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Grossman JM, Nagar A, Charmaraman L, Richer AM. A Larger Ecology of Family Sexuality Communication: Extended Family Perspectives on Relationships, Sexual Orientation, and Positive Aspects of Sex. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17031057. [PMID: 32046083 PMCID: PMC7036905 DOI: 10.3390/ijerph17031057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/04/2020] [Accepted: 02/06/2020] [Indexed: 11/16/2022]
Abstract
Extended family can be a resource for conversations about sex, but extended family perspectives have been largely left out of existing research. The present study investigates how extended family, such as aunts and uncles, siblings and cousins, perceive communication with teens in their families about sex. A thematic analysis was conducted with data from interviews in the U.S. with 39 extended family members, primarily siblings, who reported talk with teens in their families about sex. The analyses identified one theme focused on perspectives surrounding what is most important for teens to know about sex and relationships and seven themes focused on the content of conversations with teens about sex. The most prevalent content areas were: Healthy and Unhealthy Relationships (87%), Sexual Orientation (82%), Sexual Behavior (82%), and Protection (74%). The findings highlight extended family members’ unique roles in supporting the sexual health of teens in their families, which include providing information and support about issues other family members may not address, such as sexual orientation and the positive aspects of sex. The findings suggest the need to include extended family in sex education interventions to reflect the broader ecology of teens’ family relationships and access an underutilized resource for teens’ sexual health.
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Flores D, Barroso J. 21st Century Parent-Child Sex Communication in the United States: A Process Review. JOURNAL OF SEX RESEARCH 2017; 54:532-548. [PMID: 28059568 PMCID: PMC5808426 DOI: 10.1080/00224499.2016.1267693] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Parent-child sex communication results in the transmission of family expectations, societal values, and role modeling of sexual health risk-reduction strategies. Parent-child sex communication's potential to curb negative sexual health outcomes has sustained a multidisciplinary effort to better understand the process and its impact on the development of healthy sexual attitudes and behaviors among adolescents. This review advances what is known about the process of sex communication in the United States by reviewing studies published from 2003 to 2015. We used the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, SocINDEX, and PubMed, and the key terms "parent child" AND "sex education" for the initial query; we included 116 original articles for analysis. Our review underscores long-established factors that prevent parents from effectively broaching and sustaining talks about sex with their children and has also identified emerging concerns unique to today's parenting landscape. Parental factors salient to sex communication are established long before individuals become parents and are acted upon by influences beyond the home. Child-focused communication factors likewise describe a maturing audience that is far from captive. The identification of both enduring and emerging factors that affect how sex communication occurs will inform subsequent work that will result in more positive sexual health outcomes for adolescents.
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Affiliation(s)
- Dalmacio Flores
- Postdoctoral Fellow at the University of Pennsylvania School of Nursing
| | - Julie Barroso
- Professor and Department Chair at the Medical University of South Carolina College of Nursing
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Galano E, Turato ER, Succi RC, de Souza Marques HH, Della Negra M, da Silva MH, do Carmo FB, Gouvea ADFB, Delmas P, Côté J, Machado DM. Costs and benefits of secrecy: the dilemma experienced by adolescents seropositive for HIV. AIDS Care 2016; 29:394-398. [PMID: 27802773 DOI: 10.1080/09540121.2016.1248891] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13-20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other's love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice.
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Affiliation(s)
- Eliana Galano
- a Universidade Federal de São Paulo - Escola Paulista de Medicina , São Paulo , Brazil.,b Centro de Referência e Treinamento DST/Aids , São Paulo , Brazil
| | - Egberto Ribeiro Turato
- c Departamento de Psicologia Médica e Psiquiatria - Faculdade de Ciências Médicas , Universidade Estadual de Campinas , São Paulo , Brazil
| | - Regina Célia Succi
- a Universidade Federal de São Paulo - Escola Paulista de Medicina , São Paulo , Brazil
| | - Heloisa Helena de Souza Marques
- d HC/FMUSP- Instituto da Criança - Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo , São Paulo , Brazil
| | | | | | | | | | - Philippe Delmas
- f La Source, School of Nursing , University of Applied Sciences , Lausanne , Switzerland
| | - José Côté
- g Faculty of Nursing , Université de Montréal , Montreal , Canada
| | - Daisy Maria Machado
- a Universidade Federal de São Paulo - Escola Paulista de Medicina , São Paulo , Brazil
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Edwards LL, Reis JS. A Five Step Process for Interactive Parent-Adolescent Communication About HIV Prevention: Advice from Parents Living With HIV/AIDS. JOURNAL OF HIV/AIDS & SOCIAL SERVICES 2014; 13:59-78. [PMID: 24683366 PMCID: PMC3964619 DOI: 10.1080/15381501.2013.775686] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
AIM This study investigated how parents living with HIV communicated about HIV prevention with their 10-18 year old children. METHODS Interviews with 76 mothers and fathers were analyzed for (1) their experiences discussing HIV prevention with adolescents, and (2) advice on how to best broach HIV-related topics. RESULTS Interactive conversations, where both parents and adolescents participated, were regarded as effective. Parents emphasized that adolescents should have a "voice" (be able to voice their concerns) and a "choice" (have a variety of effective prevention strategies to choose from) during HIV-related talks. DISCUSSION A five step process for interactive communication emerged as a result of these discussions. IMPLICATIONS Health care professionals can facilitate adolescent sexual health by encouraging parents to actively involve their children in discussions about HIV prevention. CONCLUSION Future HIV prevention programs could benefit by providing parents with appropriate tools to foster interactive discussions about sexual health with adolescents.
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Affiliation(s)
- Laura L Edwards
- Department of Kinesiology and Community Health, College of Medicine, University of Illinois at Urbana Champaign
| | - Janet S Reis
- College of Health Sciences, Boise State University
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Cederbaum JA, Hutchinson MK, Duan L, Jemmott LS. Maternal HIV serostatus, mother-daughter sexual risk communication and adolescent HIV risk beliefs and intentions. AIDS Behav 2013; 17:2540-53. [PMID: 22677973 DOI: 10.1007/s10461-012-0218-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.
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Affiliation(s)
- Julie A Cederbaum
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Room 214, Los Angeles, CA 90089, USA.
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Cederbaum JA, Hutchinson MK, Duan L, Jemmott LS. Maternal HIV serostatus, mother-daughter sexual risk communication and adolescent HIV risk beliefs and intentions. AIDS Behav 2013; 17:2540-2553. [PMID: 22677973 DOI: 10.1007/s10461-012/0218-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Daughters of HIV-positive women are often exposed to the same factors that placed their mothers at risk. This cross-sectional study (N = 176 dyads) examined HIV status, parent-teen sexual risk communication (PTSRC), and daughters' abstinence and condom use beliefs and intentions. Maternal HIV status was not associated with PTSRC. Path analyses show that maternal depression was associated with PTSRC behavioral and normative beliefs; relationship satisfaction was associated with PTSRC normative and control beliefs. Control beliefs were solely predictive of maternal PTSRC intention. PTSRC was associated with adolescent behavioral and normative beliefs. Abstinence beliefs were associated with abstinence intentions; condom beliefs were associated with condom use intentions. Relationship satisfaction was associated with adolescent control beliefs about both abstinence and condom use. There is a need for interventions that help HIV-positive mothers recognize their daughter's HIV risk and provide them with relationship building and parent process skills to help reduce these risks.
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Affiliation(s)
- Julie A Cederbaum
- School of Social Work, University of Southern California, Montgomery Ross Fisher Building, Room 214, Los Angeles, CA 90089, USA.
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Edwards LL, Donovan-Kicken E, Reis JS. Communicating in complex situations: a normative approach to HIV-related talk among parents who are HIV+. HEALTH COMMUNICATION 2013; 29:364-374. [PMID: 23799804 DOI: 10.1080/10410236.2012.757715] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Parents with HIV/AIDS are confronted with unique challenges when discussing HIV-related information with their children. Strategies for navigating these challenges effectively have not been systematically examined. In this study, we conducted in-depth interviews with 76 parents with HIV/AIDS who had children ages 10-18 years. Guided by O'Keefe and Delia's definition of a complex communication situation and Goldsmith's normative approach to interpersonal communication, we examined parents' goals for discussing HIV-related information, factors that made conversations challenging, and instances where these conversational purposes conflicted with one another. Our data reveal the following parent-adolescent communication predicaments: relaying safety information about HIV while minimizing child anxiety, modeling open family communication without damaging one's parental identity, and balancing parent-child relational needs amid living with an unpredictable health condition. Parents also described a variety of strategies for mitigating challenges when discussing HIV-related topics. Strategies parents perceived as effective included reframing HIV as a chronic, manageable illness; keeping talk educational; and embedding HIV-related topics within more general conversations. The theoretical and practical applications of these findings are discussed with regard to their relevance to health communication scholars and HIV care professionals.
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Affiliation(s)
- Laura L Edwards
- a Department of Kinesiology and Community Health, College of Medicine , University of Illinois at Urbana-Champaign
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Edwards LL, Reis JS, Weber KM. Facilitators and barriers to discussing HIV prevention with adolescents: perspectives of HIV-infected parents. Am J Public Health 2013; 103:1468-75. [PMID: 23763390 DOI: 10.2105/ajph.2012.301111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined HIV-infected parents' conversations about HIV prevention with their uninfected children, including what facilitated or hindered communication. METHODS Parents with HIV/AIDS (n = 90) who had children aged 10 to 18 years were recruited for a mixed method study from 2009 to 2010. Interviews assessed facilitators and barriers to discussing HIV prevention. A questionnaire identified the frequency and content of conversations, parental confidence level, and perceived importance of discussing preventive topics. RESULTS Eighty-one percent of parents reported "sometimes" or "often" communicating about HIV prevention. A subset of parents found these conversations difficult; 44% indicated their desire for support. Facilitators to communication included utilizing support, focusing on the benefits of talking, and having a previous relationship with one's child. Barriers to discussions included fear of negative consequences, living in denial, and lacking a parental role model who discussed safer sex. Parents varied as to how they believed their HIV status affected communication. Those who did not disclose their HIV status to their children reported less frequent communication; self-efficacy partially mediated this relationship. CONCLUSIONS Findings highlighted the need for communication skills training that support HIV-infected parents in their efforts to discuss HIV-related information with adolescents.
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Affiliation(s)
- Laura L Edwards
- University of Illinois at Urbana-Champaign, Department of Kinesiology and Community Health, Huff Hall, 1206 S. Fourth Street, Champaign, IL 61820, USA.
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Madiba S. The impact of fear, secrecy, and stigma on parental disclosure of HIV status to children: a qualitative exploration with HIV positive parents attending an ART clinic in South Africa. Glob J Health Sci 2012; 5:49-61. [PMID: 23445694 PMCID: PMC4776781 DOI: 10.5539/gjhs.v5n2p49] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2012] [Accepted: 11/12/2012] [Indexed: 11/12/2022] Open
Abstract
South Africa is one of the sub Saharan countries where considerable progress in providing antiretroviral treatment (ART) has been made. The increased access to ART contributes to improvements in the prognosis of HIV and parents are more likely to raise their children than ever before. The study examined the social context influencing disclosure of parental HIV status to children from the perspectives of fathers and mothers accessing ART from an academic hospital in South Africa. Three focus group interviews were conducted with 26 non-disclosed biological parents of children aged between 7 and 18 years. Their ages ranged between 20-60 years and they cared for a total of 60 children. Parental decision not to disclose their HIV status to children was influenced by the fear of death and dying, the influence of television and media, stigma and discrimination. Parents delayed disclosure of their HIV status to children because children believed that AIDS kills. Parents also feared that the child may not be able to keep the parent's HIV status secret and might result in the family being subjected to stigma, discrimination, and isolation. Fear of stigma and discrimination were also responsible for the continuous efforts by parents to protect their HIV status from their children, family and neighbour's. Parents also delayed disclosure to children because they lacked disclosure skills and needed support for disclosure from health care providers. Healthcare providers are in a unique position to provide such support and guidance and assist parents to disclose and children to cope with parental HIV infection.
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Affiliation(s)
- Sphiwe Madiba
- Department of Environmental and Occupational health, University of Limpopo, South Africa.
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Murphy DA, Roberts KJ, Herbeck DM. HIV-positive Mothers' Communication About Safer Sex And STD Prevention With Their Children. JOURNAL OF FAMILY ISSUES 2012; 33:136-157. [PMID: 22368316 PMCID: PMC3285407 DOI: 10.1177/0192513x11412158] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Mothers play an important role in promoting the sexual health of their adolescent children. Fifty-seven HIV-positive mothers with adolescent children participated in an in-depth, qualitative interview regarding whether they have talked to their children about safer sex and STD prevention, including at what age they began such discussions, and what messages they gave to their children. The majority of mothers (95%) had talked with their child about safer sex; some began such discussions when the children were as young as 6 years old, but most began when the children were around 12 years old. Mothers' messages fell into the following areas: (1) protecting oneself from STDs; (2) giving factual information regarding STDs, including HIV; (3) avoiding pregnancy; (4) empowering and respecting oneself; and (5) communicating with sexual partners. The mothers' own HIV status impacted the discussions with their children. Content of mothers' messages, child reactions, and child outcomes are discussed.
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Affiliation(s)
- Debra A. Murphy
- Health Risk Reduction Projects, Integrated Substance Abuse Programs, Department of Psychiatry, University of California at Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, , (310) 794-8127, fax (310) 312-0552
| | - Kathleen Johnston Roberts
- Health Risk Reduction Projects, Integrated Substance Abuse Programs, Department of Psychiatry, University of California at Los Angeles, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, , (310) 794-8127, fax (310) 312-0552
| | - Diane M. Herbeck
- UCLA Integrated Substance Abuse Programs, 11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025, , (310) 267-5329, fax (310) 312-0552
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Cederbaum JA. The Experience of Sexual Risk Communication in African American Families Living With HIV. JOURNAL OF ADOLESCENT RESEARCH 2011; 27:555-580. [PMID: 23144530 DOI: 10.1177/0743558411417864] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Mother-daughter communication plays an influential role in adolescent development. The impact of maternal HIV infection on family communication is not clear. This study explores how living with HIV impacts sexual risk communication between mothers and daughters and whether maternal HIV status influences adolescent choices about engagement in HIV risk behaviors. Data were collected from 12 African American women and 10 of their adolescent daughters through focus groups. Both mothers and daughters shared information about issues that promoted and inhibited communication and engagement in risk behaviors. Findings show that HIV status served as a mechanism for behavioral change related to communication and risk engagement behaviors. Therefore, HIV-infected mothers should be supported in communicating values and expectations to their daughters.
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