Talking about sex in HIV-affected families: perspectives of HIV-infected mothers and their children from a mixed-methods study

Abstract

ABSTRACTSexual education in HIV-affected families could be impeded by secrecy surrounding HIV status. This paper aims to (1) examine the prevalence of mother–child communication about sexuality, (2) evaluate the impact on sexual education of disclosing the mother’s HIV-positive status to her children and (3) explore the willingness of mothers living with HIV (MLWH) to talk about sexuality with their children. A mixed-methods design (combination of quantitative and qualitative methods) was used. A total of 109 MLWH (average age: 40.7 years) and 71 of their children (average age: 16.3 years) completed a face-to-face questionnaire. Descriptive analyses and 2×2 Fisher’s exact tests were conducted to compare the occurrence of communication about nine sexual topics from the children’s and mother’s standpoint according to the children’s awareness of their mother’s HIV status or lack thereof. A subsample of 11 MLWH also took part in a semistructured interview. Interviews were analyzed using thematic content analysis. Sexually transmitted infections (STIs), puberty and dating were the three most frequently discussed subjects between MLWH and their children. Children’s awareness of their mother’s HIV status was significantly associated (p < .05) with mother–child communication about all nine subjects from the standpoint of MLWH. Children’s awareness of their mother’s HIV status was significantly associated (p < .05) with mother–child communication about contraception, condom use and STIs from the children’s standpoint. Qualitative analyses indicated that while talk about sexuality was common, MLWH raised several barriers to sexual education, including a lack of knowledge about sexuality. The results highlight the importance of targeting parental attitudes and knowledge about sexuality. Interventions should consider the mother’s willingness to disclose their HIV status and be oriented with respect to their choice.