Effect of Quality of Caregiver–Adolescent Relationship on Sexual Debut, Transactional Sex, and on Age-Disparate Relationships Among Young Women in Rural South Africa Enrolled in HPTN 068

Abstract

Background: Adolescent girls and young women (AGYW) remain burdened by the HIV epidemic. Positive caregiver-child relationships are associated with safe sexual behaviors in young people; yet, this literature often highlights the role of parent-child communication and parental monitoring, neglecting the importance of emotional relationships between a caregiver and adolescent.Setting: We used longitudinal data from HIV Prevention Trial Network 068-conducted among 2533 AGYW (13-20 years) over a period of 5 years in Agincourt, South Africa.Method: Kaplan-Meier and Cox models were used to estimate the effect of quality of caregiver-adolescent relationships (caring and closeness) on sexual debut, and log-binomial models with generalized estimating equations were used to examine the relationship between our exposures and transactional sex and agedisparate relationships.Results: Sexual debut was delayed among those who reported high levels of caregiver caring [hazard ratio: 0.80, 95% confidence interval (CI): 0.69 to 0.93] and caregiver closeness (hazard ratio: 0.80, 95% CI: 0.68 to 0.95). AGYW who reported high quality caregiver-adolescent relationships had a lower risk of transactional sex [caring: risk ratio (RR): 0.