Dynamics of parent-adolescent communication on sexual health and HIV/AIDS in Tanzania

The influence of gender-equitable attitudes on sexual behaviour among unmarried adolescents in rural Tanzania: a longitudinal study

PLAIN LANGUAGE STATEMENT

Gender norms that centre men and disadvantage women create gender inequality, which can lead to risky sexual behaviour. This study examined how both community and individual attitudes toward gender norms influenced risky sexual behaviour in adolescents, and whether that influence was different between males and females. We found that higher gender-equitable attitudes were linked to increased odds of HIV testing in the last 12 months, and decreased odds of engaging in a sexual relationship with a much older partner. Individual high gender-equitable attitudes among girls were also linked to higher odds of them using condoms and contraceptives. Gender-equitable attitudes did not seem to influence early sexual debut, engagement in transactional sex, having multiple sexual partners at the same time, or the number of sexual partners a participant had in the last 12 months. Based on these findings, programming designed to increase gender-equitable attitudes might be helpful in increasing HIV testing and condom and contraceptive use, but it needs to involve the entire community, not just individual boys and girls.

Factors Associated With Parent-Adolescent Communication on Sexual and Reproductive Health Issues in Urban Slums of Ibadan, Southwest Nigeria

In Nigeria, adolescents in urban slums are increasingly at risk of adverse sexual and reproductive health (SRH) outcomes. However, little is known about how individual factors predict parent-adolescent communication on SRH issues in a resource-poor urban setting in Ibadan. Thus, this study investigated individual factors associated with parent-adolescent communication on SRH issues in urban slums of Ibadan, southwest, Nigeria. This study is part of a larger project that explores the socio-ecological factors influencing parent-adolescent communication on SRH issues in selected slums in Ibadan, Nigeria. Within this broader framework, this paper relies on the quantitative data obtained in 10 selected slums. Interviewer-administered structured questionnaire [scripted on open data kits (ODK)] was utilized to collect data from a sample of 796 parent-adolescent dyads. Six SRH topics were investigated to describe the issues discussed. Analytical techniques utilized include; frequency counts, chi-square, and multinomial logistic regression. Parent-adolescent communication regarding SRH issues is not uncommon in urban slums of Ibadan but characterized by indirect communication, threat and warning. Parents and adolescents' age, gender, marital/relationship status, educational attainments and religion played influential role in parent-adolescent communication regarding SRH issues. These factors were identified to be significantly associated with the pattern of parent-adolescent discussion of SRH issues. Age-specific SRH education should be available to adolescents and parents need to be educated on appropriate SRH information and the best way to engage their adolescents on SRH issues.

"If your mother does not teach you, the world will…": a qualitative study of parent-adolescent communication on sexual and reproductive health issues in Border districts of eastern Uganda

BACKGROUND

Adolescents experience a host of sexual and reproductive health (SRH) challenges, with detrimental SRH and socio-economic consequences. These include early sexual debut, sexually transmitted infections including HIV/AIDS, teenage pregnancy, and early childbearing. Parent-adolescent communication about SRH has significant potential to reduce adolescents' risky sexual behaviors. However, communication between parents and adolescents is limited. This study explored the facilitators and barriers to parent-adolescent communication about sexual and reproductive health.

METHODS

We conducted a qualitative study in the border districts of Busia and Tororo in Eastern Uganda. Data collection entailed 8 Focus Group Discussions comprising of parents, adolescents (10-17 years), and 25 key informants. Interviews were audio-recorded, transcribed, and translated into English. Thematic analysis was conducted with the aid of NVIVO 12 software.

RESULTS

Participants acknowledged the key role parents play in communicating SRH matters; however, only a few parents engage in such discussions. Facilitators of parent-adolescent communication were: having a good parent-child relationship which makes parents approachable and motivates children to discuss issues openly, a closer bond between mothers and children which is partly attributed to gender roles and expectations eases communication, and having parents with high education making them more knowledgeable and confident when discussing SRH issues with children. However, the discussions are limited by cultural norms that treat parent-child conversations on SRH as a taboo, parents' lack of knowledge, and parents busy work schedules made them unavailable to address pertinent SRH issues.

CONCLUSION

Parents' ability to communicate with their children is hindered by cultural barriers, busy work schedules, and a lack of knowledge. Engaging all stakeholders including parents to deconstruct sociocultural norms around adolescent SRH, developing the capacity of parents to confidently initiate and convey accurate SRH information, initiation of SRH discussions at early ages, and integrating parent-adolescent communication into parenting interventions, are potential strategies to improve SRH communication between parents and adolescents in high-risk settings such as borders.

Exploring adolescent engagement in sexual and reproductive health research in Kenya, Rwanda, Tanzania, and Uganda: A scoping review

Adolescent sexual and reproductive health (ASRH) in East Africa has prioritized research on the barriers to care, communication, and ASRH knowledge, attitudes, and practices. However, there is little research examining the extent to which meaningful adolescent engagement in research is achieved in practice and how this influences the evidence available to inform ASRH services. This review offers a critical step towards understanding current approaches to adolescent engagement in ASRH research and identifying opportunities to build a strengthened evidence base with adolescent voices at the centre. This scoping review is based on Arksey and O'Malley's (2005) framework, employing a keyword search of four databases via OVID: Medline, Global Health, Embase and PsycINFO. Two reviewers screened title, abstract and full text to select articles examining ASRH in Tanzania, Rwanda, Kenya, and Uganda, published between 2000 and 2020. After articles were selected, data was extracted, synthesized, and thematically organized to highlight emerging themes and potential opportunities for further research. The search yielded 1201 results, 34 of which were included in the final review. Results highlight the methods used to gather adolescent perspectives of ASRH (qualitative), the content of those perspectives (knowledge, sources of information, gaps in information and adolescent friendly services), and the overall narratives that frame discussions of ASRH (risky sexual behaviour, stigma, and gender norms). Findings indicate the extent of adolescent engagement in ASRH research is limited, resulting in a lack of comprehensive evidence, consistent challenges with stigma, little information on holistic concepts and a narrow framing of ASRH. In conclusion, there is opportunity for more meaningful engagement of adolescents in ASRH research. This engagement can be achieved by involving adolescents more comprehensively throughout the research cycle and by expanding the range of ASRH topics explored, as identified by adolescents.

"Such conversations are not had in the families": a qualitative study of the determinants of young adolescents' access to sexual and reproductive health and rights information in Rwanda

Background

Access to sexual and reproductive health and rights (SRHR) information during adolescence has become a global concern. This study explored factors that enable or prevent young adolescents from accessing to SRHR information from the perspective of the key informants in Rwanda.

Methods

We conducted a qualitative study using semi-structured interviews with 16 purposively selected key informants from public and private institutions in Rwanda. This selection was based on their positions and expertise in delivering SRHR information to adolescents. The interview guide questions were designed based on the social-ecological theoretical framework of adolescent health. The interview transcripts were recorded, transcribed, translated and thematically analysed in Nvivo 11.

Results

The study reflected that multiple enablers and barriers at the individual, relationship, community and societal levels determined young adolescents’ access to SRHR information. These determinants include information-seeking behaviour and age of starting sexuality education at the individual level; and parents’ limited communication with young adolescents due to taboos, lack of skills, limited parental availability, beliefs, lack of appropriate language and peer norms at the relationships level. Enablers and barriers at the community level were the diversity of SRHR sources, the scope of sexuality education programmes, and cultural and religious beliefs. Finally, the perceived enablers and barriers at the societal level consisted of inadequate resources, inappropriate SRHR policy-making processes and unfriendly SRHR laws.

Conclusion

Enabling access to SRHR information requires addressing multiple factors within the social-ecological environment of young adolescents. Addressing these factors may facilitate improved access to SRHR information for this age group.

Shifting Social Norms and Adolescent Girls' Access to Sexual and Reproductive Health Services and Information in a South African Township

Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges.

Determinants of communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region, Ghana: a multinomial logistic regression analysis

BACKGROUND

Poor communication on sexual issues between adolescents and their parents results in high rates of negative sexual practices such as teenage pregnancy. Contributing factors to this poor communication on sexual issues between adolescents and their parents in a high teenage pregnancy setting have not been adequately explored. We sought to fill this gap by examining the factors that predict communication on sexual issues between adolescents and their parents in the Adaklu district of the Volta region of Ghana.

METHODS

A baseline cross-sectional household survey of 221 adolescents aged 10-19 years in 30 randomly selected communities was used. A well-structured questionnaire was developed. A multinomial logistic regression analysis was used to examine factors that significantly influenced communication between adolescents and their parents regarding sex.

RESULTS

Only 11.3% of adolescents had discussions on sexual issues with both parents while 27.6% of communicated sexual issues with only one parent in Adaklu district. Adolescent males (AOR = 0.21, CI = 0.06-0.75), those aged 10-14 years (AOR = 0.41, CI = 0.04-0.57), non-members of adolescent health clubs (AOR = 0.46, CI = 0.21-1.00), and those living with only a father (AOR = 0.19, CI = 0.06-0.61) had lower odds of communicating with their parents on sexual issues.

CONCLUSIONS

Adolescent-parental communication on sexual issues in Adaklu district is very low. This situation requires more empowerment of adolescents to enable them to discuss sexual issues with their parents through increased engagement with adolescent health club activities and capacity building capacity of parents with the right information on sexual and reproductive health by health staff within the district. Additionally, parents need to be equipped with communication skills to enable them to communicate effectively with their children.

Sexual health communication between sex worker mothers and their children in India

In India, relatively little is known about sex worker mothers' beliefs regarding sexual health communication with their children. Using qualitative data collected in Kolkata, India, this study used the Parent Expansion of the Theory of Planned Behaviour to examine sex worker mothers' beliefs about sexual health communication and factors shaping these beliefs. Sex worker mothers' beliefs about sexual health communication were shaped by societal norms and collectivising processes often driven by Durbar Mahila Samanwaya Committee (DMSC), a sex workers' collective in Kolkata, India. Specifically, we found that challenging stigma, assuming ownership over one's body and health, and making relevant material resources and knowledge accessible and meaningful were key in supporting mothers to overcome barriers around sexual health communication. These collectivising processes shaped mothers' beliefs about sexual health communication and facilitated their ability to engage in it. Future research, policies and programmes should consider the far-reaching impact of community-led structural interventions on sex worker mothers and their children.

A qualitative study of the health information seeking behaviour of adolescent girls in Iran indicates that public libraries could help supply information required about puberty

INTRODUCTION

The present study aimed to identify the puberty related information seeking behaviour of adolescent female members of Zarrinshahr public libraries.

METHODOLOGY

Using a phenomenology approach, this study sought to identify the puberty related information seeking behaviours for a population of female adolescent public library patrons located in the Middle East. The data were collected via event based interviews and the samples were selected by purposeful sampling method. After converting the audio to text, the transcripts were imported into MAXQDA 10, they were coded and then, the relevant categories were extracted.

RESULTS

The information needs of girls experiencing puberty were identified and divided into four thematic categories: health issues, psychological issues, religious issues (religious precepts), and issues related to physical activity. Girls get this information from a variety of resources such as people, the Internet, social networks, documents, and libraries. The process of information seeking is so problematic for them because they are faced with content, family, social, and financial barriers and mainly lack Internet literacy and search skills.

CONCLUSION

Health information seeking constitutes the main part of adolescent girls' daily lives. Identification of adolescent girls' health information needs, the main channels of information seeking, and the barriers the girls face while information seeking can help public libraries adopt the right policies regarding the provision of health information services.

Where and how do young people like to get their sexual and reproductive health (SRH) information? Experiences from students in higher learning institutions in Mbeya, Tanzania: a cross-sectional study

Background

Sexual and reproductive health (SRH) among young adults in low- and middle-income countries (LMIC) is still a major public health challenge. Early school-based sexuality education programs and sexual health information sharing between teachers, parents and young people have been considered protective against the sexual health risks to which young people are exposed. There is, however, limited information on the preferred choices of “where”, “how” and “from whom” young people would like to receive SRH information. We aimed to describe the experience and preferences of young people regarding their SRH education and learning and in particular communication with their parents/guardians.

Methods

We conducted a cross-sectional study among randomly selected students aged 18-24y attending Higher Learning Institutions (HLIs) in Mbeya, Tanzania. We used a self-administered questionnaire to collect information on SRH education received, ability to discuss SRH matters with a parent/guardian and SRH information gaps encountered during their early sexual experience.

Results

We enrolled 504 students from 5 HLIs, of whom 446 (88.5%) reported to be sexually active, with mean age at sexual debut of 18.4y (SD 2.2). About 61% (307/504) of the participants found it difficult to discuss or did not discuss SRH matters with their parent/guardian while growing up. Learning about SRH matters was reported from peers (30.2%) and teacher-led school curriculum (22.7%). There was a strong gender-biased preference on SRH matters’ discussions, female and male participants preferred discussions with adults of their respective sex. Peers (18.2%), media (16.2%) and schools (14.2%) were described as the preferred sources of SRH information. On recalling their first sexual experience, sexually-initiated participants felt they needed to know more about sexual feelings, emotions and relationships (28.8%), safer sex (13.5%), how to be able to say ‘No’ (10.7%) and how to use a condom correctly (10.2%).

Conclusion

Young people have a gender preference when it comes to learning about SRH matters from their parents; however, such conversations seldom occur. Community health education should focus on building skills of parents on parent-child communication on SRH matters so as to empower them to confidently initiate and convey accurate SRH information. Comprehensive SRH education and skills building need to be strengthened in the current school SRH curriculum in order to meet the demand and needs of students and increase the competence of teachers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11728-2.

The secret life of young adolescents living with HIV in northern Mozambique - a mixed methods study

Background

In Mozambique, HIV infection remains a leading cause of adolescent mortality. With advances in antiretroviral treatment (ART), the population of adolescents living with vertically-acquired HIV is growing. Most studies of adolescents living with HIV (ALHIV) focus on older youth with horizontal infection. As part of a larger study, we examined the characteristics and health care needs of younger ALHIV, including those with vertically-acquired infection to inform preventive interventions.

Methods

We used a convergent mixed-methods design and recruited ALHIV aged 12–14 years who were enrolled in HIV care in three health clinics in Nampula, Mozambique. From 11/2019–3/2020, we conducted 61 quantitative surveys and 14 in-depth interviews with a purposively selected subset of ALHIV who were aware of their HIV status. Descriptive statistical analysis was conducted for quantitative data. Qualitative data were transcribed and analyzed using thematic analysis.

Results

The median age of ALHIV was 13 years, 50% were female, 67% lived with ≥1 parent, 70% had lost a parent, 100% were in school; 10% were in a relationship, and 3% had initiated sexual activity. Among 31 ALHIV aware of their serostatus, the median age of antiretroviral treatment (ART) initiation was 8 years (IQR: 6–11); 55% received caregiver support for ART management; 35% reported missing ≥1 ART dose in the last 30 days; 6% had disclosed their HIV-status to friends and 48% reported no one to talk to about HIV-specific issues. Four main themes emerged from the qualitative interviews with ALHIV: a) learning one’s HIV-positive status as the beginning of a secret life; b) importance of caregivers’ support for ART management; c) high value of ALHIV peer support to overcome isolation, increase HIV literacy, and support adherence; and d) unmet needs for sexual and reproductive health education.

Conclusion

HIV-related secrecy prevails among ALHIV, a situation exacerbated by caregivers and healthcare providers. Caregivers play a major role in supporting adherence among young ALHIV, yet ALHIV could also benefit from adolescent-friendly services, including peer support, sexual and reproductive health services and preparation for independent health management. Integrating such programs into ART services in Mozambique may be critical to promoting ALHIV health.

The south american context of diagnostic disclosure of adolescents infected by HIV/AIDS: a systematic literature review

OBJECTIVE

To analyze the scientific evidence on the disclosure of the diagnostic of adolescents infected by HIV/AIDS in the South American context.

DATABASE

Systematic literature review using the PubMed, Cinahal, Embase, Cochrane, BVS, and Global Health databases and the descriptors: adolescent and HIV and family and Argentina or Bolivia or Brasil or Chile or Colombia or Ecuador or French Guiana or Paraguay or Peru or Uruguay or Venezuela.

DATA SYNTHESIS

Brasil was the country highlighted. It was verified that parents have a direct and indirect influence over the adolescents' life, especially regarding behaviors and health care. Dialog among family members can reduce adolescents' vulnerability to HIV and encourage diagnostic disclosure.

CONCLUSION

It is necessary to amplify research involving adolescents with HIV/AIDS and their parents/caregivers and family members to improve care and reduce the cases of the disease. It is suggested that policies of prevention and treatment should involve families, caregivers, partners, and the community.

Exploring barriers to sexual transmitted infections (STIs) and HIV testing among young black sub-Sahara African (BSSA) communities in diaspora, UK

Purpose

Sexual transmitted infections (STIs) are associated with high stigma leading to poor sexual health-seeking behaviour and mental health problems. Although human immunodeficiency virus (HIV) prevention has generally been successful in many communities across the world, statistics for young people have remained relatively low, especially among most affected communities such as the black sub-Sahara African (BSSA) communities. This paper aims to explore the barriers to STIs and HIV testing among young BSSA communities living in the UK.

Design/methodology/approach

The research study used an explorative qualitative approach. The study included 6 focus groups comprising 10 people each (N = 60), and 12 one-to-one follow-up interviews were held with the research participants. Two one-to-one follow-up interviews were held from each focus group (N = 12).

Findings

The study found that perceived risk taking, perceived HIV test embarrassment, sexual health professionals’ attitudes, perceived HIV as death sentence, limited educational awareness and general HIV stigma prevented research participants from testing and impacted on their mental health well-being.

Originality/value

There is a need to increase sexual health and mental health education awareness among young BSSA communities. More importantly culturally sensitive interventions to reduce the impact of HIV stigma need to be rolled out in different diverse communities. This study is the first of its kind to look at the barriers affecting young BSSA communities in accessing sexual health testing services in the UK.

Parent-child communication about sexual issues in Zambia: a cross sectional study of adolescent girls and their parents

Background

Parent-child communication about sexual issues can reduce risky sexual behaviour amongst adolescents. Risky sexual behaviour is of concern in sub-Saharan Africa where the prevalence of early pregnancy, unsafe abortion and HIV are high. Parent-child communication about sexual issues presents a feasible approach for reducing sexual risk amongst adolescents in sub-Saharan Africa but limited research exists from the region. This study from Zambia examines the sociodemographic and psychosocial factors that are associated with whether parents communicate with their daughters about sexual issues.

Methods

Data from a cluster randomized controlled trial examining the effect of interventions aiming to reduce teenage pregnancy and school drop out in Zambia was used. The data was collected between January–July in 2018 and consists of structured, face to face interviews with 4343 adolescent girls and 3878 parents. Cross sectional analyses examined the associations between parent-child communication about sexual issues and sociodemographic and psychosocial characteristics using univariate and multivariable logistic regression models.

Results

Adolescent girls who felt connected to their parents and those who perceived their parents to be comfortable in communicating about sex, were more likely to speak to their parents about sexual issues than those who did not (AOR 1.23, 95% CI 1.01–1.52; and AOR 2.94, 95% CI 2.45–3.54, respectively). Girls whose parents used fear-based communication about sexual issues, and those who perceived their parents as being opposed to education about contraception, were less likely to communicate with their parents about sex than those who did not (AOR 0.76, 95% CI 0.65–0.89; and AOR 0.76, 95% CI 0.63–0.91, respectively). Girls enrolled in school were less likely to communicate with their parents about sex than those out of school (AOR 0.56, 95% CI 0.44–0.71).

Conclusion

Parenting style, children’s perception of parental attitudes and parental communication styles are associated with whether parents and children communicate about sexual issues. This may imply that parents can improve the chances of communicating with their children about sex by conveying non-judgemental attitudes, using open communication styles with neutral messages and appearing comfortable whilst displaying positive attitudes towards communication around sex and contraceptive use.

Trial registration

ISRCTN registry: ISRCTN12727868, (4 March 2016).

Iranian mothers' needs for reproductive health education of their adolescent daughters: a qualitative study

INTRODUCTION

In order to be effective in discussing high-risk sexual behaviors with adolescents, mothers need to be educated about their adolescent daughters' sexual issues. As no detailed and exact knowledge on mothers' educational needs concerning adolescent girls' reproductive health is available, the current study was intended to investigate mothers' educational needs concerning their adolescent daughters' reproductive health.

MATERIALS AND METHODS

This research was a qualitative content analysis. Purposive sampling was performed to the saturation point. The samples included 26 mothers and 14 key informants. Semi-structured interviews were used for data collection. Data authenticity was verified based on Lincoln and Guba's criteria and data analysis was conducted using conventional content analysis with MAXQDA10 software.

FINDINGS

In this study, three themes and 13 main categories, each with a number of subcategories were extracted. The themes and main categories included: "appropriate educational content (reproductive health, sexual health, general health, psychological health, family health, social health and spiritual health)", "characteristics of the educator (communicative skill, cognitive skill and moral competence)", and "effective factors in learning (teaching method, learning conditions and environment, and the learner's readiness)".

CONCLUSIONS

The results demonstrated that mothers need to be informed about sexual, reproductive, general, psychological, family, social and spiritual health in adolescent girls. Consequently, the results can help the healthcare authorities to implement need-based programs and boost the effectiveness of education about adolescent girls' reproductive health for mothers.

Parent-child sexual and reproductive health communication among very young adolescents in Korogocho informal settlement in Nairobi, Kenya

Background

Parents are an important source of sexual and reproductive health (SRH) information for very young adolescents and are likely to have a significant influence on adolescents’ sexual attitudes, values, and risk-related beliefs. This study explored the nature and content of parent-child communication about SRH issues.

Methods

Thirty-two parents and 30 adolescent boys and girls aged between 11 and 13 years participated in narrative interviews in a resource-poor urban setting in Nairobi, Kenya. Interviews were audio-recorded, transcribed, translated into English, and uploaded on Atlas.ti software for coding and analysis.

Results

Findings from the study show gender differences in parent-child communication. More girls than boys reported that they had talked with their parents about romantic relationships. Four approaches—no communication, fear-based communication, supportive communication, and involving an external person were used by parents in SRH communication. Parents hostile attitudes towards romantic relationships during adolescence discouraged adolescents from disclosing their relationship status. While communication did occur, it was mainly reactive, one-sided, and authoritarian, often initiated by parents.

Conclusions

Parents need to be empowered with adequate and factual SRH information and effective communication strategies to enhance communication with very young adolescents. There is a need for further research to identify the most effective parent-child communication approaches to improve SRH outcomes among adolescents.

Obstacles to intergenerational communication in caregivers' narratives regarding young people's sexual and reproductive health and lifestyle in rural South Africa

BACKGROUND

Statistics from South Africa show the world's highest HIV prevalence with an estimated seven million people living with the virus. Several studies have pointed to communication about sexuality between parents/caregivers and children as a protective factor. However, communication between generations has been described as problematic, especially due to discomfort in discussing sexual matters. The aim of this study was to explore how caregivers in a poor, rural part of South Africa talked about young people in general, their sexuality, and their lifestyle practices. A particular interest was directed towards central discourses in the caregivers' narratives and how these discourses were of importance for the caregivers to function as conversation partners for young people.

METHODS

In this qualitative study convenience sampling was used to select and invite participants. Information was collected from nine one-on-one interviews conducted with caregivers from rural areas within South Africa. The interview guide included nine main questions and optional probing questions. Each interview took place in an uninterrupted setting of choice associated with the caregivers' home environment. The interviews were transcribed and analyzed using discourse analysis.

RESULTS

Interview narratives were characterized by three central discourses - demoralized youths in a changing society, prevailing risks and modernity and a generation gap. The youths were discursively constructed as a problematic group relating to specific prevailing risks such as early pregnancies, modern technologies, STI/HIV and contraceptives. The interview narratives illustrated that caregivers tried to impose their views of a respectable lifestyle in young people. At the same time caregivers expressed a morality of despair mirroring a generation gap which counteracted their ability to communicate with their children and grandchildren.

CONCLUSIONS

The findings add to the body of earlier research illustrating that rural South African caregivers and their children/grandchildren hold different moral standards. The interview material reflected a 'clash' between generations relating to their differing perceptions of a desirable lifestyle. To overcome the generational gap, we recommend further research about how a well-founded national and community collaboration linked to school-based programs can support family participation in order to empower adults in their communication with young people.

Effects of a parenting sexual education program for immigrant parents: A cluster randomized trial

OBJECTIVES

The aim was to assess the effects of a parental sex education program on knowledge, attitudes, self-efficacy, and practices among immigrant parents.

METHODS

A cluster randomized trial was conducted at immigrant activity centers in northern Taiwan. Recruited participants were randomly assigned to an experimental (four centers, n = 86) or control (four centers, n = 67) group. A practical booklet and a booster session were delivered. In total, 132 participants' knowledge, attitudes, self-efficacy, and practice of parenting sexual education were examined at the baseline and 6 weeks after the intervention.

RESULTS

After controlling for possible confounders, the posttest scores of self-efficacy of the experimental group were higher than those of the control group. The Johnson-Neyman procedure indicated that the intervention was effective for participants who had pretest knowledge, attitude, and practice scores of <14.62, <110.27, and <41.5, respectively.

CONCLUSIONS

An intervention with both practical booklet and booster session can improve knowledge, attitudes, self-efficacy and practices of parental sex education among immigrant parents.

PRACTICE IMPLICATIONS

In addition to practical booklets, health care professionals should provide booster sessions that meet the needs of immigrant parents to prevent sexual problems among children and adolescents at an early age.

Adult and young women communication on sexuality: a pilot intervention in Maputo-Mozambique

BACKGROUND

Communication on sexuality within the family has been considered a determinant factor for the sexual behaviour of young women, contributing to delaying sexual initiation. Taking into account that young women are increasingly exposed to sexualized messages, they need clear, trustful and open communication on sexuality more than ever. However, in Mozambique, communication about sexuality is hampered by strict social norms. This paper evaluates the case of an intervention aimed at reducing the generational barrier for talking about sexuality and to contribute to better communication within the family context.

METHODS

The intervention consisted of three weekly one-hour coached sessions in which female adults and young interacted about sexuality. Realist evaluation was used as a framework to assess context, mechanisms, and outcomes of the intervention. Interviews were conducted among 13 participants of the sessions.

RESULT

The interaction sessions were positively appreciated by the participants and contributed to change norms and attitudes towards communication on sexuality within families. Recognition of similarities and awareness of differences were key in the mechanisms leading to these outcomes. This was reinforced by the use of visual materials and the atmosphere of respect and freedom of speech that characterized the interactions. Limiting factors were related to the long-standing taboo on sexuality and existing misconceptions on sexuality education and talks about sex.

CONCLUSION

By elucidating mechanisms and contextual factors our study adds knowledge on strategies to improve transgenerational communication about sexuality.

Sexual and reproductive health communication intervention for caretakers of adolescents: a quasi-experimental study in Unguja- Zanzibar

Background

Caretakers/parents or parents figure need to be trained to promote effective communication about sexual and reproductive health to their adolescents. This study assessed the effect of an intervention aiming to improve caretaker-adolescent communication on sexual and reproductive health matters through improving information, motivation, and behavioral skills related to sexual health communication. The study also evaluated the relationship of information, motivation, and behavioral skills model-constructs with communication practice. Information-Motivation-Behavioural skills model was used as a framework to guide the intervention implementation and evaluation process.

Method

This is a quasi-experimental non-randomized controlled pre- and post-test study which involved one thousand caretakers of adolescents in all the six districts of Unguja-Zanzibar. All participants completed interviewer-administered structured pre-test questionnaire. The experimental group then received sexual health communication intervention addressing the information, motivation, and behavioral skills related to sexual health communication, while the control group received the sexual health information only. All participants were then reassessed for their information, motivation, behavioral skills and their sexual health communication after 1 month, 6 months and at 1 year following the intervention. To evaluate the effect of intervention at the post-test measures, Univariate Analyses of Covariance was performed whereby the pre-test score and variables on which the groups differed were considered as covariates. Standardized mean difference statistics of Cohen’s d was used to calculate the effect size, and the cut-off point for the level of significance was set at two-sided, p-value < 0.05.

Results

Results shows that the immediate post-test sexual health communication, motivation and behavioral skills scores were statistically significantly higher in the experimental group compared to control group (p < 0.05). Moreover, sexual health communication score after 6 months and at 1 year were statistically significantly higher in the experimental group compared to control group (p < 0.05). Information construct however did not differ between groups in post-test measures. Furthermore, results revealed that communication practice is statistically significantly associated with information, motivation and behavioural skills in post-test measures.

Conclusion

The findings provided preliminary evidence for the effectiveness of SRH communication intervention and supported the significance of IMB model-constructs to inform the SRH-communication intervention and to guide the intervention evaluation.

Community Stakeholders' Perceptions of the Role of Family in HIV Prevention in Iringa, Tanzania

Although HIV is identified as a family disease, the overall response to the global HIV epidemic continues to predominantly focus on individuals. The aim of this qualitative study was to explore how the role of the family in HIV prevention is perceived by community-based stakeholders. Understanding the role of the family within the context of the HIV/AIDS is essential for community/public health nurses. In total, 34 stakeholders participated in the study. Three major categories were identified namely: fostering positive intra-familial relations, utilizing external resources, and barriers to family roles. The study findings have implications for community-based HIV family interventions.

HIV Knowledge and Risk among Zambian Adolescent and Younger Adolescent Girls: Challenges and Solutions

In sub-Saharan Africa, young women are at the highest risk of HIV infection. Comprehensive sexuality education (CSE) and open parent-child communication about sex have been shown mitigate risky sexual practices associated with HIV. This study aimed to identify sources of HIV prevention knowledge among young women aged 10-14 years and community-based strategies to enhance HIV prevention in Zambia. Focus group discussions were conducted with 114 young women in Zambian provinces with the highest rates (~20%) of HIV. Discussions were recorded, transcribed and coded, and addressed perceived HIV risk, knowledge and access to information. Participants reported that limited school-based sexuality education reduced the potential to gain HIV prevention knowledge, and that cultural and traditional practices promoted negative attitudes regarding condom use. Parent-child communication about sex was perceived to be limited; parents were described as feeling it improper to discuss sex with their children. Initiatives to increase comprehensive sexuality education and stimulate parental communication about sexual behavior were suggested by participants. Culturally tailored programmes aiming to increase parent-child communication appear warranted. Community-based strategies aimed at enhancing protective sexual behaviour among those most at risk are essential.

A Systematic Review and Narrative Synthesis of Interventions for Parental Human Immunodeficiency Virus Disclosure

INTRODUCTION

Disclosure of parental human immunodeficiency virus (HIV) infection to their children remains a difficult process for parents living with HIV (PLWH). In order to identify the best strategies to facilitate parental HIV disclosure, it is necessary to examine the efficacy of existing interventions designed to help PLWH parents with the disclosure process to their children.

OBJECTIVES

To systematically review the efficacy of interventions designed to assist PLWH disclose their HIV status to their children.

METHODS

We conducted a systematic review and narrative synthesis of interventions designed to assist PLWH disclose their HIV status to their children. MEDLINE/PubMed, PsycINFO, Embase, Global Health, and Web of Science were searched.

RESULTS

Studies were eligible for inclusion if they evaluated an intervention for parental HIV disclosure. Five studies published between 2001 and 2015 met the inclusion criteria. The interventions were conducted in South Africa, China, and the United States. Three of the studies used two-arm randomized controlled trials, in which the intervention group was given enhanced care while the control group received standard care. Four of the five studies included a theoretically informed intervention and three were limited to mothers. Results showed that four of the interventions increased parental HIV disclosure.

CONCLUSION

The findings suggest that parental HIV disclosure interventions are successful in assisting parents with the disclosure process and can be adapted in different cultural context. Future parental HIV disclosure interventions should include fathers in order to assist men with parental HIV disclosure.

Associations Between Fathers' and Sons' Sexual Risk in Rural Kenya: The Potential for Intergenerational Transmission

PURPOSE

Despite high rates of HIV in areas of Sub-Saharan Africa and men's role in driving the epidemic, little is known about whether or how sexual risk-both behaviors and beliefs-may be passed down through generations of males. This study examined associations between sexual risk behaviors and sex-related beliefs of adolescent males and those of their male caregivers in Kenya, as well as the potential moderating effects of parenting characteristics and father-son relationship quality.

METHODS

Cross-sectional linear regression analysis was applied to baseline data from a trial of a family- and church-based intervention for families in rural Kenya that followed a stepped-wedge cluster randomized design. Our subsample consisted of 79 male caregiver and son (aged 10-16 years) dyads.

RESULTS

Results demonstrated a direct relationship between fathers' and sons' sex-related beliefs that was not moderated by parenting or quality of father-son relationship. Parenting/relationship characteristics did moderate the relationship between fathers' and sons' sexual behavior; if fathers did not engage in high-risk sex and exhibited more positive parenting/higher relationship quality, their sons were less likely to be sexually active. Among fathers having high-risk sex, parenting was unrelated to sons' behavior except at very high levels of positive parenting/relationship quality; at these levels, sons were actually more likely to have had sex.

CONCLUSIONS

Findings support recommendations to include male caregivers in youth HIV prevention efforts, potentially by targeting fathers' parenting strategies and their individual risk.

Predicting Primary and Secondary Abstinence Among Adolescent Boys and Girls in the Western Cape, South Africa

Two of the most effective health behaviours with regard to HIV prevention are condom use and sexual abstinence. While determinants of condom use among sub-Saharan African adolescents have been studied extensively, factors related to abstinence have received far less attention. This study identified socio-cognitive determinants of primary and secondary abstinence intentions and of early sexual activity. This study also assessed whether these factors had a direct or indirect association with intentions to abstain from sex. A longitudinal design was used in which 1670 students (age 12–16) of non-private South African high schools filled in a questionnaire, with a follow-up after 6 months, concerning sexual abstinence, attitudes, social norms, self-efficacy, risk perception and knowledge. Logistic and linear regression analysis with latent factors was used to assess determinants of intentions and abstinence, and structural equation modelling was used to assess indirect effects. Results showed that among sexually inactive students, social norms predicted the intention to abstain from sex in the next 6 months. Among sexually active students, reporting less disadvantages of abstinence predicted the intention to abstain. Sexual activity at follow-up was predicted by attitudes and intention among sexually inactive girls, and by knowledge among sexually inactive boys. No predictors were found for sexually active adolescents. Structural equation modelling further showed that risk perception was indirectly related to intentions to abstain from sexual intercourse. We conclude that addressing socio-cognitive factors in order to motivate adolescents to delay sex is more likely to be successful before they experience sexual debut. In addition, this study shows that the effect of increasing risk perceptions, a strategy often applied by parents and HIV prevention programmes, is to a large extent mediated by more proximal cognitive factors such as attitude. Research is needed to identify factors that influence the execution of intentions to abstain from sex.

Sexual learning among East African adolescents in the context of generalized HIV epidemics: A systematic qualitative meta-synthesis

BACKGROUND

AIDS-related illness is the leading cause of mortality for adolescents in sub-Saharan Africa. Together, Kenya, Tanzania, and Uganda account for 21% of HIV-infected adolescents in sub-Saharan Africa. The United Nations framework for addressing the epidemic among adolescents calls for comprehensive sexual and reproductive health education. These HIV prevention efforts could be informed by a synthesis of existing research about the formal and informal sexual education of adolescents in countries experiencing generalized epidemics. The purpose of this study was to describe the process of sexual learning among East African adolescents living in the context of generalized HIV epidemics.

METHODS

Qualitative metasynthesis, a systematic procedure for integrating the results of multiple qualitative studies addressing a similar phenomenon, was used. Thirty-two research reports met study inclusion criteria. The reports were assessed in a four-step analytic process: appraisal, classification of findings, synthesis of findings, and construction of a framework depicting the process of sexual learning in this population.

RESULTS

The framework includes three phases of sexual learning: 1) being primed for sex, 2) making sense of sex, and 3) having sexual experiences. Adolescents were primed for sex through gender norms, cultural practices, and economic structures as well as through conversations and formal instruction. They made sense of sex by acquiring information about sexual intercourse, reproduction and pregnancy, sexually transmitted infections, and relationships and by developing a variety of beliefs and attitudes about these topics. Some adolescents described having sexual experiences that met wants or needs, but many experienced sex that was coerced or violent. Whether sex was wanted, coerced, or violent, adolescents experienced worry about sexually transmitted infections or premarital pregnancy.

CONCLUSIONS

The three phases of sexual learning interact to shape adolescents' sexual lives and their risk for HIV infection. This framework will contribute to the development of sexual education programs that address HIV risk within the broader context of sexual learning.

Participatory science and innovation for improved sanitation and hygiene: process and outcome evaluation of project SHINE, a school-based intervention in Rural Tanzania

Background

Diarrheal disease is a major cause of mortality and morbidity in low and middle income countries with children being disproportionately affected. Project SHINE (Sanitation & Hygiene INnovation in Education) is a grassroots participatory science education and social entrepreneurship model to engage youth and the wider community in the development of sustainable strategies to improve sanitation and hygiene.

Methods

Based in rural and remote Tanzania, this pilot study engaged pastoralist high-school students and communities in the development and evaluation of culturally and contextually relevant strategies to improve sanitation and hygiene. Using a train-the-trainer approach, key activities included teacher workshops, school-based lessons, extra-curricular activities, community events and a One Health sanitation science fair which showcased projects related to water, sanitation and hygiene in relation to human and animal health. The process and outcome of the study were evaluated through qualitative interviews and focus group discussions with diverse project participants, as well as pre- and post- questionnaires completed by students on knowledge, attitudes and practices concerning sanitation and hygiene.

Results

The questionnaire results at baseline and follow-up showed statistically significant improvements on key measures including a decrease in unhygienic behaviors, an increase in the perceived importance of handwashing and intention to use the toilet, and increased communication in the social network about the importance of clean water and improved sanitation and hygiene practices, however there were no significant changes in sanitation related knowledge. Qualitative data highlighted strong leadership emerging from youth and enthusiasm from teachers and students concerning the overall approach in the project, including the use of participatory methods. There was a high degree of community engagement with hundreds of community members participating in school-based events. Sanitation science fair projects addressed a range of pastoralist questions and concerns regarding the relationship between water, sanitation and hygiene. Several projects, such as making soap from local materials, demonstrate potential as a sustainable strategy to improve health and livelihoods in the long-term.

Conclusions

The Project SHINE model shows promise as an innovative capacity building approach and as an engagement and empowerment strategy for youth and communities to develop locally sustainable strategies to improve sanitation and hygiene.

Parents Support Implementation of HIV Testing and Counseling at School: Cross-Sectional Study with Parents of Adolescent Attending High School in Gauteng and North West Provinces, South Africa

Background. A formative assessment of the implementation of HIV testing and counseling (HTC) at school showed high acceptability and willingness to test among learners. However, the success of the proposed HTC depends on the support and acceptability of key stakeholders, including the parents. The aim of the study was to assess the opinions and acceptability of the implementation of HTC at school among parents of adolescents in high school. Methods. This was a cross-sectional household survey conducted with parents of adolescents attending high schools in educational districts in North West and Gauteng provinces, South Africa. Results. A total of 804 parents participated, and 548 (68.3%) were biological mothers, 85 (10.6%) were fathers, and the remaining were other relatives including grandmothers. Almost all (n = 742, 92.9%) parents were in support of implementation and provision of HTC at school, 701 (87.7%) would allow their children to be tested at school, 365 (46%) felt that parental consent was not needed to test at school, and 39.4% preferred to receive the HIV test results with their children. Conclusion. Parents accept the roll-out of an HTC program at school and have a role to play in supporting children who test positive for HIV.

Adolescents' Communication with Parents, Other Adult Family Members and Teachers on Sexuality: Effects of School-Based Interventions in South Africa and Tanzania

Cluster-randomized controlled trials were carried out to examine effects on sexual practices of school-based interventions among adolescents in three sites in sub-Saharan Africa. In this publication, effects on communication about sexuality with significant adults (including parents) and such communication as a mediator of other outcomes were examined. Belonging to the intervention group was significantly associated with fewer reported sexual debuts in Dar es Salaam only (OR 0.648). Effects on communication with adults about sexuality issues were stronger for Dar es Salaam than for the other sites. In Dar, increase in communication with adults proved to partially mediate associations between intervention and a number of social cognition outcomes. The hypothesized mediational effect of communication on sexual debut was not confirmed. Promoting intergenerational communication on sexuality issues is associated with several positive outcomes and therefore important. Future research should search for mediating factors influencing behavior beyond those examined in the present study.

Congruence in reported frequency of parent-adolescent sexual health communication: A study from Mexico

BACKGROUND

Most studies on parent-adolescent sexual health communication come from developed countries and are based on either parents' or children's reports. In developing countries, there is little evidence about the agreement among reports of all parties involved in parent-adolescent sexual health communication.

OBJECTIVE

The objective of this study is to explore the congruence (agreement) between adolescents and their parents about how frequently they discuss on selected sexual health topics.

SUBJECTS

A total of 1606 parent-adolescent dyads of adolescents attending the first year in public high schools and their parents, in Morelos, Mexico were sampled in this study.

METHODS

The participants completed a self-administered questionnaire that included the frequency of parent-adolescent communication about eight sexual health topics. An ordinal logistic threshold model was used to estimate intra-class correlation coefficients within parent-adolescent dyads (as a measure of congruence) and to test if thresholds were equal between parents and adolescents.

RESULTS

Congruence in reported frequency of parent-adolescent sexual health communication ranged from 0.205 (menstruation) to 0.307 (condoms) for mother-adolescent dyads, and from 0.103 (ejaculation) to 0.380 (condoms) for father-adolescent dyads. The thresholds (i.e., the cutoff points that define the categories in the observed ordinal variable) differed between parents and adolescents for each of the sexual health topics explored (p<0.05 for father-adolescent dyads and p<0.001 for mother-adolescent dyads).

CONCLUSION

Our findings suggest a low congruence between parents' and adolescents' reports on parent-adolescent sexual health communication. This might be due to interpretation of frequency and intensity of sexual health communication which differs between parents and adolescents.

"Bend a fish when the fish is not yet dry": adolescent boys' perceptions of sexual risk in Tanzania

Despite decades of effort, the spread of HIV/AIDS continues among many African young people. A key contributor is unsafe sexual behavior that is desired, persuaded, or coerced. We explored the masculinity norms shaping pubescent boys' perceptions of and engagement in (unsafe) sexual behaviors in Tanzania. Through a comparative case study in rural and urban Tanzania, qualitative and participatory methods were used with 160 adolescent boys in and out of school to better understand the social and contextual factors promoting unsafe sexual behaviors. Adolescent boys in both the rural and urban sites reported struggling with intense sexual desires, strong peer pressures to have sex, and social norms dissuading condom use. A growing "normalization" of AIDS suggests messages promoting the dangers of HIV infection may be less effective. Findings reinforce the need for interventions with very young adolescents. Research is needed to identify more effective approaches for promoting safer sexual practices among boys in sub-Saharan Africa. Harm reduction approaches and gender transformative approaches might prove more effective than current HIV prevention efforts focused on youth.