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.

KEYWORDS:

• Adolescent
• HIV prevention
• mental health
• South Africa
• orphans and vulnerable children

Acknowledgements

We thank Anita Sampson, Naletsana Masango and Lauren Murphy of USAID Southern Africa for their support of the study and the development of the Let's Talk program. We also extend our appreciation to the partner organizations involved in the study, CINDI and HIVSA, for their leadership and tireless efforts to make a positive difference in the lives of participants.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Tonya Renee Thurman http://orcid.org/0000-0002-3488-011X

Johanna Nice http://orcid.org/0000-0003-0118-3489

Brian Luckett http://orcid.org/0000-0001-7561-7329

Maretha Visser http://orcid.org/0000-0002-2830-7050

Notes

1. The authors wish to acknowledge another program in South Africa called Let's Talk! which similarly focuses on improving parenting practices to prevent children from acquiring HIV. That program focuses exclusively on parents and there is no affiliation with the current program under study. Further details on that program are available elsewhere (Bogart et al., 2013).

Additional information

Funding

This work was supported by USAID Southern Africa under PEPFAR: [Cooperative Agreement AID-674-A-12-00002 awarded to Tulane University]. The views expressed in this document do not necessarily reflect those of USAID or the US Government.