adolescents can more easily invite members of their networks who have had sexual intercourse to join the study.
Our study differs from previous research in terms of the age of participants and the methods used to reveal adolescent sexual behavior. Compared to other research in Indonesia, the prevalence of sexual intercourse among EAWAPTSI in Semarang was relatively higher than among the general adolescent population, even compared to adolescents who are over 15 years old (5, 28). There are no national data on the prevalence of sexual intercourse among adolescents aged 10–14 years. The higher prevalence of sexual intercourse in this study can be explained by the fact that the RDS method is used specifically for capturing events in hidden populations (8, 9), whereas previous studies used a household national survey (5) and school-based approach (28), which can be influenced by family and peer pressure to maintain secrecy.
Some of our research results are similar to previous studies that show that the prevalence of sexual intercourse is higher in the following conditions: older age group(29), male (26, 29), low parental education (30), poor communication between parents and children about sexuality (31–33), and adolescents’ agreement with sexual intercourse behavior (34, 35). However, there are differences from other studies that state that adolescents whose sexual debut is at the age of less than 15 years are less likely to complete school (36). In this study, the high prevalence of sexual intercourse among adolescents who were registered in school was because most of the adolescent population in Indonesia is enrolled in school due to government regulations that eliminate school fees and obligate children to attend school to the junior high school level (37).
Sexual intercourse behavior that occurs in early adolescence can be correlated with the development of sexual maturity and its effect on sexual behavior (29). Sexual maturity in female adolescents begins at an earlier age that is marked by the onset of menarche (38). The higher prevalence of sexual intercourse in boys may be related to differences in the developmental stages of boys and girls, because during this time, boys may think more about pleasure than the risks that may occur (26). In addition, parental education has a positive correlation with knowledge and methods of conveying sex education to children so they can make safe and appropriate sexual decisions (30). Most of the early adolescents who had engaged in sexual intercourse were under the care of their mothers. Poor communication about sexuality also has an impact on risky behavior (31–33) because when teenagers and their parents do not feel comfortable discussing sexuality, this may lead to a lack of advice for adolescents (39). Adolescents’ agreement with sex before marriage tends to lead to their intention and behavior to have sex before marriage (34, 35).
A limitation of this study was the possibility of bias in the recruitment of participants. It was possible for participants to ask for the maximum number of recruitment vouchers and take the survey more than once to obtain the greatest incentive possible. However, to minimize this bias, we limited the number of recruitment vouchers to a maximum of 6. In addition, to avoid repeated enrollment, the participants' physical characteristics were recognized, participants had to show their identity card (student card or family card) to the field workers, and recruitment vouchers were assigned a unique number. However, we succeeded in determining the prevalence of sexual intercourse in early adolescents using the RDS method. This finding had not been previously reported in Indonesia. The prevalence of sexual intercourse among early adolescents was revealed by the RDS method based on the premise that peers are better able than outreach workers and researchers to locate and recruit other members of a hidden population (40),(41).
The findings indicate that adolescents aged 10–14 years have been exposed to sexual activity, so it is necessary to provide education on healthy sexual behavior. Education should focused on educating adolescents about safer sexual behaviors and increasing adolescents’ resilience (42–44).