142nd APHA Annual Meeting and Exposition

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Adapting an evidence-based family intervention program for adolescent HIV prevention in South Africa

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 8:45 AM - 9:00 AM

Caroline Kuo, DPhil , Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
Millicent Atujuna, PhD , University of Cape Town, Cape Town, South Africa
Catherine Mathews, PhD , Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
Dan J. Stein, MD, PhD , Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
Jackie Hoare, MD , Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
William Beardslee, MD , Judge Baker Children’s Center, Boston, MA
Don Operario, PhD , Department of Behavioral and Social Sciences and Center for Alcohol and Addiction Studies, Brown University School of Public Health, Providence, RI
Lucie D. Cluver, DPhil , Department of Social Policy and Intervention, Oxford University, Oxford, United Kingdom
Larry K. Brown, MD , Brown University Alpert Medical School, Providence, RI
Audio (mp3) recording Recorded Presentation (mp4)
Background: Engaging early adolescents (13-15 years) in HIV prevention is crucial given the majority of new infections occur among young people. South Africa has few family-based adolescent HIV interventions. We use an iterative process to adapt a CDC “best-evidence” family-based HIV intervention to South Africa, using data from phase 1 of an intervention acceptability and feasibility trial.

Methods: The study took place in Khayelitsha, South Africa during 2013. Adaptation needs were assessed during 8 focus groups (5-9 participants per group) with Xhosa-speaking mixed gender adolescents (13-15 years) and parents or guardians (18+ years) and 19 interviews with HIV experts (ongoing, target n=30). Brown and Cape Town Universities provided ethical approvals. Focus groups and interviews were recorded, transcribed verbatim, translated from Xhosa to English, and analyzed in NVivo using a thematic analysis.

Results: Findings identify cultural factors that necessitate adaptations to increase intervention acceptability. Beliefs regarding foreign origins of HIV, that anal sex or menstruation carry no risk for transmission, and traditional cures affected risk perceptions and behaviors. Parent-child communication regarding sex was taboo, with sexual communication viewed as an invitation to engage in HIV risk behavior, social sanctions for parents who discussed sex, and animosity towards children who asked about sex. Respondents identified culturally appropriate modalities to increase intervention engagement including family meetings and communal parenting.

Conclusions: An existing family-based intervention will be adapted to include new content, topics, and delivery modalities for South Africa. The adapted family HIV intervention will be tested in a randomized pilot trial in 2014-2015.

Learning Areas:

Implementation of health education strategies, interventions and programs
Public health or related research
Social and behavioral sciences

Learning Objectives:
Describe the process of adapting evidence-based interventions to international populations and settings. Identify cultural and contextual adaptations needed to increase family engagement in HIV prevention in South Africa.

Keyword(s): HIV Interventions, Family Involvement

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal or co-principal investigator of several federally or internationally funded grants focusing on the health outcomes of HIV affected populations. My research interests include the epidemiology of mental health among HIV affected populations, and developing and testing psychosocial and behavioral HIV interventions for vulnerable populations in HIV endemic settings.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 5058.0: HIV Prevention in Africa