Developing family interventions for adolescent HIV prevention in South Africa

Caroline Kuo, Millicent Atujuna, Catherine Mathews, Dan J Stein, Jacqueline Hoare, William Beardslee, Don Operario, Lucie Cluver, Larry K Brown, Caroline Kuo, Millicent Atujuna, Catherine Mathews, Dan J Stein, Jacqueline Hoare, William Beardslee, Don Operario, Lucie Cluver, Larry K Brown

Abstract

Adolescents and young people account for 40% of all new HIV infections each year, with South Africa one of the hardest hit countries, and having the largest population of people living with HIV. Although adolescent HIV prevention has been delivered through diverse modalities in South Africa, and although family-based approaches for adolescent HIV prevention have great potential for highly affected settings such as South Africa, there is a scarcity of empirically tested family-based adolescent HIV preventive interventions in this setting. We therefore conducted focus groups and in-depth interviews with key informants including clinicians, researchers, and other individuals representing organizations providing HIV and related health services to adolescents and parents (N = 82). We explored family perspectives and interactions around topics such as communication about sex, HIV, and relationships. Participants described aspects of family interactions that presented both challenges and opportunities for family-based adolescent HIV prevention. Parent-child communication on sexual topics were taboo, with these conversations perceived by some adults as an invitation for children to engage in HIV risk behavior. Parents experienced social sanctions for discussing sex and adolescents who asked about sex were often viewed as disrespectful and needing discipline. However, participants also identified context-appropriate strategies for addressing family challenges around HIV prevention including family meetings, communal parenting, building efficacy around parent-adolescent communication around sexual topics, and the need to strengthen family bonding and positive parenting. Findings indicate the need for a family intervention and identify strategies for development of family-based interventions for adolescent HIV prevention. These findings will inform design of a family intervention to be tested in a randomized pilot trial (ClinicalTrials.gov #NCT02432352).

Keywords: HIV prevention; South Africa; adolescent; family-based interventions; intervention development.

Figures

Figure 1.
Figure 1.
Summary of study themes around family interactions around sex and HIV.

References

    1. Armistead L., Cook S., Skinner D., Toefy Y., Anthony E. R., Zimmerman L., Chow L. Preliminary results from a family-based HIV prevention intervention for South African youth. Health Psychology. 2014;(7):668–676. doi: 10.1037/hea0000067.
    1. Bhana A., Mellins C. A., Petersen I., Alicea S., Myeza N., Holst H., McKay M. The VUKA family program: Piloting a family-based psychosocial intervention to promote health and mental health among HIV infected early adolescents in South Africa. AIDS Care. 2014;(1):1–11. doi: 10.1080/09540121.2013.806770.
    1. Cape Town Government . City health HIV, AIDS, STI, and TB plan 2012/2013. Cape Town: Metro District Health Services; 2014. Retrieved from .
    1. Gile K., Handcock M. Respondent-driven sampling: An assessment of current methodology. Sociological Methodology. 2010:285–327. doi: 10.1111/j.1467-9531.2010.01223.x.
    1. Harrison A., Newell M. L., Imrie J., Hoddinott G. HIV prevention for South African youth: Which interventions work? A systematic review of current evidence. BMC Public Health. 2010:102. doi: 10.1186/1471-2458-10-102.
    1. Johnson B., Scott-Sheldon L., Huedo-Medina T., Carey M. Interventions to reduce sexual risk for human immunodeficiency virus in adolescents. Archives of Pediatrics & Adolescent Medicine. 2011;(1):77–84. doi: 10.1001/archpediatrics.2010.251.
    1. Johnson B., Michie S., Snyder L. B. Effects of behavioral intervention content on HIV prevention outcomes: A meta-review of meta-analyses. JAIDS Journal of Acquired Immune Deficiency Syndromes. 2014:S259–S270. doi: 10.1097/qai.0000000000000235.
    1. Pequegnat W., Bray J. H. HIV/STD prevention interventions for couples and families: A review and introduction to the special issue. Couple and Family Psychology: Research and Practice. 2012;(2):79–93. doi: 10.1037/a0028682.
    1. QSR International Pty Ltd 2012 NVivo (Version 10). QSR International Pty Ltd.
    1. Scott-Sheldon L., Walstrom P., Harrison A., Kalichman S. C., Carey M. P. Sexual risk reduction interventions for HIV prevention among South African youth: A meta-analytic review. Current HIV Research. 2013;(7):549–558. doi: 10.2174/1570162X12666140129105726.
    1. Simbayi L. C., Shisana O., Rehle T., Onoya D., Jooste S., Zungu N., Zuma K. 2014 South African National HIV Prevalence, Incidence and Behaviour Survey, 2012. Retrieved from Cape Town.
    1. Statistics South Africa 2011 Latest key indictors. Retrieved from .
    1. Strauss A., Corbin J. Basics of qualitative research: Techniques and procedures for developing grounded theory. 2nd ed. Thousand Oaks, CA: Sage; 1998.
    1. UNAIDS 2012a Global AIDS response: Country progress report 2012, Republic of South Africa. Retrieved from Pretoria: .
    1. UNAIDS 2012b UNAIDS world AIDS day report 2012. Retrieved from Geneva.
    1. UNAIDS 2014 The GAP report. Retrieved from Geneva.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe