Facilitators and barriers to discussing HIV prevention with adolescents: perspectives of HIV-infected parents

"Whenever you're ready to talk about it": Prompts and barriers to inclusive family sex communication with gay, bisexual, and queer sons

Despite growing evidence that parent-child sex communication (PCSC) is a positive strategy for adolescent sexual health outcomes, there is little research about what prompts and impedes these conversations among parents of gay, bisexual, and queer (GBQ) adolescent sons. Using interview data from a multi-method qualitative study, we analyzed parental perspectives (N=15) on non-heteronormative sex communication with GBQ adolescent sons. Our results revealed that parents are most likely to engage in sex communication if they established open communication with their child, accepted their child's sexual orientation, encouraged safe sex practices, and were knowledgeable about LGBTQ issues. Conversely, parents who experience communication discomfort were unable to engage in inclusive and comprehensive sex conversations, thus creating a barrier to effective sex-positive communication. These findings have implications for future research and interventions that promote parents' ability to successfully facilitate conversations about sexual health with their sexuality diverse children.

Missed opportunities for HIV prevention: Results of a qualitative study on mother-daughter communication

This qualitative study examines the role of communication among African American mothers living with HIV and their daughters in HIV prevention. Multiple themes emerged from our analysis of semistructured interviews with mothers (n = 15), and their adult daughters, (n = 15) such as perceptions of HIV risk communication, HIV/AIDS knowledge, attitudes, and beliefs. The findings of the study revealed differences in communication between mothers and daughters. Daughters felt they did not receive adequate and frequent HIV prevention advice from their mothers. Implications include strengthening communication content between mother-daughter dyads in HIV prevention programs that can aid in reducing HIV risk.

"They said "be careful'": sexual health communication sources and messages for adolescent girls living with perintally-acquired HIV infection

Due to advances in highly active antiretroviral treatment (HAART), children "who perinatally acquired HIV infection" (PHIV+) in the United States have been reaching adolescence and adulthood in large numbers. As youth PHIV + become sexually active it is important to understand their sources of sexual health information and the messages communicated by those sources to safeguard their sexual health and that of their partners. This paper explores sexual health communication for adolescent girls PHIV + in comparison to adolescent girls who were exposed but did not acquire HIV perinatally (PHIV-) to understand how HIV infection influences the sexual health communication needs of the former. A convenience sample size of 30 (20 PHIV + and 10 PHIV-, mean age 14.5) girls completed survey and participated in a 45-90 min developmentally appropriate semi-structured interview. The interviews aimed to elicit the girls' sources of sexual health communication, the sexual health messages they receive, their comfort or discomfort with these communications, and to determine how their sexual health communication experiences differ from those of their PHIV- peers. Transcripts of the interviews were coded and analyzed for themes related to sexual health communication sources, sexual health communication messages and comfort/discomfort with sexual health communication sources. Our findings suggest that girls PHIV + do not differ significantly from Girls PHIV- in their sources of sexual health information, yet girls PHIV + are most comfortable receiving sexual health information from their health providers, whereas for girls PHIV, the comfort is higher with caregivers. However, the messages Girls PHIV + reported receiving from their providers and caregivers were vague. Both providers and caregivers of Girls PHIV + are uniquely positioned to provide information to adolescents about sexuality and responsible sex decision-making. Some caregivers and providers may need training to prepare them to provide appropriate and accurate sexual health information to girls PHIV + .

Understanding disclosure behaviours in HIV-positive young people

Disclosure of sero-status is part of living with HIV and involves a complex decision-making process. Disclosure is not a one-off event and can be viewed as a sequential process and, while affording opportunities for individuals to access appropriate physical and psychological support, it is also an important part of secondary prevention. It is, however, often fraught with emotional challenges, and there is a considerable amount of evidence demonstrating the barriers that individuals face to making a disclosure. Adolescents are one such group that face challenges over disclosing their HIV status. Many adolescents are choosing not to disclose their status, through fear of potentially adverse outcomes, such as rejection and stigma, which could amplify onward transmission rates. In order to better support young people through disclosure journeys, it is essential to understand the reasons and motivations behind why young people choose not to disclose their sero-status in order to develop interventions which may facilitate supporting young people through the disclosure process.

Taking HIV Testing to Families: Designing a Family-Based Intervention to Facilitate HIV Testing, Disclosure, and Intergenerational Communication

INTRODUCTION

Facility-based HIV testing does not capture many adults and children who are at risk of HIV in South Africa. This underscores the need to provide targeted, age-appropriate HIV testing for children, adolescents, and adults who are not accessing health facilities. While home-based counseling and testing has been successfully delivered in multiple settings, it also often fails to engage adolescents. To date, the full potential for testing entire families and linking them to treatment has not been evaluated.

METHODS

The steps to expand a successful home-based counseling and testing model to a family-based counseling and testing approach in a high HIV prevalence context in rural South Africa are described. The primary aim of this family-based model is to increase uptake of HIV testing and linkage to care for all family members, through promoting family cohesion and intergenerational communication, increasing HIV disclosure in the family, and improving antiretroviral treatment uptake, adherence, and retention. We discuss the three-phased research approach that led to the development of the family-based counseling and testing intervention.

RESULTS

The family-based intervention is designed with a maximum of five sessions, depending on the configuration of the family (young, mixed, and older families). There is an optional additional session for high-risk or vulnerable family situations. These sessions encourage HIV testing of adults, children, and adolescents and disclosure of HIV status. Families with adolescents receive an intensive training session on intergenerational communication, identified as the key causal pathway to improve testing, linkage to care, disclosure, and reduced stigma for this group. The rationale for the focus on intergenerational communication is described in relation to our formative work as well as previous literature, and potential challenges with pilot testing the intervention are explored.

CONCLUSION

This paper maps the process for adapting a novel and largely successful home-based counseling and testing intervention for use with families. Expanding the successful home-based counseling and testing model to capture children, adolescents, and men could have significant impact, if the pilot is successful and scaled-up.

Clinical Questions in Online Health Communities: The Case of "See your doctor" Threads

Online health communities are known to provide psychosocial support. However, concerns for misinformation being shared around clinical information persist. An existing practice addressing this concern includes monitoring and, as needed, discouraging asking clinical questions in the community. In this paper, I examine such practice where moderators redirected patients to see their health care providers instead of consulting the community. I observed that, contrary to common beliefs, community members provided constructive tips and persuaded the patients to see doctors rather than attempting to make a diagnosis or give medical advice. Moderators' posts on redirecting patients to see their providers were highly associated with no more follow up replies, potentially hindering active community dynamic. The findings showed what is previously thought of as a solution-quality control through moderation-might not be best and that the community, in coordination with moderators, can provide critical help in addressing clinical questions and building constructive information sharing community environment.

Future directions in communication research: individual health behaviors and the influence of family communication

Although numerous fields continue to advance research toward various areas of health prevention, communication researchers have yet to examine fully the link between communication and health improvement. This is particularly true of those studying the intersections of family and health communication--unfortunate, given that family members serve as primary socialization agents in health attitudes and behaviors. Using the example of obesity-related health behaviors, the following essay advances the argument that continued research aimed at understanding the intersection of health and families' communicative influence may help to illuminate the nature, causes, and redress to health issues that are correlated with individual health practices. This is accomplished by (a) reviewing contributions and limitations of pioneering studies in (family) health literature and (b) offering three key research areas for health communication exploration that will move scholars toward communication-based solutions (e.g., family-level communication health interventions).

A Five Step Process for Interactive Parent-Adolescent Communication About HIV Prevention: Advice from Parents Living With HIV/AIDS

AIM

This study investigated how parents living with HIV communicated about HIV prevention with their 10-18 year old children.

METHODS

Interviews with 76 mothers and fathers were analyzed for (1) their experiences discussing HIV prevention with adolescents, and (2) advice on how to best broach HIV-related topics.

RESULTS

Interactive conversations, where both parents and adolescents participated, were regarded as effective. Parents emphasized that adolescents should have a "voice" (be able to voice their concerns) and a "choice" (have a variety of effective prevention strategies to choose from) during HIV-related talks.

DISCUSSION

A five step process for interactive communication emerged as a result of these discussions.

IMPLICATIONS

Health care professionals can facilitate adolescent sexual health by encouraging parents to actively involve their children in discussions about HIV prevention.

CONCLUSION

Future HIV prevention programs could benefit by providing parents with appropriate tools to foster interactive discussions about sexual health with adolescents.