Sheri Bastien

A review of studies of parent-child communication about sexuality and HIV/AIDS in sub-Saharan Africa

Parent-child sexuality communication has been identified as a protective factor for adolescent sexual and reproductive health, including HIV infection. The available literature on this topic in sub-Saharan Africa is increasing; however a systematic review of studies has not been conducted. This article reviews the literature in the area of parental or caregiver and child communication about sexuality and HIV/AIDS in sub-Saharan Africa. A review of peer reviewed literature published between 1980 and April 2011 was conducted. Communication process studies investigating the frequency, content, style, tone of discussions, preferences, as well as associations with and barriers to sexuality communication are reviewed. In addition, studies which examine behavioral associations with parent-child sexuality communication, and intervention studies to improve parent-child sexuality communication are examined. The findings from process studies suggest wide variation in terms of frequency of discussions, with a range of socio-demographic and other factors associated with sexuality communication. Overall, findings demonstrate that discussions tend to be authoritarian and uni-directional, characterized by vague warnings rather than direct, open discussion. Moreover, parents and young people report a number of barriers to open dialogue, including lack of knowledge and skills, as well as cultural norms and taboos. Findings are less clear when it comes to associations between parental communication and adolescent sexual activity and contraception use. However, nascent indications from intervention research suggest positive findings with increases in frequency and comfort of discussions, among other outcomes. Gaps in the research are identified and discussed with implications for future studies.

Dating violence among school students in Tanzania and South Africa: Prevalence and socio-demographic variations

Aims: Widespread adolescent dating violence (DV) in Sub-Saharan Africa calls for immediate action, particularly since it is linked to the spread of HIV/AIDS. This article presents prevalence and demographic correlates of DV among school students in Cape Town and Mankweng (South Africa) and Dar es Salaam (Tanzania). Methods: Data were derived from the baseline data collection of a multi-site randomized controlled trial of an HIV prevention intervention among young adolescents. The results were confined to students who reported previously or currently being in a relationship (n = 6,979). Multiple logistic regression analysis with demographic predictors was employed, controlled for cluster effect. Results: Within our sample 10.2%—37.8% had been victims, 3.1%—21.8% had been perpetrators, and 8.6%—42.8% had been both (percentages dependent on site and gender). Before controlling for other factors, religion was a protective factor against violence in Cape Town. After controlling for other factors, a higher age and lower socioeconomic status were associated with belonging to any of the three groups of violence. Being male in all sites was associated with perpetration; being female with victimization (except in Cape Town where the converse finding was obtained). Higher parental education in Cape Town was protective against all types of violence. Ethnicity and living with biological parents were not associated with violence. Conclusions: DV is prevalent and widespread in the study sites. Violence control policies and interventions should target young adolescents. Since there was not one clearly defined subgroup identified as being at high risk, such programmes should not be limited to high risk groups only.

Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania

Young people in sub-Saharan Africa constitute an important group for HIV prevention efforts. Determining their exposure to HIV/AIDS information and communication and their perceived credibility of information sources is imperative to the development of interventions. However, the majority of studies on this topic have been conducted among school-based populations, with few focused on those out of school or on comparing the two groups. A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1 007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/ AIDS information and they communicated more frequently about the topic than did the out-of-school group. Among both groups, exposure to HIV/AIDS information occurred more frequently than discussing the topic. The in-school group gave high credibility ratings to medical doctors, the radio and parents as sources of information, while the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents and doctors as preferred communicators of sexual and reproductive health information. Interventions that address the determinants of educational attainment are needed, as well as ones specifically intended to reach girls or those out of school. The preferences and credibility rankings for sources of HIV/AIDS information suggest the need for evidence-based programmes that utilise peers and promote the involvement of parents or doctors. Particularly needed are interventions that explicitly aim to stimulate discussion among young people about HIV/AIDS and that foster the development of interpersonal skills.

Changes in exposure to information, communication and knowledge about AIDS among school children in Northern Tanzania, 1992–2005

Abstract This article aims to investigate changes in primary school students’ reported exposure to AIDS information and communication, and knowledge levels from 1992 to 2005. A repeated cross-sectional design was used. In 1992, a self-administered questionnaire was completed by 2,026 sixth and seventh grade students from 18 randomly selected primary schools in Arusha and Kilimanjaro regions, Tanzania. The same procedures were repeated in 2005 with a sample of 2,069 students. Mean values with 95% confidence intervals are reported. Chi-square was used to test for differences in proportions. Students in 2005 reported higher levels of exposure to information and communication from all sources than in 1992. Knowledge scores also increased, yet there was a significant decline in four variables, two of which are related to transmission and two of which are factual. An alarming decline in awareness of the condom as a preventative measure was found. Findings also indicate that myths related to transmission and infection persist. Salient sex differences remain, but the knowledge gap is narrowing. Interventions should aim to stimulate discussion in young peoples social networks in order to increase overall exposure to AIDS information, communication and knowledge.

Herpes simplex virus type 2 infection as a biomarker for sexual debut among young people in sub-Saharan Africa: a literature review.

Biological markers are needed in order to provide objective measures to validate self-reported sexual behaviour and interpret prevention trial data. In this review, we evaluated herpes simplex type 2 virus (HSV-2), one of the most prevalent sexually transmitted infections in sub-Saharan Africa as a biological marker of sexual debut. Based on our findings, we do not recommend using HSV-2 as a biomarker for sexual debut due to its low transmission probabilities and the fact that HSV-2 prevalence is not 100% among potential sexual partners. We recommend that the validation of alternative biological measures should be prioritized, and included in future studies and trials of interventions to reduce sexual health risk.

Perceptions and experiences of adolescents, parents and school administrators regarding adolescent-parent communication on sexual and reproductive health issues in urban and rural Uganda

BackgroundEvidence suggests that in spite of some adolescents being sexually active, many parents do not discuss sex-related issues with them due to lack of age-appropriate respectful vocabulary and skills. The likelihood of parent-adolescent communication improving sexual and reproductive health outcomes appears plausible. The desire to understand parent-adolescent communication and how to improve it for promotion of healthy sexual behaviours inspired this research. The paper is meant to describe perceptions of adolescents, parents and school administrators about parent-adolescent communication on sexual issues; describe the content of such communication and identify factors that influence this communication.MethodsThe study was done among two urban and two rural secondary school students in their second year of education. Data were collected from 11 focus group discussions and 10 key Informants Interviews. Data management, analysis and interpretation followed thematic analysis principles. Illuminating verbatim quotations are used to illustrate findings.ResultsParental warmth and acceptability of children was perceived by parents to be foundational for a healthy adolescent- parent communication. Perceptions of adolescents tended to point to more open and frequent communication with mothers than fathers and to cordial relationships with mothers. Fathers were perceived by adolescents to be strict, intimidating, unapproachable and unavailable. While adolescents tended to generally discuss sexual issues with mothers, male adolescents communicated less with anyone on sex, relationships and condoms. Much of the parent-adolescent communication was perceived to focus on sexually transmitted infections and body changes. Discussions of sex and dating with adolescents were perceived to be rare. Common triggers of sexuality discussions with female adolescents were; onset of menstruation and perceived abortion in the neighbourhood. Discussion with male adolescents, if it occurred was perceived to be triggered by parental suspicion of having female ‘friends’ or coming home late. Peers at school and mass media were perceived to the main source of sexuality information.ConclusionsCommunication on sexuality issues between parents and their adolescent children was infrequent and critical elements like sex and specifics of protection against undesirable sexual behaviour consequences were avoided. Peers, schools and mass media should be creatively harnessed to improve parent-adolescent communication about sexuality issues.

Reflecting and shaping the discourse : The role of music in AIDS communication in Tanzania

Failure to recognize the importance of oral traditions in Africa and the potential of music and song for stimulating social and behavior change would represent a missed opportunity in HIV prevention strategies. Local narratives concerning AIDS are often utilized in popular songs and constitute rich sources of contextual information about the epidemic that have thus far been un- or underutilized in HIV prevention strategies. Endogenously conceived messages delivered via a channel such as music increase the likelihood of messages being contextually appropriate and culturally engaging. This form of media also presents the greatest opportunity for wide dissemination. Drawing on field work conducted in the Kilimanjaro region, this paper presents examples of how music and musicians in Tanzania reflect and potentially shape AIDS discourse. Three broad recurrent themes addressed in songs are discussed: AIDS metaphors, stigma and broader HIV prevention messages. By tapping into the wealth of information about AIDS discourse contained within popular songs, and by recognizing musicians as potential opinion leaders and agents of social change, the effectiveness of prevention strategies may be increased.

Access, agency and ambiguity: communication about AIDS among young people in Northern Tanzania.

Developing interpersonal communication skills is a key component in HIV prevention. Understanding the contexts and content of communication about HIV and AIDS among young people is important for the development of effective programmes and interventions. The aim of this paper is to build on study findings suggesting that significant differences exist between young people in- and out-of-school in exposure to AIDS-related information and communication in Kilimanjaro. In-depth interviews were conducted with young people between the ages of 13 and 18. Data were analyzed using a thematic and comparative approach to explore similarities and differences. A trinity of factors including access, agency and ambiguity emerged as influencing communication about HIV and AIDS. The role of social networks in structuring differences in communication is examined. Findings reveal a discourse laden with fear and mistrust. Coupled with low levels of health literacy, young people regardless of school attendance demonstrate an inability to critically appraise modes of transmission and prevention. An increased emphasis should be placed on the development of critical health literacy and open dialogue. Accessible, unambiguous and culturally relevant interventions built on an understanding of barriers to open communication, which link with community-based initiatives to stimulate dialogue and debate, are needed.

Fear appeals in HIV-prevention messages: young people’s perceptions in northern Tanzania

The aims of the study were to elicit the perceptions of young people in Tanzania on the role of fear appeals in HIV-prevention messages and to identify important contextual factors that may influence young peoples perceptions of HIV-prevention posters. A total of 10 focus groups were conducted to investigate the role of fear appeals using the extended parallel process model (EPPM) as a guide. Young people were shown a series of images (mostly posters) with alternating high and low-threat messages (fear appeals), and then asked questions about their overall beliefs about HIV and AIDS, as well as about their response in terms of perceived susceptibility to HIV infection, the severity of the message, and their perceptions of self-efficacy and response efficacy. The images and messages that specifically targeted young people were highest in inducing perceived susceptibility to HIV infection, while pictorial descriptions of the physical consequences of HIV infection and those messages related to the stigma and discrimination faced by HIV-infected or affected people induced greater perceptions of severity. The information-based posters rated high in inducing response efficacy, while none of the images seemed to convince young people that they had the self-efficacy to perform the recommended health behaviours. The young people expressed a preference for fear-based appeals and a belief that this could work well in HIV-prevention efforts, yet they also stated a desire for more information-based messages about how to protect themselves. Finally, the messages evoking the most emotional responses were those that had been locally conceived rather than ones developed by large-scale donor-funded campaigns. Finding the appropriate balance between fear and efficacy in HIV-prevention messages is imperative. Further research is needed to better understand how and when fear appeals work and do not work in African settings, especially among young people.

Growing Up Global

This volume comes at a time when there is a great need to take stock. With the 25th anniversary of the Convention on the Rights of the Child in November 2014 and the Millennium Development Goals (MDGs) which formed the blueprint for the majority of the world’s countries and development institutions coming to a close in 2015, it is an important time to assess and reflect.