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Kizito S, Namuwonge F, Nabayinda J, Nabunya P, Nattabi J, Sensoy Bahar O, Kiyingi J, Magorokosho N, Ssewamala FM. Using Hierarchical Regression to Examine the Predictors of Sexual Risk-Taking Attitudes among Adolescents Living with Human Immunodeficiency Virus in Uganda. J Adolesc Health 2023; 73:244-251. [PMID: 37074235 PMCID: PMC10523903 DOI: 10.1016/j.jadohealth.2023.02.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/20/2023]
Abstract
PURPOSE We explored the factors influencing sexual risk-taking attitudes-defined as beliefs and values regarding sexual activity-among adolescents living with human immunodeficiency virus (ALHIV) in Uganda. METHODS The study used baseline data from a five-year cluster-randomized control trial (2012-2018) among 702 ALHIV in Uganda. Participants were aged 10-16 years, HIV-positive, taking antiretroviral therapy, and living within a family. We fitted hierarchical regression models to assess the demographic, economic, psychological, and social predictors of sexual risk-taking attitudes. Using R2, the final model explained 11.4% of the total variance. RESULTS Under economic factors, caregiver being formally employed (β = -0.08, 95% confidence interval [CI]: -0.10-0.06, p < .001), and the ALHIV working for pay (β = 1.78, 95% CI: 0.28-3.29, p = .022), were associated with sexual risk-taking attitudes. Among the psychological factors, more depressive symptoms (β = 0.22, 95% CI: 0.11-0.32, p < .001) were associated with more approving attitudes toward sexual risk-taking. Family and social factors including communicating with the caregiver about HIV (β = 1.32, 95% CI: 0.56-2.08, p = .001), sex (β = 1.09, 95% CI: 0.20-1.97, p = .017), and experiencing peer pressure (β = 3.37, 95% CI: 1.85-4.89, p < .001) were also associated with more approving attitudes toward sexual risk-taking. The final model explained 11.54% of the total variance. DISCUSSION Economic, psychological, and social factors influence sexual risk-taking attitudes among ALHIV. There is a need for more research to understand why discussing sex with caregivers improves adolescents' positive attitudes toward sexual risk-taking. These findings have significant ramifications in preventing sexual transmission of HIV among adolescents in low-income settings.
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Affiliation(s)
- Samuel Kizito
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Flavia Namuwonge
- International Center for Child Health and Development, Masaka, Uganda
| | - Josephine Nabayinda
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Proscovia Nabunya
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Jennifer Nattabi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Joshua Kiyingi
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Natasja Magorokosho
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri
| | - Fred M Ssewamala
- International Center for Child Health and Development, Brown School, Washington University in St. Louis, Missouri.
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Nxumalo V, Nxumalo S, Smit T, Khoza T, Mdaba F, Khumalo T, Cislaghi B, McGrath N, Seeley J, Shahmanesh M, Harling G. Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study. Wellcome Open Res 2022; 7:164. [PMID: 36324699 PMCID: PMC9608251 DOI: 10.12688/wellcomeopenres.17896.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/13/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success. Methods: We therefore designed a cohort study (named Sixhumene or ‘we are connected’) to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people’s sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions. Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.
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Affiliation(s)
- Vuyiswa Nxumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | | | - Theresa Smit
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thandeka Khoza
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Fikile Mdaba
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Thulile Khumalo
- Africa Health Research Institute, KwaZulu-Natal, South Africa
| | - Beniamino Cislaghi
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Nuala McGrath
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Faculty of Medicine, University of Southampton, Southampton, SO16 6YD, UK
- Faculty of Social Sciences, University of Southampton, Southampton, SO17 1BJ, UK
| | - Janet Seeley
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, WC1H 9SH, UK
| | - Maryam Shahmanesh
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- Institute for Global Health, University College London, London, WC1E 6JB, UK
| | - Guy Harling
- Africa Health Research Institute, KwaZulu-Natal, South Africa
- School of Nursing and Public Health, University of KwaZulu Natal, Durban, 4041, South Africa
- MRC/Wits-Agincourt Unit, University of the Witwatersrand, Johannesburg, Gauteng, 2193, South Africa
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Harvard Center for Population and Development Studies, Harvard Univeristy, Cambridge, MA, 02138, USA
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Simbar M, Rahmanian F, Nazarpour S, Ramezankhani A, Zayeri F. Priorities for a gender-sensitive sexually transmitted infections and human immunodeficiency virus (STIs/HIV) services: An exploratory mixed methods study. Health Sci Rep 2022; 5:e553. [PMID: 35308420 PMCID: PMC8908080 DOI: 10.1002/hsr2.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 01/21/2022] [Accepted: 02/08/2022] [Indexed: 02/05/2023] Open
Abstract
Background and Aim Providing gender‐sensitive health services is emphasized by the World Health Organization. This study aimed to assess and prioritize the needs for the gender‐sensitive sexually transmitted infections/human immunodeficiency viruses (STIs/HIV) prevention services by a valid and reliable questionnaire. Methods This was an exploratory mixed methods sequential study in Shiraz Iran 2019. The first phase was a qualitative study on 37 providers and managers of the services who were recruited using the purposive and then snowball sampling method. In the second phase, following the content analysis of the qualitative data and a review of related literature, a questionnaire was developed and its psychometric properties were evaluated. Then, in the third phase, the questionnaire was used to assess and prioritize the needs through a quantitative descriptive cross‐sectional study on all 290 providers of STI/HIV prevention services affiliated with Shiraz University of Medical Sciences. Results The finding of the qualitative phase showed gender‐sensitive STI/HIV prevention services should provide gender‐sensitive care and education by the trained personnel and manages with appropriate facilities and equipment. Providing these services also requires supportive policies, intersectoral cooperation, and community capacitation. In the second phase, a questionnaire was developed with 63 items. Assessment of psychometric properties of the questionnaire demonstrated the scale content validity index and ratio (S‐CVI = 0.98 and S‐CVR = 0.87, respectively), as well as the reliability of the questionnaire (internal consistency = 0.972 and intracluster correlation coefficient = 0.910). Results of the third descriptive phase of the study demonstrated the highest priorities for gender‐sensitive education (92.01 ± 11.76%) and care services (92.11 ± 12.04%), respectively. Conclusions To improve the quality of the services, a gender‐based education and care process, as well as a gender‐sensitive structure, including gender‐sensitive personnel, facilities, and management are necessary. Recognizing and meeting the needs for gender‐sensitive services will improve the quality of the services.
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Affiliation(s)
- Masoumeh Simbar
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Midwifery and Reproductive Health Research Center Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Fatemeh Rahmanian
- Department of Midwifery, School of Nursing and Midwifery Shiraz University of Medical Sciences Shiraz Iran
| | - Soheila Nazarpour
- Department of Midwifery, Chalous Branch Islamic Azad University Chalous Iran
| | - Ali Ramezankhani
- Department of Public Health, School of Public Health and Safety Shahid Beheshti University of Medical Sciences Tehran Iran
| | - Farid Zayeri
- Department of Biostatistics Shahid Beheshti University of Medical Sciences Tehran Iran
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Isaksen KJ, Musonda P, Sandøy IF. Parent-child communication about sexual issues in Zambia: a cross sectional study of adolescent girls and their parents. BMC Public Health 2020; 20:1120. [PMID: 32677930 PMCID: PMC7364553 DOI: 10.1186/s12889-020-09218-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 07/06/2020] [Indexed: 11/10/2022] Open
Abstract
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).
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Affiliation(s)
- Katja Jezkova Isaksen
- Plan International Norge, Tullins gate 4C, 0166, Oslo, Norway. .,Centre for International Health, University in Bergen, Årstadveien 21, Postboks 7804, 5020, Bergen, Norway.
| | - Patrick Musonda
- School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia
| | - Ingvild Fossgard Sandøy
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University in Bergen, Årstadveien 21, Postboks 7804, 5020, Bergen, Norway
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Thurman TR, Nice J, Visser M, Luckett BG. Pathways to sexual health communication between adolescent girls and their female caregivers participating in a structured HIV prevention intervention in South Africa. Soc Sci Med 2020; 260:113168. [PMID: 32717662 DOI: 10.1016/j.socscimed.2020.113168] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 11/08/2019] [Accepted: 06/21/2020] [Indexed: 11/15/2022]
Abstract
RATIONALE Interventions that promote sexual health communication between adolescents and their parents or other primary caregivers are an important tool for reducing female adolescents' behavioral risk. Understanding the mechanisms by which interventions effectively foster communication can inform future programs. OBJECTIVE An initial evaluation of Let's Talk, a structured, family-centered HIV prevention intervention for vulnerable adolescents in South Africa, found an increase in caregiver-adolescent sexual communication. This analysis expands upon initial findings to explore the role of parental knowledge, the quality of the parent-adolescent relationship, and the mental health of both parties on caregiver-adolescent sexual health communication. METHOD Using mixed methods data collected in 2015 and 2016, structural equation modeling of differenced pre- and postintervention survey data from 64 female Let's Talk participants ages 13-17 and their caregivers was used to explore the pathway to increased frequency of caregiver-adolescent sexual health communication. Focus group discussions (FGDs) were held with intervention participants (n = 25) and facilitators (n = 6). RESULTS The path analysis indicates that caregivers' mental health indirectly affected caregiver-adolescent relationship quality, and adolescents' mental health exerted a direct effect. Relationship quality, in turn, directly affected the level of parental sexual communication reported by the adolescent. FGDs suggested that cultural norms inhibit frank discussions between caregivers and adolescents about sexual health, but that thoughtfully designed interventions such as Let's Talk can mitigate this barrier. Qualitative findings also echoed quantitative findings about the role of caregiver-adolescent relationship quality and mental health on communication frequency and highlighted the importance of enhancing participants' technical knowledge and particularly their skills related to expression, listening, and anger management to help enable sensitive conversations. CONCLUSIONS Findings overall suggest that a holistic intervention approach emphasizing caregiver-adolescent relationship development and designed to support the mental health of both parties may hold significant promise for enhancing sexual health communication.
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Affiliation(s)
- Tonya R Thurman
- Highly Vulnerable Children Research Center, Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA; Tulane International LLC, East Block, Tannery Park, 23 Belmont Road, Rondebosch, Cape Town, 7700, South Africa.
| | - Johanna Nice
- Highly Vulnerable Children Research Center, Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA.
| | - Maretha Visser
- Department of Psychology, University of Pretoria, Lynnwood Rd, Hatfield, Pretoria, 0002, South Africa.
| | - Brian G Luckett
- Highly Vulnerable Children Research Center, Tulane University School of Social Work, 127 Elk Place, New Orleans, LA, 70112, USA.
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Edwards T, Mkwanazi N, Mitchell J, Bland RM, Rochat TJ. Empowering parents for human immunodeficiency virus prevention: Health and sex education at home. South Afr J HIV Med 2020; 21:970. [PMID: 32670624 PMCID: PMC7343931 DOI: 10.4102/sajhivmed.v21i1.970] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 11/24/2019] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Improving health literacy amongst human immunodeficiency virus (HIV)-positive mothers could strengthen child and adolescent HIV prevention. The Amagugu intervention included health literacy materials to strengthen maternal communication and has demonstrated success in low-resource HIV-endemic settings. OBJECTIVES Our aims were to (1) evaluate whether Amagugu materials improved health literacy leading to changes in parental behaviour towards communicating on topics such as HIV, health behaviours and sex education, and (2) explore what additional information and materials mothers would find helpful. METHOD The Amagugu evaluation included 281 HIV-positive mothers and their HIV-uninfected children (6-10 years). Process evaluation data from exit interviews were analysed using content analysis and logistic regression techniques. RESULTS Of 281 mothers, 276 (98.0%) requested more educational storybooks: 99 (35.2%) on moral development/future aspirations, 92 (32.7%) on general health, safety and health promotion, and 67 (23.8%) on HIV and disease management. Compared to baseline, mothers reported that the materials increased discussion on the risks of bullying from friends (150; 53.4%), teacher problems (142; 50.5%), physical abuse (147; 52.3%) and sexual abuse (126; 44.8%). Most mothers used the 'HIV Body Map' for health (274; 97.5%) and sex education (267; 95.0%). The use of a low-cost doll was reported to enhance mother-child communication by increasing mother-child play (264; 94.3%) and maternal attentiveness to the child's feelings (262; 93.6%). CONCLUSION Parent-led health education in the home seems feasible, acceptable and effective and should be capitalised on in HIV prevention strategies. Further testing in controlled studies is recommended.
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Affiliation(s)
- Taygen Edwards
- Africa Health Research Institute, Somkhele, South Africa
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Ntombizodumo Mkwanazi
- Human and Social Capabilities Division, Human Sciences Research Council, Durban, South Africa
- DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanie Mitchell
- Lentegeur Psychiatric Hospital, Department of Health, Government of the Western Cape, Cape Town, South Africa
| | - Ruth M Bland
- Royal Hospital for Sick Children, Glasgow, Scotland
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Tamsen J Rochat
- DSI-NRF Centre of Excellence in Human Development, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC Developmental Pathways to Health Research Unit (DPHRU), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Frederico M, Arnaldo C, Michielsen K, Decat P. Adult and young women communication on sexuality: a pilot intervention in Maputo-Mozambique. Reprod Health 2019; 16:144. [PMID: 31533752 PMCID: PMC6751840 DOI: 10.1186/s12978-019-0809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 09/06/2019] [Indexed: 11/25/2022] Open
Abstract
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.
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Affiliation(s)
- Mónica Frederico
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, UZ Belgium
- Centro de Estudos Africanos, Departmento de Estudos de Desenvolvimento e Género, Universidade Eduardo Mondlane, Moçambique, Julius Nyerere Ave., Main Campus, P.O.Box 1993, Maputo, Mozambique
- Departmento de Estudos de Desenvolvimento e Género, Centro de Estudos Africanos, Universidade Eduardo Mondlane, Moçambique, Julius Nyerere Ave., Main Campus, P.O.Box 1993, Maputo, Mozambique
| | - Carlos Arnaldo
- Centro de Estudos Africanos, Departmento de Estudos de Desenvolvimento e Género, Universidade Eduardo Mondlane, Moçambique, Julius Nyerere Ave., Main Campus, P.O.Box 1993, Maputo, Mozambique
| | - Kristien Michielsen
- International Centre for Reproductive Health (ICRH), Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, UZ Belgium
| | - Peter Decat
- Department of Public Health and Primary Care, C. Heymanslaan 10, 9000 Ghent, Belgium
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Seif SA, Kohi TW, Moshiro CS. Sexual and reproductive health communication intervention for caretakers of adolescents: a quasi-experimental study in Unguja- Zanzibar. Reprod Health 2019; 16:92. [PMID: 31253159 PMCID: PMC6599269 DOI: 10.1186/s12978-019-0756-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 06/17/2019] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Saada A Seif
- Department of Nursing and Public Health, School of Nursing, The University of Dodoma, P.O. Box 259, Dodoma, Tanzania.
| | - Thecla W Kohi
- Department of Nursing Management, School of Nursing, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
| | - Candida S Moshiro
- Department of Epidemiology and Biostatistics, School of Public health and Social Sciences, Muhimbili University of Health and Allied Sciences, P. O. Box 65001, Dar es Salaam, Tanzania
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Mpondo F, Ruiter RAC, Schaafsma D, van den Borne B, Reddy PS. Understanding the role played by parents, culture and the school curriculum in socializing young women on sexual health issues in rural South African communities. SAHARA J 2018; 15:42-49. [PMID: 29621922 PMCID: PMC5917307 DOI: 10.1080/17290376.2018.1455603] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: the decline in South Africa’s HIV infection rates especially among young women is encouraging. However, studies show that the 15–24-year-old cohort remains vulnerable. As they still report early sexual debut, being involved in sexual partnerships with older men as well as having unprotected sex. These risky sexual behaviors may be linked to factors such as the parent–child sexual health communication and the timing of the first talk. The quality of sexual health information received in school may also be important for enhancing healthier sexual behaviors. Aims and Objectives: to investigate the what, when and how sexual health communication occurs in rural South African families and to determine whether such communication patterns have changed over time. We also wanted to get an in-depth understanding of the roles played by culture, sexual health education and peers in the socialization of young women on sexual matters. Methods: a purposive sample of (n = 55) women who were 18–35 years old was selected and interviewed in focus group discussions (FGDs). Results: the FGD findings show that parent–child communication on sexual matters in rural communities is limited to messages that warn against pregnancy. It is also laden with cultural idioms that are not well explained. The school sexual health curriculum also fails to adequately equip adolescents to make informed decisions regarding sexual matters. All this seems to leave room for reception of misguided information from peers. Conclusions: findings highlight a need for designing interventions that can create awareness for parents on the current developmental needs and sexual behavior of adolescents. For adolescents programs would need to focus on providing skills on personal responsibility, and how to change behavior to enhance sexual health.
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Affiliation(s)
- Feziwe Mpondo
- a Department of Work and Social Psychology , Maastricht University , Maastricht , Netherlands *
| | - Robert A C Ruiter
- a Department of Work and Social Psychology , Maastricht University , Maastricht , Netherlands *
| | - Dilana Schaafsma
- b Fontys University of Applied Sciences , Eindhoven , Netherlands
| | - Bart van den Borne
- c CAPHRI School of Public Health and Primary Care , Maastricht University , Maastricht , Netherlands
| | - Priscilla S Reddy
- d Population Health, Health Systems and Innovation , Human Sciences Research Council , Cape Town , South Africa.,e Child and Family Studies, Social Work Department , University of the Western Cape , Cape Town , South Africa
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Harling G, Gumede D, Shahmanesh M, Pillay D, Bärnighausen TW, Tanser F. Sources of social support and sexual behaviour advice for young adults in rural South Africa. BMJ Glob Health 2018; 3:e000955. [PMID: 30498588 PMCID: PMC6254751 DOI: 10.1136/bmjgh-2018-000955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 09/18/2018] [Accepted: 09/22/2018] [Indexed: 11/25/2022] Open
Abstract
Introduction While young people in sub-Saharan Africa (SSA) are at greatest risk of HIV acquisition, uptake of HIV prevention interventions among them has been limited. Interventions delivered through social connections have changed behaviour in many settings, but not to date in SSA. There is little systematic evidence on whom young SSA adults turn to for advice. We therefore conducted an exploratory cross-sectional study from whom young rural South Africans received support and sexual behaviour-specific advice. Methods We asked 119 18–34 year olds in rural KwaZulu-Natal about the important people in their lives who provided emotional, informational, financial, physical, social or other support. We also asked whether they had discussed sex or HIV prevention with each contact named. We used descriptive statistics and logistic regression to analyse support and advice provision patterns. Results Respondents named 394 important contacts, each providing a mean of 1.7 types of support. Most contacts were relatives, same-gender friends or romantic partners. Relatives provided most informational, financial and physical support; friends and partners more social support and sexual advice. Respondents reported discussing sexual matters with 60% of contacts. Sources of support changed with age, from friends and parents, towards siblings and partners. Discussion Sexual health interventions for young adults in rural South Africa may be able to harness friend and same-generation kin social ties through which sex is already discussed, and parental ties through which other forms of support are transmitted. The gender-segregated nature of social connections may require separate interventions for men and women.
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Affiliation(s)
- Guy Harling
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Dumile Gumede
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Maryam Shahmanesh
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
| | - Deenan Pillay
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,Division of Infection and Immunity, University College London, London, UK
| | - Till W Bärnighausen
- Institute for Global Health, University College London, London, UK.,Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,Department of Global Health and Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.,Institute of Public Health, University of Heidelberg, Heidelberg, Germany
| | - Frank Tanser
- Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa.,School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.,Centre for the AIDS Programme of Research in South Africa - CAPRISA, University of KwaZulu-Natal, Congella, South Africa
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Thurman TR, Nice J, Luckett B, Visser M. Can family-centered programing mitigate HIV risk factors among orphaned and vulnerable adolescents? Results from a pilot study in South Africa. AIDS Care 2018; 30:1135-1143. [PMID: 29606017 DOI: 10.1080/09540121.2018.1455957] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Let's Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers' mental health and parenting skills. Twelve Let's Talk groups, each serving approximately 10 families, were piloted by two local community-based organizations in Gauteng and Kwa-Zulu Natal provinces, South Africa. Face-to-face interviews were conducted among participating caregivers and adolescents at baseline and three months post-intervention to explore the potential effects of the program on intermediate outcomes that may support HIV preventive behavior. Specifically, generalized estimation equations were used to estimate average change on HIV prevention knowledge and self-efficacy, caregiver and adolescent mental health, and family dynamics. Among the 105 adolescents and their 95 caregivers who participated in Let's Talk and completed both surveys, statistically significant improvements were found for adolescents' HIV and condom use knowledge as well as condom negotiation self-efficacy, but not sexual refusal self-efficacy. Both caregivers and adolescents demonstrated significantly better mental health at post-test. Adolescent/caregiver connection and communication about healthy sexuality also improved. These preliminary results highlight the potential of HIV prevention interventions that engage caregivers alongside the vulnerable adolescents in their care to mitigate adolescent HIV risk factors. A more rigorous evaluation is warranted to substantiate these effects and identify their impact on adolescents' risk behavior and HIV incidence.
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Affiliation(s)
- Tonya Renee Thurman
- a Highly Vulnerable Children Research Center , Tulane University School of Social Work , New Orleans , LA , USA
| | - Johanna Nice
- a Highly Vulnerable Children Research Center , Tulane University School of Social Work , New Orleans , LA , USA
| | - Brian Luckett
- a Highly Vulnerable Children Research Center , Tulane University School of Social Work , New Orleans , LA , USA
| | - Maretha Visser
- b Department of Psychology , University of Pretoria , Pretoria , South Africa
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12
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Ziaei T, Ghanbari Gorji M, Behnampour N, Rezaei Aval M. Effect of communication skills based group counseling on mothers' sex dialogue with their adolescent daughters. Int J Adolesc Med Health 2018; 32:ijamh-2017-0141. [PMID: 29397382 DOI: 10.1515/ijamh-2017-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Accepted: 10/26/2017] [Indexed: 11/15/2022]
Abstract
Background Sex dialogue is one of the most critical and challenging topics between mothers and adolescents. The knowledge and skills of mothers in sex dialogue with their daughters are essential. The purpose of this study is to determine the effect of group counseling based on communication skills on mothers through their sex dialogue with their daughters. Methods A randomized controlled field trial was conducted on 168 couples of mothers and their daughters selected by the stratified matching method and randomly divided into two control and intervention groups. The mothers in the intervention group participated in a communication-based consultation in groups consisting of 6-12 people for 6-7 weekly sessions, each one lasting 60 min. The data collection tool was a Persian-translated questionnaire by Jaccard for sex dialogue between mother and daughter. The data were analyzed using Chi-square (χ2), ANOVA with repeated measures and modified post hoc Bonferroni tests. Results There was a significant difference in the mean score of mother-daughter sex dialogue 1 week after intervention between the intervention (34.48 ± 8.74) and control (40.44 ± 9.49) groups (p = 0.001) and 1 month after the intervention between the intervention (30.41 ± 10.07) and control (42.47 ± 9.62) groups (p < 0.001). Conclusion Through applying communication skills, an increase in mother-daughter sex dialogue frequency was observed after group counseling. Therefore, it is suggested to promote mother-daughter communication skills by accessing the mothers via schools, health centers and with the aid of midwifery counselors, midwives and other trained caretakers.
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Affiliation(s)
- Tayebe Ziaei
- Counseling and Reproductive Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Maryam Ghanbari Gorji
- Counseling and Reproductive Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Naser Behnampour
- Department of Biostatistics, Faculty of Health, Golestan University of Medical Sciences, Gorgan, Iran
| | - Masumeh Rezaei Aval
- Counseling and Reproductive Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran
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13
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Abstract
The aim of the research was to gain increased knowledge regarding the sexual risk behaviour of school-going young people in South Africa after two decades of HIV-education in schools, to contribute to the development of improved HIV prevention strategies. In collaboration with the Department of Education, a sample of 5305 learners (between 10 and 18 years in Grades 5-12) from high-risk communities were identified. They completed a survey that assessed self-reported sexual risk behaviour and variables that potentially underlie sexual risk, such as attitudes towards preventive behaviour, perceived social norms and self-efficacy (based on the theory of planned behaviour [TPB]) and social factors like caregiver relationships and gender norms (based on the social ecological theory). Lifetime sex was reported by 49.4% of boys and 30.5% of girls in Grades 8-12, while 56% of the sexually active young people reported consistent condom use. Accurate knowledge about HIV transmission was low (37.8%). Regression analysis showed that risk behaviour was more prominent among older male youths, who perceived social norms as encouraging sexual activity, who use alcohol excessively, and who have negative attitudes towards abstinence. Perceived traditional community gender norms and negative relationships with caregivers were also associated with sexual risk behaviour. This research showed that the TPB can be used in planning HIV prevention interventions for young people. It also revealed that HIV-prevention strategies should focus beyond educating the individual, to address community factors such as improving caregiver relationships, the culture of substance abuse, peer group norms and inequality in community gender norms. These community processes influence young people's behaviour and need to be addressed to allow the youth to make healthy behavioural choices.
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Affiliation(s)
- Maretha Visser
- PhD, is a professor in Psychology at the Department of Psychology, University of Pretoria, Pretoria, South Africa
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Fagbamigbe AF, Ojebuyi BR. Influence of Spousal Communication about Family Planning and HIV/AIDS-related Issues on Modern Contraceptive Use in Nigeria. JOURNAL OF HEALTH MANAGEMENT 2017. [DOI: 10.1177/0972063417699693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Contraceptive use in Nigeria at 15 per cent is low, despite a high human immunodeficiency virus (HIV) prevalence of 3.4 per cent and fertility rate of 5.7 per cent. We assessed the levels of spousal communication on family planning and contraception (FPC) and HIV/acquired immune deficiency syndrome (HIV/AIDS), influence of demographic characteristics on this communication and association between this communication and the respondents’ health behaviours. We used a cross-sectional and nationally representative data on reproductive health and HIV/AIDS-related issues from randomly selected 30,752 men and women of reproductive age. Descriptive statistics, Pearson chi-square (c2) and logistic regression were used to analyze the data at 5 per cent significance level. About 61 per cent of the respondents were 25–49 years old and mostly from rural areas (65 per cent). Only 20 per cent of the respondents discussed HIV/AIDS with their spouses within 12 months preceding the survey while 15 per cent discussed FPC. A discussion of both HIV/AIDS and FPC among spouses was reported among 9 per cent compared to 26 per cent who reported discussing either. Respondents aged 35–39 years had higher odds of discussing HIV/AIDS (Odds Ratios [OR] = 7.06:6.16–8.09) than those aged 15–19 years. Urban dwellers also had higher odds (OR = 1.24:1.16–1.31) of HIV/AIDS discussions than rural respondents. Modern contraceptive use was 35 per cent and 23 per cent among respondents who discussed FPC and HIV/AIDS compared to 8 per cent and 9 per cent, respectively, among those who did not. Spousal communication on FP and HIV/AIDS was low and has influenced contraceptive use and HIV positivity in Nigeria. There is a need to encourage spousal discussion on FP and HIV/AIDS, especially among the rural dwellers and the poor and uneducated as a strategy for improving modern contraceptive use.
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Affiliation(s)
- Adeniyi Francis Fagbamigbe
- Department of Epidemiology and Medical Statistics, Faculty of Public Health, College of Medicine, University of Ibadan, Nigeria
- School of Research and Postgraduate Studies, Faculty of Human and Social Sciences, North West University, MC, South Africa
| | - Babatunde Raphael Ojebuyi
- Department of Communication and Language Arts, Faculty of Arts, University of Ibadan, Nigeria
- School of Research and Postgraduate Studies, Faculty of Human and Social Sciences, North West University, MC, South Africa
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Vilanculos E, Nduna M. “The child can remember your voice”: parent–child communication about sexuality in the South African context. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 16:81-89. [DOI: 10.2989/16085906.2017.1302486] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Wathuta J. Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach. Int J Adolesc Med Health 2016; 30:/j/ijamh.ahead-of-print/ijamh-2016-0044/ijamh-2016-0044.xml. [PMID: 27831919 DOI: 10.1515/ijamh-2016-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/30/2016] [Indexed: 11/15/2022]
Abstract
The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-à-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.
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Affiliation(s)
- Jane Wathuta
- Postdoctoral Research Fellow, University of the Witwatersrand, Johannesburg, South Africa
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Schriver B, Mandal M, Muralidharan A, Nwosu A, Dayal R, Das M, Fehringer J. Gender counts: A systematic review of evaluations of gender-integrated health interventions in low- and middle-income countries. Glob Public Health 2016; 12:1335-1350. [DOI: 10.1080/17441692.2016.1149596] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Brittany Schriver
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Mahua Mandal
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Anthony Nwosu
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
| | - Radhika Dayal
- Public Health Foundation of India (PHFI), New Delhi, India
| | - Madhumita Das
- International Center for Research on Women (ICRW), New Delhi, India
| | - Jessica Fehringer
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, NC, USA
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Adolescents' Communication with Parents, Other Adult Family Members and Teachers on Sexuality: Effects of School-Based Interventions in South Africa and Tanzania. AIDS Behav 2015; 19:2162-76. [PMID: 25724974 DOI: 10.1007/s10461-015-1019-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
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.
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Muhwezi WW, Katahoire AR, Banura C, Mugooda H, Kwesiga D, Bastien S, Klepp KI. Perceptions and experiences of adolescents, parents and school administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda. Reprod Health 2015; 12:110. [PMID: 26621129 PMCID: PMC4665849 DOI: 10.1186/s12978-015-0099-3] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 11/13/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Evidence suggests that in spite of some adolescents being sexually active, many parents do not discuss sex-related issues with them due to lack of age-appropriate respectful vocabulary and skills. The likelihood of parent-adolescent communication improving sexual and reproductive health outcomes appears plausible. The desire to understand parent-adolescent communication and how to improve it for promotion of healthy sexual behaviours inspired this research. The paper is meant to describe perceptions of adolescents, parents and school administrators about parent-adolescent communication on sexual issues; describe the content of such communication and identify factors that influence this communication. METHODS The study was done among two urban and two rural secondary school students in their second year of education. Data were collected from 11 focus group discussions and 10 key Informants Interviews. Data management, analysis and interpretation followed thematic analysis principles. Illuminating verbatim quotations are used to illustrate findings. RESULTS Parental warmth and acceptability of children was perceived by parents to be foundational for a healthy adolescent- parent communication. Perceptions of adolescents tended to point to more open and frequent communication with mothers than fathers and to cordial relationships with mothers. Fathers were perceived by adolescents to be strict, intimidating, unapproachable and unavailable. While adolescents tended to generally discuss sexual issues with mothers, male adolescents communicated less with anyone on sex, relationships and condoms. Much of the parent-adolescent communication was perceived to focus on sexually transmitted infections and body changes. Discussions of sex and dating with adolescents were perceived to be rare. Common triggers of sexuality discussions with female adolescents were; onset of menstruation and perceived abortion in the neighbourhood. Discussion with male adolescents, if it occurred was perceived to be triggered by parental suspicion of having female 'friends' or coming home late. Peers at school and mass media were perceived to the main source of sexuality information. CONCLUSIONS Communication on sexuality issues between parents and their adolescent children was infrequent and critical elements like sex and specifics of protection against undesirable sexual behaviour consequences were avoided. Peers, schools and mass media should be creatively harnessed to improve parent-adolescent communication about sexuality issues.
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Affiliation(s)
- Wilson Winstons Muhwezi
- Department of Psychiatry, Makerere University College of Health Sciences, School of Medicine, P. O. Box 7072, Kampala, Uganda.
| | - Anne Ruhweza Katahoire
- Child Health and Development Centre, Makerere University College of Health Sciences, School of Medicine, P. O. Box 7072, Kampala, Uganda.
| | - Cecily Banura
- Child Health and Development Centre, Makerere University College of Health Sciences, School of Medicine, P. O. Box 7072, Kampala, Uganda.
| | - Herbert Mugooda
- Child Health and Development Centre, Makerere University College of Health Sciences, School of Medicine, P. O. Box 7072, Kampala, Uganda.
| | - Doris Kwesiga
- Child Health and Development Centre, Makerere University College of Health Sciences, School of Medicine, P. O. Box 7072, Kampala, Uganda.
| | - Sheri Bastien
- University of Calgary, Global Health & International Partnerships, Faculty of Medicine, 2500 University Drive NW, Calgary, AB, T2N 1 N4, Canada.
| | - Knut-Inge Klepp
- Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Atienzo EE, Ortiz-Panozo E, Campero L. Congruence in reported frequency of parent-adolescent sexual health communication: A study from Mexico. Int J Adolesc Med Health 2015; 27:275-283. [PMID: 25153551 DOI: 10.1515/ijamh-2014-0025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 06/06/2014] [Indexed: 06/03/2023]
Abstract
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.
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Wamoyi J, Wight D. 'Mum never loved me.' How structural factors influence adolescent sexual and reproductive health through parent-child connectedness: a qualitative study in rural Tanzania. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2015; 13:169-78. [PMID: 25174634 PMCID: PMC4151808 DOI: 10.2989/16085906.2014.945387] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Research in high income countries shows parent–child connectedness to be protective against undesirable sexual and reproductive health (SRH) outcomes among young people. Little has been done to understand the nature of parent–child connectedness, the structural factors that impact on connectedness and parents’ understanding of how connectedness affects their children's sexual behaviour in sub-Saharan Africa and Tanzania in particular. Ethnographic research involved 30 days of observation in 10 households, 9 focus group discussions and 60 in-depth interviews. Thematic analysis was conducted using NVIVO qualitative data analysis software. The structural factors with greatest influence on connectedness were economic circumstances, gender, social status, state education, and globalisation. Economic circumstances impacted on parent–child connectedness through parents’ ability to provide for their children's material needs, and the time their occupation allowed for them to spend with their children and monitor their activities. Appropriate parent–child interactions were shaped by gender norms and by social status in the form of respectability, adolescents’ adherence to norms of respect/ obedience shaping their parents’ affection. State education affected parents’ preferences between children but also undermined parental authority, as did broader globalisation. Connectedness was related to SRH in a bi-directional way: lack of connectedness was linked to young people's low self-esteem and risky sexual behaviour while unplanned pregnancies seriously undermined young women's connectedness with their parents. Since material provision was perceived to be a central element of parent–child connectedness, structural factors limiting provision made transactional sex more likely both through direct material pathways and emotional ones. Motives for transactional sex were said to be material needs and to feel loved and cared for. An important pathway by which structural factors shape adolescent SRH outcomes is through parent–child connectedness, especially parents’ ability to spend time with their children and provide for their economic needs. Modifying these structural factors should facilitate parent–child connectedness, which may help delay early sexual intercourse, protect young people against unplanned pregnancy through encouraging communication on contraception use and, overall, promote healthy adolescent development.
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Affiliation(s)
- Joyce Wamoyi
- a National Institute for Medical Research , Department of Sexual and Reproductive Health , PO Box 1462, Mwanza , Tanzania
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Soon CN, Kaida A, Nkala B, Dietrich J, Cescon A, Gray G, Miller CL. Adolescent experiences of HIV and sexual health communication with parents and caregivers in Soweto, South Africa. SAHARA J 2015; 10:163-9. [PMID: 24809230 DOI: 10.1080/17290376.2014.902769] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Communication about sexual health between parents and adolescents has been shown to have a protective influence on behaviours that reduce the risk of HIV transmission. This study explored experiences of HIV and sexual health (HSH) communication between parents and/or caregivers and adolescents in an urban HIV-endemic community in Southern Africa. Adolescents (aged 14-19 years) were recruited from the Kganya Motsha Adolescent Centre and the Kliptown community between June and August 2009. Qualitative data were collected through focus group discussions (n=10 adolescents) and semi-structured interviews (n=31 adolescents). In total, 41 adolescents (56% female, 44% male, mean age=17.2) participated in the study. Adolescent participants identified emotional, physical and sociocultural barriers to initiating HSH communication with parents and caregivers including fear of verbal warnings, threats and physical assault. Adolescents also expressed a desire for mentorship around HSH communication beyond abstinence and peer-based information. Public health interventions need to support adolescents' access to bi-directional HSH information from adult mentors that address the lived realities of adolescents beyond expectations of abstinence.
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Affiliation(s)
- Christine N Soon
- a MPH, is a graduate at the School of Population and Public Health , University of British Columbia , Vancouver , British Columbia , Canada
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Caregivers' intentions to disclose HIV diagnosis to children living with HIV in South Africa: a theory-based approach. AIDS Behav 2014; 18:1027-36. [PMID: 24310931 DOI: 10.1007/s10461-013-0672-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.
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Goodnight B, Salama C, Grim EC, Anthony ER, Armistead L, Cook SL, Skinner D, Toefy Y. Perceived control and communication about sex: A study of South African families. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2014; 13:31-6. [DOI: 10.2989/16085906.2014.892016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Coetzee J, Dietrich J, Otwombe K, Nkala B, Khunwane M, van der Watt M, Sikkema KJ, Gray GE. Predictors of parent-adolescent communication in post-apartheid South Africa: a protective factor in adolescent sexual and reproductive health. J Adolesc 2014; 37:313-24. [PMID: 24636691 DOI: 10.1016/j.adolescence.2014.01.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 01/07/2014] [Accepted: 01/25/2014] [Indexed: 10/25/2022]
Abstract
In the HIV context, risky sexual behaviours can be reduced through effective parent-adolescent communication. This study used the Parent Adolescent Communication Scale to determine parent-adolescent communication by ethnicity and identify predictors of high parent-adolescent communication amongst South African adolescents post-apartheid. A cross-sectional interviewer-administered survey was administered to 822 adolescents from Johannesburg, South Africa. Backward stepwise multivariate regressions were performed. The sample was predominantly Black African (62%, n = 506) and female (57%, n = 469). Of the participants, 57% (n = 471) reported high parent-adolescent communication. Multivariate regression showed that gender was a significant predictor of high parent-adolescent communication (Black African OR:1.47, CI: 1.0-2.17, Indian OR: 2.67, CI: 1.05-6.77, White OR: 2.96, CI: 1.21-7.18). Female-headed households were predictors of high parent-adolescent communication amongst Black Africans (OR:1.49, CI: 1.01-2.20), but of low parent-adolescent communication amongst Whites (OR:0.36, CI: 0.15-0.89). Overall levels of parent-adolescent communication in South Africa are low. HIV prevention programmes for South African adolescents should include information and skills regarding effective parent-adolescent communication.
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Affiliation(s)
- Jenny Coetzee
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa; Department of Human and Community Development, University of the Witwatersrand, Johannesburg 2000, South Africa; Canadian African Prevention Trials Network, Ottawa Hospital General Campus, Ottawa, ON K1H 8L6, Canada.
| | - Janan Dietrich
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa; Department of Human and Community Development, University of the Witwatersrand, Johannesburg 2000, South Africa; Canadian African Prevention Trials Network, Ottawa Hospital General Campus, Ottawa, ON K1H 8L6, Canada
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Busi Nkala
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Mamakiri Khunwane
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Martin van der Watt
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa
| | - Kathleen J Sikkema
- Department of Psychology and Neuroscience, and Global Health, Duke University, North Carolina 27710, USA
| | - Glenda E Gray
- Perinatal HIV Research Unit, University of the Witwatersrand, Chris Hani Baragwanath Hospital, Johannesburg 1864, South Africa; Department of Paediatrics, University of the Witwatersrand, Johannesburg 2000, South Africa
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Busza J, Besana GVR, Mapunda P, Oliveras E. "I have grown up controlling myself a lot." Fear and misconceptions about sex among adolescents vertically-infected with HIV in Tanzania. REPRODUCTIVE HEALTH MATTERS 2014; 21:87-96. [PMID: 23684191 DOI: 10.1016/s0968-8080(13)41689-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
With increased access to HIV treatment throughout Africa, a generation of HIV positive children is now transitioning to adulthood while living with a chronic condition requiring lifelong medication, which can amplify the anxieties of adolescence. This qualitative study explored how adolescents in Tanzania with HIV experience their nascent sexuality, as part of an evaluation of a home-based care programme. We interviewed 14 adolescents aged 15-19 who had acquired HIV perinatally, 10 of their parents or other primary caregivers, and 12 volunteer home-based care providers who provided support, practical advice, and referrals to clinical services. Adolescents expressed unease about their sexuality, fearing that sex and relationships were inappropriate and hazardous, given their HIV status. They worried about having to disclose their status to partners, the risks of infecting others and for their own health. Thus, many anticipated postponing or avoiding sex indefinitely. Caregivers and home-based care providers reinforced negative views of sexual activity, partly due to prevailing misconceptions about the harmful effects of sex with HIV. The adolescents had restricted access to accurate information, appropriate guidance, or comprehensive reproductive health services and were likely to experience significant unmet need as they initiated sexual relationships. Care programmes could help to reduce this gap by facilitating open communication about sexuality between adolescents and their caregivers, providers, and HIV-positive peers.
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Affiliation(s)
- Joanna Busza
- London School of Hygiene and Tropical Medicine, London, UK.
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More than re-establishing the partner relationship: Intimate aftercare for Somali parents in diaspora. Midwifery 2013; 29:863-70. [DOI: 10.1016/j.midw.2012.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/16/2012] [Accepted: 09/03/2012] [Indexed: 11/19/2022]
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Harris AL, Sutherland MA, Hutchinson MK. Parental Influences of Sexual Risk Among Urban African American Adolescent Males. J Nurs Scholarsh 2013; 45:141-50. [DOI: 10.1111/jnu.12016] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Allyssa L. Harris
- Alpha Chi , Assistant Professor; William F. Connell School of Nursing, Boston College; Chestnut Hill MA USA
| | - Melissa A. Sutherland
- Alpha Chi , Assistant Professor; William F. Connell School of Nursing, Boston College; Chestnut Hill MA USA
| | - M. Katherine Hutchinson
- Alpha Chi , Associate Dean of Graduate Programs and Professor; William F. Connell School of Nursing, Boston College; Chestnut Hill MA USA
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Sommer M, Likindikoki S, Kaaya S. PARENTS, SONS, AND GLOBALIZATION IN TANZANIA: IMPLICATIONS FOR ADOLESCENT HEALTH. THYMOS (HARRIMAN, TENN.) 2013; 7:43-63. [PMID: 34422152 PMCID: PMC8375493 DOI: 10.3149/thy.0701.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
As the global youth population grows exponentially across Africa, there is increasing recognition of the risky health behaviors impeding boys' healthy transitions through puberty. This study in Tanzania sought to capture boys' voiced experiences of transitioning through adolescence, and the masculinity norms shaping boys' engagement in risky behaviors. A critical finding was the gap in parent-son communication around pubertal body changes and avoidance of risk behaviors. Findings also suggest influences from globalization and modernization are changing boys' pubertal experiences and introducing new challenges for parents attempting to provide guidance. Given evidence from high-income countries indicating parents can serve as protective factors for young people during the transition through adolescence, additional research is needed to understand current parent-son dynamics and potential interventions.
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Affiliation(s)
- Marni Sommer
- Mailman School of Public Health, Columbia University
| | | | - Sylvia Kaaya
- Muhimbili University of Health and Allied Sciences
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Wight D, Fullerton D. A review of interventions with parents to promote the sexual health of their children. J Adolesc Health 2013; 52:4-27. [PMID: 23260830 DOI: 10.1016/j.jadohealth.2012.04.014] [Citation(s) in RCA: 110] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Revised: 04/12/2012] [Accepted: 04/13/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess the effectiveness of interventions involving parents or carers intended to improve the sexual health of their children. METHODS Eleven databases were searched for evaluations of interventions with some parental involvement and with outcomes related to the sexual health of the parents' children. Studies had to be experimental, quasi-experimental, or of the before-and-after type. Results were analyzed in a narrative systematic review, taking account of methodological quality. RESULTS We identified adequately robust evaluations of 44 programs, delivered in diverse settings. In nearly all cases, the parenting component focused on improving parent-child communication about sex. In general, where measured, parent-child interaction and adolescents' knowledge and attitudes improved, but sexual behavior outcomes only improved in approximately half the studies. Three programs in which the parenting component made up at least one-fourth of the overall program were found, through randomized controlled trials, to modify some aspect of adolescents' sexual behavior. All programs involved parents for at least 14 hours, were community-based, and encouraged delayed sex. CONCLUSIONS Targeted programs with intensive parental involvement can modify adolescents' sexual behavior, although the review was limited by the lack of rigorous evaluations. Few programs addressed behavioral control, parent-child connectedness, or parental modeling, all suggested by observational research.
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Affiliation(s)
- Daniel Wight
- Social and Public Health Sciences Unit, Medical Research Council, Glasgow, United Kingdom.
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Dunkle KL, Decker MR. Gender-based violence and HIV: reviewing the evidence for links and causal pathways in the general population and high-risk groups. Am J Reprod Immunol 2012; 69 Suppl 1:20-6. [PMID: 23216606 DOI: 10.1111/aji.12039] [Citation(s) in RCA: 154] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Accepted: 10/16/2012] [Indexed: 10/27/2022] Open
Abstract
A growing body of international research documents strong associations between gender-based violence and HIV, both in the general population and among high-risk subpopulations such as female sex workers. The causal pathways responsible are multiple and complex, thus conceptual clarity is needed to best inform population-based, clinical, and individually oriented interventions. Our brief overview is intended to provide an introduction to the research on the various mechanisms that link GBV to HIV risk. We review the evidence, describe the causal pathways, provide a conceptual framework, and outline prevention and intervention priorities at both the individual and population levels.
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Affiliation(s)
- Kristin L Dunkle
- Department of Behavioral Sciences and Health Education and Center for AIDS Research, Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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Wight D, Plummer M, Ross D. The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation. BMC Public Health 2012; 12:788. [PMID: 22978613 PMCID: PMC3490722 DOI: 10.1186/1471-2458-12-788] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Accepted: 08/23/2012] [Indexed: 11/16/2022] Open
Abstract
Background Few of the many behavioral sexual health interventions in Africa have been rigorously evaluated. Where biological outcomes have been measured, improvements have rarely been found. One of the most rigorous trials was of the multi-component MEMA kwa Vijana adolescent sexual health programme, which showed improvements in knowledge and reported attitudes and behaviour, but none in biological outcomes. This paper attempts to explain these outcomes by reviewing the process evaluation findings, particularly in terms of contextual factors. Methods A large-scale, primarily qualitative process evaluation based mainly on participant observation identified the principal contextual barriers and facilitators of behavioural change. Results The contextual barriers involved four interrelated socio-structural factors: culture (i.e. shared practices and systems of belief), economic circumstances, social status, and gender. At an individual level they appeared to operate through the constructs of the theories underlying MEMA kwa Vijana - Social Cognitive Theory and the Theory of Reasoned Action – but the intervention was unable to substantially modify these individual-level constructs, apart from knowledge. Conclusion The process evaluation suggests that one important reason for this failure is that the intervention did not operate sufficiently at a structural level, particularly in regard to culture. Recently most structural interventions have focused on gender or/and economics. Complementing these with a cultural approach could address the belief systems that justify and perpetuate gender and economic inequalities, as well as other barriers to behaviour change.
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Affiliation(s)
- Daniel Wight
- Medical Research Council Social and Public Health Sciences Unit, 4 Lilybank Gardens, Glasgow, G12 8RZ, UK.
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Fehringer JA, Babalola S, Kennedy CE, Kajula LJ, Mbwambo JK, Kerrigan D. Community perspectives on parental influence on engagement in multiple concurrent sexual partnerships among youth in Tanzania: implications for HIV prevention programming. AIDS Care 2012; 25:207-14. [PMID: 22775066 DOI: 10.1080/09540121.2012.699666] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Although concurrent sexual partnerships (CPs) have been hypothesized to be an important risk factor for HIV in sub-Saharan Africa, the social and cultural factors that encourage CPs are not well understood. This study explored the community's perspectives on the role that parents can play in influencing their children's decision to engage in CPs. We conducted 16 in-depth interviews, 32 focus group discussions, and 16 key informant interviews with 280 adult participants in Tanzania. Data were coded; findings and conclusions were developed based on themes that emerged from coding. Three parental influences on CPs emerged: parent-child communication about sex, both silent and explicit encouragement of CPs, and parental behavior modeling. Parents are typically either too busy or too "embarrassed" to talk with their children about sex and CPs. The information parents do give is often confusing, fear-based, inadequate, and/or only focused on daughters. Parents themselves also encourage CPs through complicity of silence when their daughters come home with extra cash or consumer goods. In some cases, parents overtly encourage their children, particularly daughters, to practice CPs due to the promise of money from wealthy partners. Finally, when parents engage in CPs, the children themselves learn to behave similarly. These results suggest that parents can influence their children's decision to engage in CPs. HIV prevention interventions should address this by promoting parent-child communication about sexuality; associated disease risks and gender-equitable relationships; promoting positive parental role modeling; and educating parents on the implications of encouragement of CPs in their children.
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Affiliation(s)
- Jessica A Fehringer
- MEASURE Evaluation, Carolina Population Center, University of North Carolina, Chapel Hill, USA.
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Guilamo-Ramos V, Soletti AB, Burnette D, Sharma S, Leavitt S, McCarthy K. Parent-adolescent communication about sex in rural India: U.S.-India collaboration to prevent adolescent HIV. QUALITATIVE HEALTH RESEARCH 2012; 22:788-800. [PMID: 22232297 PMCID: PMC3343220 DOI: 10.1177/1049732311431943] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
In this article, we examine parent-adolescent communication about sex among rural Indian youth and their parents. We conducted in-depth interviews (N = 40) with mothers, fathers, and adolescent boys and girls aged 14 to 18 years in a rural community in Maharashtra, India. In the context of key cultural factors, including gender-related norms, we explore issues of sexual health and critically assess widely held beliefs that Indian parents are unwilling or unable to discuss sex-related topics with their children. Our findings suggest that despite communication barriers, e.g., lack of knowledge and cultural proscriptions, Indian families are interested in and willing to communicate about sex-related topics. Future research should seek to determine the viability of family-based HIV prevention interventions for Indian adolescents.
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Mall S, Swartz L. Parents’ anxieties about the risk of HIV/Aids for their Deaf and hard of hearing adolescents in South Africa: A qualitative study. J Health Psychol 2011; 17:764-73. [DOI: 10.1177/1359105311421051] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Adolescents who are Deaf or hard of hearing may be vulnerable to HIV/AIDS. Adolescents’ open communication with parents encourages positive sexuality. The relationship between the Deaf adolescent and their parent could be obstructed by communication difficulties. This article explores parents’ anxieties about HIV risk. We interviewed nine parents of Deaf adolescents in South Africa. We explored their fears of the risk of HIV/AIDS for their children. Participants believed that their children were at risk of HIV infection. Although they did communicate with their children about sexuality and HIV/AIDS, some experienced communication difficulties. Communicative relationships between these adolescents and their parents should be encouraged.
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A review of studies of parent-child communication about sexuality and HIV/AIDS in sub-Saharan Africa. Reprod Health 2011; 8:25. [PMID: 21943095 PMCID: PMC3192730 DOI: 10.1186/1742-4755-8-25] [Citation(s) in RCA: 174] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 09/24/2011] [Indexed: 11/26/2022] Open
Abstract
Parent-child sexuality communication has been identified as a protective factor for adolescent sexual and reproductive health, including HIV infection. The available literature on this topic in sub-Saharan Africa is increasing; however a systematic review of studies has not been conducted. This article reviews the literature in the area of parental or caregiver and child communication about sexuality and HIV/AIDS in sub-Saharan Africa. A review of peer reviewed literature published between 1980 and April 2011 was conducted. Communication process studies investigating the frequency, content, style, tone of discussions, preferences, as well as associations with and barriers to sexuality communication are reviewed. In addition, studies which examine behavioral associations with parent-child sexuality communication, and intervention studies to improve parent-child sexuality communication are examined. The findings from process studies suggest wide variation in terms of frequency of discussions, with a range of socio-demographic and other factors associated with sexuality communication. Overall, findings demonstrate that discussions tend to be authoritarian and uni-directional, characterized by vague warnings rather than direct, open discussion. Moreover, parents and young people report a number of barriers to open dialogue, including lack of knowledge and skills, as well as cultural norms and taboos. Findings are less clear when it comes to associations between parental communication and adolescent sexual activity and contraception use. However, nascent indications from intervention research suggest positive findings with increases in frequency and comfort of discussions, among other outcomes. Gaps in the research are identified and discussed with implications for future studies.
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Hatcher A, de Wet J, Bonell CP, Strange V, Phetla G, Proynk PM, Kim JC, Morison L, Porter JDH, Busza J, Watts C, Hargreaves JR. Promoting critical consciousness and social mobilization in HIV/AIDS programmes: lessons and curricular tools from a South African intervention. HEALTH EDUCATION RESEARCH 2011; 26:542-555. [PMID: 20965911 DOI: 10.1093/her/cyq057] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
The development of critical consciousness is seen as a key stage in communities increasing levels of dialogue about priority problems and effecting structural change for health. However, relatively little research identifies concrete methods for programmes to build critical consciousness. We examined how a South African structural intervention used critical consciousness as a tool for prevention of intimate partner violence and HIV infection. We collected qualitative data in the form of in-depth interviews with managers, trainers, and participants of the Intervention with Microfinance for AIDS and Gender Equity intervention (IMAGE) in rural South Africa. The data were analysed through a coding structure developed in QSR NVivo. We draw practical lessons from IMAGE to guide other HIV programmes aiming to promoting critical consciousness and social mobilization. This research suggests that specific curricular tools can work towards critical consciousness and that mobilization efforts in future programmes can be strengthened by including individual and collective efforts by participants.
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Affiliation(s)
- Abigail Hatcher
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, CA 94105, USA.
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Akers AY, Holland CL, Bost J. Interventions to improve parental communication about sex: a systematic review. Pediatrics 2011; 127:494-510. [PMID: 21321027 PMCID: PMC3065139 DOI: 10.1542/peds.2010-2194] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT The relative effectiveness of interventions to improve parental communication with adolescents about sex is not known. OBJECTIVE To compare the effectiveness and methodologic quality of interventions for improving parental communication with adolescents about sex. METHODS We searched 6 databases: OVID/Medline, PsychInfo, ERIC, Cochrane Review, Communication and Mass Media, and the Cumulative Index to Nursing and Allied Health Literature. We included studies published between 1980 and July 2010 in peer-reviewed English-language journals that targeted US parents of adolescents aged 11 to 18 years, used an experimental or quasi-experimental design, included a control group, and had a pretest/posttest design. We abstracted data on multiple communication outcomes defined by the integrative conceptual model (communication frequency, content, skills, intentions, self-efficacy, perceived environmental barriers/facilitators, perceived social norms, attitudes, outcome expectations, knowledge, and beliefs). Methodologic quality was assessed using the 11-item methodologic quality score. RESULTS Twelve studies met inclusion criteria. Compared with controls, parents who participated in these interventions experienced improvements in multiple communication domains including the frequency, quality, intentions, comfort, and self-efficacy for communicating. We noted no effects on parental attitudes toward communicating or the outcomes they expected to occur as a result of communicating. Four studies were of high quality, 7 were of medium quality, and 1 was of lower quality. CONCLUSIONS Our review was limited by the lack of standardized measures for assessing parental communication. Still, interventions for improving parent-adolescent sex communication are well designed and have some targeted effects. Wider dissemination could augment efforts by schools, clinicians, and health educators.
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Affiliation(s)
- Aletha Y. Akers
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, Pennsylvania; and
| | - Cynthia L. Holland
- Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital, Pittsburgh, Pennsylvania; and
| | - James Bost
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
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Carnevale J, Gropper AB, Agnew-Blais J, Mimiaga MJ, Mhango A, Bail R, Ngoma M. Knowledge base and caretaker-child communication about HIV in peri-urban schoolchildren of Lusaka, Zambia. AIDS Care 2011; 23:646-53. [PMID: 21293994 DOI: 10.1080/09540121.2010.516347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Peri-urban communities, which face health risks of both urban and rural environments, have grown extensively with recent global urbanization. These communities' combination of multiple HIV risk factors with the lack of a formalized sexual education system sets the stage for high-risk behavior in peri-urban youth. We conducted a cross-sectional survey of children (ages 5-17, N=331) and accompanying caretakers in peri-urban Lusaka, Zambia, using both closed- and open-ended questions to investigate HIV knowledge and communication. We found that while 67% of children had heard of HIV, only 26% and 23% could accurately name a major mode of transmission and prevention, respectively. In a multivariate model, increasing age was the only significant demographic correlate of a child's ability to offer accurate responses to either question. Though HIV/AIDS knowledge levels were high in the eldest (14-17-year old) age group, in the 10-13-year-old age group accurate modes of transmission and prevention were provided by only 41% and 33% of study participants, respectively. Sharp instruments, particularly razor blades, were mentioned nearly as frequently as sexual intercourse with respect to both transmission and prevention, a response trend that predominated in the youngest age group but persisted into the oldest. Seventy percent of caretakers had not spoken with their child about HIV. A history of caretaker-child communication about HIV was associated with an increased likelihood of a child offering an accurate mode of transmission (OR 2.70, 95% confidence interval (CI) 1.41-5.18, p=0.0029) or prevention (OR 3.43, 95% CI 1.78-6.60, p=0.0002), in multivariate analyses. Our results demonstrate a lack of knowledge and dialog about HIV in the pre-adolescent subset of high-risk peri-urban youth, and uncover undue emphasis on razor blades as a major mode of disease transmission.
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Bogale GW, Boer H, Seydel ER. Effects of a theory-based audio HIV/AIDS intervention for illiterate rural females in Amhara, Ethiopia. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2011; 23:25-37. [PMID: 21341958 DOI: 10.1521/aeap.2011.23.1.25] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
In Ethiopia the level of illiteracy in rural areas is very high. In this study, we investigated the effects of an audio HIV/AIDS prevention intervention targeted at rural illiterate females. In the intervention we used social-oriented presentation formats, such as discussion between similar females and role-play. In a pretest and posttest experimental study with an intervention group (n = 210) and control group (n = 210), we investigated the effects on HIV/AIDS knowledge and social cognitions. The intervention led to significant and relevant increases in HIV/AIDS knowledge, self-efficacy, perceived vulnerability to HIV/AIDS infection, response efficacy of condoms and condom use intention. In the intervention group, self-efficacy at posttest was the main determinant of condom use intention, with also a significant contribution of vulnerability. We conclude that audio HIV/AIDS prevention interventions can play an important role in empowering rural illiterate females in the prevention of HIV/AIDS.
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Dworkin SL, Dunbar MS, Krishnan S, Hatcher AM, Sawires S. Uncovering tensions and capitalizing on synergies in HIV/AIDS and antiviolence programs. Am J Public Health 2010; 101:995-1003. [PMID: 21164091 DOI: 10.2105/ajph.2009.191106] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Research frequently points to the need to empower women to effectively combat the twin epidemics of HIV/AIDS and gender-based violence. Simultaneously, there has been increased attention given to working with men in gender equality efforts. The latter approach intervenes on masculinities as part of the fight against HIV/AIDS and violence. No research has considered these 2 lines of work side by side to address several important questions: What are the points of overlap, and the tensions and contradictions between these 2 approaches? What are the limitations and unintended consequences of each? We analyzed these 2 parallel research trends and made suggestions for how to capitalize on the synergies that come from bolstering each position with the strengths of the other.
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Affiliation(s)
- Shari L Dworkin
- Department of Social and Behavioral Sciences and the Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA 94143-0612, USA.
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Kim J, Ferrari G, Abramsky T, Watts C, Hargreaves J, Morison L, Phetla G, Porter J, Pronyk P. Assessing the incremental effects of combining economic and health interventions: the IMAGE study in South Africa. Bull World Health Organ 2010; 87:824-32. [PMID: 20072767 DOI: 10.2471/blt.08.056580] [Citation(s) in RCA: 131] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2008] [Accepted: 03/19/2009] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To explore whether adding a gender and HIV training programme to microfinance initiatives can lead to health and social benefits beyond those achieved by microfinance alone. METHODS Cross-sectional data were derived from three randomly selected matched clusters in rural South Africa: (i) four villages with 2-year exposure to the Intervention with Microfinance for AIDS and Gender Equity (IMAGE), a combined microfinance-health training intervention; (ii) four villages with 2-year exposure to microfinance services alone; and (iii) four control villages not targeted by any intervention. Adjusted risk ratios (aRRs) employing village-level summaries compared associations between groups in relation to indicators of economic well-being, empowerment, intimate partner violence (IPV) and HIV risk behaviour. The magnitude and consistency of aRRs allowed for an estimate of incremental effects. FINDINGS A total of 1409 participants were enrolled, all female, with a median age of 45. After 2 years, both the microfinance-only group and the IMAGE group showed economic improvements relative to the control group. However, only the IMAGE group demonstrated consistent associations across all domains with regard to women's empowerment, intimate partner violence and HIV risk behaviour. CONCLUSION The addition of a training component to group-based microfinance programmes may be critical for achieving broader health benefits. Donor agencies should encourage intersectoral partnerships that can foster synergy and broaden the health and social effects of economic interventions such as microfinance.
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Affiliation(s)
- Julia Kim
- Bureau for Development Policy, United Nations Development Programme, New York, NY, USA.
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Hargreaves J, Hatcher A, Strange V, Phetla G, Busza J, Kim J, Watts C, Morison L, Porter J, Pronyk P, Bonell C. Process evaluation of the Intervention with Microfinance for AIDS and Gender Equity (IMAGE) in rural South Africa. HEALTH EDUCATION RESEARCH 2010; 25:27-40. [PMID: 19797337 DOI: 10.1093/her/cyp054] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
The Intervention with Microfinance for AIDS and Gender Equity (IMAGE) combines microfinance, gender/HIV training and community mobilization (CM) in South Africa. A trial found reduced intimate partner violence among clients but less evidence for impact on sexual behaviour among clients' households or communities. This process evaluation examined how feasible IMAGE was to deliver and how accessible and acceptable it was to intended beneficiaries during a trial and subsequent scale-up. Data came from attendance registers, financial records, observations, structured questionnaires (378) and focus group discussions and interviews (128) with clients and staff. Gender/HIV training and CM were managed initially by an academic unit ('linked' model) and later by the microfinance institution (MFI) ('parallel' model). Microfinance and gender/HIV training were feasible to deliver and accessible and acceptable to most clients. Though participation in CM was high for some clients, others experienced barriers to collective action, a finding which may help explain lack of intervention effects among household/community members. Delivery was feasible in the short term but both models were considered unsustainable in the longer term. A linked model involving a MFI and a non-academic partner agency may be more sustainable and is being tried. Feasible models for delivering microfinance and health promotion require further investigation.
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Affiliation(s)
- James Hargreaves
- Infectious Disease Epidemiology Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, UK.
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Soletti AB, Guilamo-Ramos V, Burnette D, Sharma S, Bouris A. India-US collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV-prevention intervention for rural Indian youth. J Int AIDS Soc 2009; 12:35. [PMID: 19925680 PMCID: PMC2788348 DOI: 10.1186/1758-2652-12-35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2009] [Accepted: 11/19/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the centrality of family in Indian society, relatively little is known about family-based communication concerning sexual behaviour and HIV/AIDS in rural Indian families. To date, very few family-based adolescent HIV-prevention interventions have been developed for rural Indian youth. This study conducted formative research with youth aged 14 to18 years and their parents in order to assess the feasibility of conducting a family-based HIV-prevention intervention for rural Indian adolescents. METHODS Eight focus groups were conducted (n = 46) with mothers, fathers, adolescent females and adolescent males (two focus groups were held for each of the four groups). All focus groups consisted of same-gender participants. Adolescents aged 14 to18 years old and their parents were recruited from a tribal community in rural Maharashtra, India. Focus group transcripts were content analyzed to identify themes related to family perceptions about HIV/AIDS and participation in a family-based intervention to reduce adolescent vulnerability to HIV infection. RESULTS Six primary thematic areas were identified: (1) family knowledge about HIV/AIDS; (2) family perceptions about adolescent vulnerability to HIV infection; (3) feasibility of a family-based programme to prevent adolescent HIV infection; (4) barriers to participation; (5) recruitment and retention strategies; and (6) preferred content for an adolescent HIV prevention intervention. CONCLUSION Despite suggestions that family-based approaches to preventing adolescent HIV infection may be culturally inappropriate, our results suggest that a family-based intervention to prevent adolescent HIV infection is feasible if it: (1) provides families with comprehensive HIV prevention strategies and knowledge; (2) addresses barriers to participation; (3) is adolescent friendly, flexible and convenient; and (4) is developmentally and culturally appropriate for rural Indian families.
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Affiliation(s)
- Asha Banu Soletti
- School of Social Work, Tata Institute of Social Sciences, Mumbai, India
| | | | - Denise Burnette
- Columbia University School of Social Work, New York, NY, USA
| | - Shilpi Sharma
- School of Social Work, Tata Institute of Social Sciences, Mumbai, India
| | - Alida Bouris
- School of Social Service Administration, University of Chicago, USA
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