Abstract: Parental Communication, Engagement, and Support during the Adolescent Voluntary Medical Male Circumcision Experience: Adolescent and Parent Perspectives (Society for Prevention Research 26th Annual Meeting)

Schedule:

Wednesday, May 30, 2018

Congressional C (Hyatt Regency Washington, Washington, DC)

* noted as presenting author

Kim H. Dam, MPH, Senior Research Data Analyst, The Johns Hopkins University, Baltimore, MD

Michelle R. Kaufman, PhD, Assistant Professor, The Johns Hopkins University, Baltimore, MD

Eshan U. Patel, MPH, Research Data Analyst, The Johns Hopkins University, Baltimore, MD

Lynn M. Van Lith, MPA, Technical Director, The Johns Hopkins University, Baltimore, MD

Karin Hatzold, MD, MPH, Deputy Director HIV/TB, Population Services International, Harare, Zimbabwe

Arik V. Marcell, MD, MPH, Associate Professor, The Johns Hopkins University, Baltimore, MD

Webster Mavhu, PhD, Deputy Director, Centre for Sexual Health & HIV/AIDS Research, Harare, Zimbabwe

Catherine Kahabuka, MD, PhD, CEO, CSK Research Solutions Ltd., Dar Es Salaam, Tanzania, United Republic of

Lusanda Mahlasela, BSc, Deputy - Research, M&E, Centre for Communication Impact, Pretoria, South Africa

Emmanuel Njeuhmeli, MD, MPH, MBA, Senior Biomedical Prevention Advisor, United States Agency for International Development Washington/Global Health Bureau/Office of HIV/AIDS, Crystal City, VA

Kim Seifert Ahanda, MPH, Senior Behavior Change Advisor, United States Agency for International Development Washington/Global Health Bureau/Office of HIV/AIDS, Crystal City, VA

Getrude Ncube, MIH, National HIV Prevention Coordinator, Zimbabwe Ministry of Health and Child Care, Harare, Zimbabwe

Gissenge Lija, MD, MMed, Tanzania Ministry of Health, Community, Development, Gender, Elderly, Tanzania Ministry of Health, Community, Development, Gender, Elderly, Dodoma, Tanzania, United Republic of

Collen Bonnecwe, MBA, Director, South Africa National Department of Health, Pretoria, South Africa

Aaron A. R. Tobian, MD, PhD, Associate Professor, The Johns Hopkins University, Baltimore, MD

Introduction: Voluntary medical male circumcision (VMMC) is a highly effective prevention strategy in reducing HIV transmission and one of the few opportunities in sub-Saharan Africa to engage male adolescents in the health care system. A better understanding of parents’ role in communication, engagement, and support for VMMC is needed to respond effectively to high demands for the service among adolescents.

Methods: We conducted 24 focus group discussions with parents/guardians of adolescents (n=192) who agreed to be circumcised or were recently circumcised in South Africa, Tanzania, and Zimbabwe. Discussions were analyzed by two coders using pre-determined areas of inquiry. In addition, male adolescents (n=1293) in South Africa (n=299), Tanzania (n=498), and Zimbabwe (n=496) were surveyed about their VMMC experience within 7-10 days post-procedure. We estimated adjusted prevalence ratios (aPR) using multivariable Poisson regression.

Results: Qualitative data revealed a dynamic multi-directional dialogue between parents/guardians and their sons, supplemented by support from other sources such as religious or community leaders. Parents/guardians noted challenges and gaps in communicating with their sons about VMMC, especially when they did not accompany them to the clinic. Parents/guardians found it more difficult to be involved in wound care for older adolescents than for adolescents under 15 years. Across all three countries, parents rarely discussed sexual health messages related to condom use, safer sex practices, and HIV with older adolescents and not at all with adolescents 10-12 years old. They felt ashamed, embarrassed, or ill-equipped to discuss sexuality and feared talking about sex would encourage their sons to engage in it. Survey data revealed that adolescents ages 10-14 were significantly more likely than 15-19 year olds to report their parent accompanied them to a pre-procedure counseling session (56.5%vs.12.5%;P<0.001). Among adolescents, younger age (aPR=0.86;95%CI=0.76-0.99) and rural setting (aPR=0.34;95%CI=0.13-0.89) were associated with improved parental-adolescent communication, while lower socioeconomic status (aPR=1.37;95%CI=1.00-1.87), being agnostic (or of a non-dominant/traditional religion) (aPR=2.87;95%CI=2.21-3.72), and living in South Africa (aPR=2.63;95%CI=1.29-4.73) were associated with greater parental-adolescent communication barriers.

Conclusions: Parents play a vital role in the VMMC experience, especially for younger adolescents. However, the level of parental support appears to be age-dependent, with parents of younger male adolescents more implicated. Strategies are needed to inform parents completely throughout the VMMC adolescent experience, irrespective of whether or not they accompany their sons to clinics.

Abstract: Parental Communication, Engagement, and Support during the Adolescent Voluntary Medical Male Circumcision Experience: Adolescent and Parent Perspectives (Society for Prevention Research 26th Annual Meeting)

170 Parental Communication, Engagement, and Support during the Adolescent Voluntary Medical Male Circumcision Experience: Adolescent and Parent Perspectives