Adapting an HIV Prevention Program for Families Affected By Maternal HIV Infection

Introduction: One potentially vulnerable group overlooked by HIV prevention efforts is adolescent children of mothers living with HIV (MLH). MLH are raising healthy children well into adulthood, yet through genetic and environmental pathways, intergenerational transmission of HIV-related risk factors is possible. Barriers to keeping youth safe from sexual risks can stem from problems in the family environment such as HIV non-disclosure, parent-child attachment disruptions, low family communication, and difficulties with monitoring child behavior. Nevertheless, MLH possess many strengths, particularly related to their experience of living with HIV, which can be leveraged to protect adolescents from infection. The current study describes the structured process of adapting a parent-based HIV prevention intervention for MLH and their adolescent children in consideration of the families’ strengths and challenges. We highlight findings from each phase of adaptation, including qualitative formative work and a pilot feasibility evaluation of the newly formed program, Moms Stopping It Now! (Ms. Now).

Methods: Focus groups with 15 MLH and individual interviews with 13 of their children helped identify the ways in which our original evidence-based intervention could be modified to fit the needs of this population while maintaining core intervention components. A community advisory board (n = 11), consisting of MLH, staff from organizations serving MLH, facilitators familiar with the original intervention, and adolescent children of MLH, provided feedback on the modified intervention content. A small pilot of Ms. Now was then conducted with 12 MLH-adolescent dyads to assess participant engagement and satisfaction. Preliminary efficacy was also examined via pre-/post-intervention assessments of main intervention targets and outcomes.

Results: Formative data indicated MLH were highly motivated to discuss sexual risks with their adolescents, yet some faced challenges to disclosing protective information about their HIV status, particularly with sons. Many had prior histories of addiction which had caused separations with their child. These formative results resulted in several changes to the intervention. Participants in the pilot found Ms. Now to be highly acceptability and had only a few suggestions for programmatic changes. Promising preliminary efficacy trends were found, including increased relationship quality, parental monitoring, and discussions about mothers’ HIV status.

Conclusions: Our findings highlight the importance of structured program adaptation, as well as the feasibility of a parent-based HIV prevention approach for families affected by maternal HIV infection.