Moderators of a Family-Based HIV Prevention Intervention in South Africa: Relationship Power, Intimate Partner Violence, and Neighborhood Safety

PRESENTATION TYPE: Individual Poster

 

CATEGORY/THEME: Context and Prevention

 

TITLE: Moderators of a Family-Based HIV Prevention Intervention in South Africa: Relationship Power, Intimate Partner Violence, and Neighborhood Safety

ABSTRACT BODY:

Introduction: HIV is a major concern for many South African communities. Prevention efforts through behavioral interventions have recently targeted family processes (e.g., family communication) thought to reduce youth sexual risk. Often these interventions are developed abroad and adapted to the local context. South African caregivers face many barriers to the effectiveness of such interventions—for example, gender inequality and household and community violence. Our current study examines these influences, conceptualized as moderators, as they relate to the outcome of a family-based intervention implemented in Cape Town.

 

Methods: Ninety-nine caregiver-youth dyads were recruited for the pilot study of the intervention. Participants were randomized into intervention or wait-list control arms and assessed at pre- and post-intervention, and at a six-month follow-up. Our outcome was number of topics related to sex reported to have been discussed between caregiver and youth. Three moderators of the intervention were explored: caregiver’s report of decision-making power in her relationship with an intimate partner, experience of recent physical or sexual intimate partner violence (IPV), and perceptions of neighborhood safety.

 

Results: Baseline rates of topics discussed were similar across conditions and levels of the moderators. Moderation analyses revealed that over time among intervention participants, caregivers who perceived their neighborhoods as less safe and those who experienced recent IPV talked about fewer topics related to sex than those living in more safe neighborhoods and those who did not report recent IPV (p < .05), respectively. In addition, regardless of receiving the intervention, caregivers with high decision-making power reported talking about more topics related to sex over time than those with medium or low levels of decision-making power (p < .05). Among those with low or moderate decision-making power, number of topics discussed only increased among participants receiving the intervention (p < .05). Thus, it is likely that without the intervention those with low or moderate decision-making power would not have achieved an increase in topics discussed.

 

Conclusions: While it appears our intervention was advantageous for female caregivers without greater decision-making power in their relationships, it was unable to produce similar outcomes in caregivers who experienced household violence or perceived their neighborhoods as relatively dangerous. These findings have significant implications for translating family-based HIV prevention interventions into high-risk contexts.