Adolescent choices and caregiver roles: Understanding individual and interpersonal influences on sexual decision-making in South Africa

South African adolescents are at-risk for HIV infection. Understanding the factors influencing sexual decision-making is crucial for developing effective HIV prevention strategies. We conducted a qualitative study with adolescents and caregivers in Rustenburg, South Africa to explore individual and interpersonal factors that influence adolescent sexual decision-making. Focus Group Discussions (FGDs) were conducted in English and Setswana with 17 adolescents (13 females and 4 males) and 19 caregivers (17 females and 2 males) between April and July 2018. Thematic analysis revealed that while adolescents had access to sexual education from various sources, where the knowledge does not translate into healthy sexual decision-making. A contributing barrier was the lack of effective communication and support between caregivers and adolescents in discussing topics related to sexual activity. Although adolescents expressed a strong need to be understood and supported by caregivers regarding their sexual activity, there was perceived distrust, judgemental attitude from caregivers, poor role models of a father figure, and the traditional taboo of having these discussions with caregivers. While female adolescents and female caregivers discussed sensitive matters, this type of communication was limited with adolescent males. Male adolescents were uncomfortable communicating with either caregiver, fearing caregiver judgemental attitudes and being misunderstood. Female caregivers perceived male caregiver roles to be absent and non-engaging when it came to adolescent education and support in sexual matters. Caregivers desired to support their children, yet they seemed to doubt their skills. Communication tools and guidance on how adolescents and caregivers could communicate about sensitive matters could create enabling environments for adolescents to make informed, healthy decisions regarding their risky sexual behaviours. To address adolescent intention-behaviour gap, future interventions could consider gain-framed messaging within intervention packages to promote healthy sexual choices

南非青少年面临HIV感染风险。明晰影响青少年性决策的各类因素，对于制定高效的HIV预防策略至关重要。我们于南非鲁斯滕堡（Rustenburg）开展了一项针对青少年与照护者的质性研究，旨在探究影响青少年性决策的个体与人际层面因素。研究于2018年4月至7月间开展，以英语与塞茨瓦纳语（Setswana）为访谈语言，共招募17名青少年（其中13名女性、4名男性）与19名照护者（其中17名女性、2名男性）参与焦点小组讨论（Focus Group Discussions, FGDs）。主题分析结果显示：尽管青少年可通过多种渠道获取性教育知识，但这些知识并未转化为健康的性决策行为。其中一项关键阻碍因素为，照护者与青少年在讨论性相关话题时，缺乏有效的沟通与支持。尽管青少年明确表示，希望在性相关事宜上获得照护者的理解与支持，但他们感知到照护者存在不信任、评判性态度，缺乏父亲形象的正向榜样，且与照护者讨论此类话题存在传统禁忌。尽管女性青少年与女性照护者能够就敏感议题展开沟通，但这类交流在男性青少年群体中极为有限。男性青少年不愿与任何照护者沟通，因他们害怕被照护者评判与误解。女性照护者认为，在青少年性教育与性事务支持方面，男性照护者的角色缺位且未参与其中。照护者虽希望支持子女，但似乎对自身的沟通能力缺乏信心。若能提供沟通工具与相关指导，帮助青少年与照护者就敏感议题展开沟通，可为青少年创造有利环境，使其能够针对自身高风险性行为做出知情且健康的决策。为缩小青少年的意图-行为差距，未来的干预项目可在干预方案中采用获益框架式信息传递策略，以推广健康的性选择。