Can family-centered programing mitigate HIV risk factors among orphaned and vulnerable adolescents? Results from a pilot study in South Africa

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.

“Knowledge I seek because culture doesn’t work anymore … It doesn’t work, death comes”: The experiences of third generation female caregivers (“gogos”) in South Africa discussing sex, sexuality and HIV and AIDS with children in their care

“…Although a number of studies in South Africa have commented on the importance of the extended family and caregivers other than parents (23,24,26,27,28), this study reinforces the view that it is essential to examine the changes in family composition in SRH conversations in South Africa (23,26,27,28). A number of studies in South Africa have commented on the importance of the extended family and caregivers other than parents (23,24,26,27,28).…”

“…In this study, where nearly 50% of caregivers were grandmothers or aunts, found statistically signi cant improvements in adolescents' HIV and condom use knowledge, as well as condom negotiation self-e cacy (26). , was found although an improvement was not re ected in sexual refusal self-e cacy (26).Communication about healthy sexuality between caregiver and adolescent also improved (26).…”

“…Although a number of studies in South Africa have commented on the importance of the extended family and caregivers other than parents (23,24,26,27,28), this study reinforces the view that it is essential to examine the changes in family composition in SRH conversations in South Africa (23,26,27,28). A number of studies in South Africa have commented on the importance of the extended family and caregivers other than parents (23,24,26,27,28). In addition, this study supported ndings in other research (17,22) for the need for healthcare providers and programs to recognise that there are differences in SRH communication and conversations between parents and grandparents.…”

“…An evaluation of a study based in Kwa-Zulu Natal, l used a structured, familycentered adolescent HIV prevention programme, Let's Talk, that aimed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents (28). In this study, where nearly 50% of caregivers were grandmothers or aunts, found statistically signi cant improvements in adolescents' HIV and condom use knowledge, as well as condom negotiation self-e cacy (26). , was found although an improvement was not re ected in sexual refusal self-e cacy (26).Communication about healthy sexuality between caregiver and adolescent also improved (26).…”

Community‐Based Caregiver and Family Interventions to Support the Mental Health of Orphans and Vulnerable Children: Review and Future Directions

“…Methodologies should therefore include process evaluation and foci on qualitative and participatory methods. Of the studies identified in our review, one conducted a process evaluation as part of the RCT (Bhana et al, 2014), one evaluated qualitative outcomes in addition to quantitative (Visser et al, 2015), and two studies had conducted previous process evaluations as part of pilot trials or intervention development (Thurman, Nice, Luckett, & Visser, 2018;Ward et al, 2019). In addition, the majority of interventions utilized community participatory methods during the process of designing and adapting the intervention for the local community; this is discussed in more detail below.…”