People In Rural South Africa Research Articles

Uptake of multi-level HIV interventions and HIV-related behaviours among young people in rural South Africa.

Combination HIV prevention packages have reduced HIV incidence and improved HIV-related outcomes among young people. However, there is limited data on how package components interact to promote HIV-related prevention behaviours. We described the uptake of HIV prevention interventions supported by Determined, Resilient, Empowered, AIDS-free, Motivated and Safe (DREAMS) Partnership and assessed the association between uptake and HIV-related behaviours among young people in rural KwaZulu-Natal, South Africa. We analysed two cohorts followed from May 2017 to December 2019 to evaluate the impact of DREAMS, covering 13-29 year-old females, and 13-35 year-old males. DREAMS interventions were categorised as healthcare-based or social. We described the uptake of interventions and ran logistic regression models to investigate the association between intervention uptake and subsequent protective HIV-related outcomes including no condomless sex and voluntary medical male circumcision (VMMC). For each outcome, we adjusted for socio-demographics and sexual/pregnancy history and reported adjusted odds ratios (aOR) and 95% confidence intervals (CI). Among 5248 participants, uptake of healthcare interventions increased from 2018 to 2019 by 8.1% and 3.7% for males and females respectively; about half of participants reported receiving both healthcare and social interventions each year. The most utilised combinations of interventions included HIV testing and counselling, school-based HIV education and cash transfers. Participation in social interventions only compared to no intervention was associated with reduced condomless sex (aOR = 1.60, 95%CI: 1.03-2.47), while participation in healthcare interventions only was associated with increased condomless sex. The uptake of interventions did not significantly affect subsequent VMMC overall. Among adolescent boys, exposure to school-based HIV education, cash transfers and HIV testing and counselling was associated with increase in VMMC (aOR = 1.79, 95%CI: 1.04-3.07). Multi-level HIV prevention interventions were associated with an increase in protective HIV-related behaviours emphasizing the importance of accessible programs within both school and community settings for young people.

Digital Mental Health Interventions for Young People in Rural South Africa: Prospects and Challenges for Implementation.

Globally, most young people living with mental health conditions lack access to mental health care but have access to a mobile device. The growing access to mobile devices in South Africa has the potential to increase access to mental health care services through digital platforms. However, uptake of digital mental health interventions may be hampered by several factors, such as privacy, confidentiality, informed consent, and affordability. This study identified the prospects and challenges of implementing a mobile phone-based mental health intervention for young people in Ingwavuma area. Data were collected from 93 young people in three villages purposefully selected in Ingwavuma area. Participants included in the study were aged 16-24. Data were collected through a questionnaire. Thematic and descriptive analysis was performed on the qualitative and quantitative data, respectively. Mental health education was low, with only 22% of participants having received prior education on mental health. About 50% of the participants had come across a mental health app, but none of them had used any of these apps; 87% of participants had Internet access; 60% preferred to use social media to contact a health worker; and 92% suggested that use of digital apps would improve mental health literacy among young people. Barriers to access of digital mental health interventions were identified as the high cost of data, restrictive religious beliefs, limited privacy, lack of native languages on most digital platforms, low digital literacy, and complicated user interface. In uMkhanyakude, uptake of digital mental health apps among the young people was low. We recommend that, developers create context-specific digital applications catered for young people from different cultural backgrounds. Socio-economic issues such as affordability also need to be addressed in developing these tools.

COVID-19, Rural Livelihoods and Human Rights: A South African Perspective

This article describes how the COVID-19 pandemic has exposed and worsened the existing social and economic conditions of rural people in South Africa, how their livelihoods have been affected and how their rights have been violated as a result. The rights considered and discussed include those contained in the South African Bill of Rights with a particular focus on socio-economic rights which, by their very nature, have important social and economic dimensions. The implications of these social and economic dimensions on rural people under the COVID-19 pandemic are discussed. The article partly adopts a qualitative research methodology in which information gathered through interviews, webinar discussions, and workshops with various stakeholders and participants are presented and analysed. The paper also discusses the balance between the need to prevent the spread of the COVID-19 pandemic through lockdown measures, the impact of these measures on rural livelihoods, and the constitutional requirement to protect human rights. The paper concludes with recommendations, including adopting a human rights-based approach to minimize the impact of COVID-19 on rural livelihoods.

Effect of Moist Cooking Blanching on Colour, Phenolic Metabolites and Glucosinolate Content in Chinese Cabbage (Brassica rapa L. subsp. chinensis).

Non-heading Chinese cabbage (Brassica rapa L. subsp. chinensis) is a widely consumed leafy vegetable by the rural people in South Africa. Traditional blanching methods (5%, 10% or 20% lemon juice solutions in steam, microwave treatments and hot water bath at 95 °C) on the changes of colour properties, phenolic metabolites, glucosinolates and antioxidant properties were investigated in this study. Blanching at 95 °C in 5% lemon juice solution maintained the chlorophyll content, reduced the difference in colour change ∆E, and increased the total phenolic content and the antioxidant activities (ferric reducing-antioxidant power assay (FRAP) and Trolox equivalent antioxidant capacity (TEAC) assay). The highest concentration of kaempferol-dihexoside, kaempferol-sophoroside, kaempferol hexoside, and ferulic acid was noted in samples blanched in 5% lemon juice, at 95 °C. However, concentrations of kaempferol O-sophoroside-O-hexoside was highest in raw leaf samples. Supervised Orthogonal Projections to Latent Structures Discriminant Analysis (OPLS-DA) and the UPLC-MS and chemometric approach showed the acid protocatechuoyl hexose unique marker identified responsible for the separation of the blanching treatments (5% lemon juice at 95° C) and raw leaves. However, other unidentified markers are also responsible for the separation of the two groups (the raw leaves and the hot water moist blanched samples) and these need to be identified. Blanching at 95 °C in 10% lemon solution significantly increased the glucosinolate sinigrin content. Overall blanching at 95 °C in 5% lemon juice solution can be recommended to preserve the functional compounds in Nightshade leaves.

Pensions and Low Sodium Salt: A Qualitative Evaluation of a New Strategy for Managing Hypertension in Rural South Africa.

This paper describes a pilot study to assess the feasibility of a novel intervention to improve the management of hypertension among older people in rural South Africa. Older South Africans have the highest rates of uncontrolled hypertension recorded for any country. Notably, South Africa has a widely-available old age grant (pension), which is delivered on a monthly basis to citizens living in rural villages. We assessed the feasibility of engaging with older people at the point of pension delivery in the Agincourt sub-district of Mpumalanga Province. This included providing information about hypertension, measuring blood pressure, referral to primary care services, and providing a monthly supply of low sodium salt. We recruited 20 people aged 60 and over to participate in the pilot intervention, which was conducted over three months in two villages. Towards the end of the intervention, we conducted focus groups with study participants and held a meeting with local stakeholders, including the district health office and the state social security agency. The pilot study demonstrated (i) Sustained engagement with the original 20 participants. Of these, 19 continued to participate in the intervention during subsequent monthly pension days. (ii) A high level of acceptance of the low sodium salt product reflected in repeat usage and comments made in the focus groups. (iii) Strong support for the intervention and a willingness to collaborate with local stakeholders. (iv) A perception among participants that symptoms they associated with hypertension had abated. This is supported by blood pressure readings made over the three months of follow-up. Though limited in scope, this pilot study provided evidence of the feasibility of the intervention and justification for it to be tested on a larger and more robust basis.

Chronic disease profile, health utilization and self-reported financial situation of older people in rural South Africa

Background: Chronic diseases are more prevalent among older people. These illnesses require seeking continuous medical services which oftentimes have spill-over effects on the financial situation of individuals and households. Objective: To describe the chronic disease profile, health utilization and self-reported financial situation of older people in a rural population. Methods: Cross-sectional data from South Africa Wellbeing and Older People Study (WOPS)-wave 2 was utilized for this study. The survey included 519 respondents and was carried out between April 2013 and August 2013. Descriptive statistics was used to report respondents’ socio-economic characteristics, chronic disease profile, health utilization patterns, hospitalizations and access to medical and non-medical financial aid. Chi square test was conducted to examine the factors associated with chronic diseases and self-reported financial situation at 5% level of confidence. Results: The mean age of respondents was 62 years. Of the respondents, 259 (50%) had hypertension and 122 (24%) had arthritis, twenty-two (4%) had stroke, 43 (8%) had diabetes, 25 (5%) hade asthma, 10 (2%) had heart disease and 6 (1%) had cancer. Following the experience of a health problem, 119 (46.67%) adopted self-medication and 36 (14.12%) consulted traditional healer. Four hundred and fifty-four (97.63%) respondents received no financial aid for buying drugs and paid out-of-pocket. Also, 452 (97.41%) had no access to financial aid to pay for hospital bills. Risk factors like tobacco use (χ2 =6.77, p=0.009) and alcohol consumption (χ2 = 8.90, p= 0.003) were also associated with hypertension. Also, being hospitalized in the last 1 year (χ2 = 8.15, p=0.017) was associated with whether households’ financial condition got better, remained the same or got worse. Having chronic disease (χ2 = 7.68, p= 0.022) was similarly significantly associated with self-reported financial situation. Conclusions: The burden of chronic disease was high among older persons in this study. The study provided evidence that suggests that unearned income such as government grants and transfers as well financial supports from individuals’ families and acquaintances can provide some form of insurance against worsening financial condition among older people.

Analysis of rural people’s attitude towards the management of tribal forests in South Africa

ABSTRACTThe management of forests for multiple purposes coupled with a varying socioeconomic profile of forest users can result in attitudinal differences towards forest management. This study examines the attitudes of rural people in South Africa towards the management of tribal forests. Attitude towards forest management was analysed with respect to five forest management objectives: 1, forest management for rural livelihood resilience to climate change; 2, forest management for reduction and management of forest fire risk; 3, forest management for sustainable forest-based livelihood; 4, forest management for household socioeconomic wellbeing; and 5, forest management for community-based climate change adaptation initiative. A household questionnaire survey was used to elicit information from 155 rural households using the proportionate random sampling procedure. Chi-square test was used to analyse data from the household survey. Factorial analysis was used to analyse variance in attitude towards forest management. The results showed that rural people generally have positive attitudes toward the management of tribal forests. Factor analysis isolated 2 major factors that explained 61% variance in attitude. Based on the findings we conclude that centralising forest management around the four management objectives (1, 3, 4 & 5) are likely to promote inclusive forest-based development in the study communities.

The Future of Our Histories: Young Rural Voices from Dullstroom-Emnotweni

This article reports on three sets of interviews conducted with children and young people living in Dullstroom-Emnotweni on the Mpumalanga Highveld in eastern South Africa. Firstly, 50 learners between the ages of 10 and 14 were interviewed on their dreams for the future. Later that year, in 2011, a total of 60 young people who were still unemployed ten or more years after having finished school were interviewed on what was left of their dreams. Five years later, in 2016, a third group of young people between the ages of 18 and 24 were interviewed in order to establish whether the situation of marginalised young people in rural South Africa had changed. The primary school learners expressed their career hopes in terms of the needs of their marginalised society, that is, to become nurses, teachers and social workers. The first group of young people interviewed in 2011 blamed their shattered dreams on the unavailability of tertiary education and the reality of HIV infection. The second group, interviewed in 2016, quite similarly, expressed their concerns as a lack of job and educational opportunities, a lack of agency and choice, a lack of respect from society and decision makers, and an inability to escape from drugs and unhealthy sex.

Socio-economic development through the exploitation of natural resources in rural South Africa

South Africa has many developmental challenges but three have been identified as affecting each other. The three challenges are unemployment, poverty and inequality. The Second Quarter Report by Statistics South Africa (STATSSA) confirms that poverty, unemployment and inequality are highest in rural areas and most especially among people with no or little education. Meanwhile, many people in rural South Africa have access to land which can be used to produce food for the ever increasing population in both the rural and urban areas, as well as for export and other value adding agribusinesses. The task of addressing the challenges of poor communities calls for a multi-stakeholder approach which can include the private sector, NGOs, communities, traditional leaders and the state coming together to pursue economic transformation in rural South Africa by tapping into the natural resources nature has provided for the communities. This article reports on how some stakeholders have come together to transform a rural community in South Africa. The paper uses qualitative data from personal and focus group interviews and observations as the main data collection instruments. The findings indicate that the stakeholders have been able to empower a community by tapping into and effectively using the natural resources in an area to transform it through collaborations and partnerships. The model is recommended to the government and development practitioners for adoption on how the natural resources that exist within communities can be exploited and effectively managed to transform rural economies to ensure inclusive growth and development.

Perspectives on intimate relationships among young people in rural South Africa: the logic of risk

This paper explores how young people in rural South Africa understand gender, dating, sexuality and risk-taking in adolescence. The empirical material drawn upon consists of 20 interviews with young men and women (aged 18–19) and reflects normative gender patterns characterised by compulsory heterosexuality and dating as obligatory, and representing key symbols of normality. However, different meanings of heterosexual relationships are articulated in the interviews, for example in the recurring concept of ‘passing time’, and these meanings show that a relationship can be something arbitrary: a way to reduce boredom and have casual sex. Such a rationale for engaging in a relationship reflects one of several other normative gender patterns, which relate to the trivialisation of dating and sexual risk-taking, and which entail making compromises and legitimising deviations from the ‘ideal’ life-script and the hope of a better future. However, risks do not exclusively represent something bad, dangerous or immoral, because they are also used as excuses to avoid sex, HIV acquisition and early pregnancy. In conclusion, various interrelated issues can both undermine and/or reinforce risk awareness and subsequent risk behaviour. Recognition of this tension is essential when framing policies to support young people to reduce sexual risk-taking behaviour.

Social Conditions and Disability Related to the Mortality of Older People in Rural South Africa.

South Africa is experiencing a health and social transition including an ageing population and an HIV epidemic. We report mortality experience of an older rural South African population. Individual survey data and longer-term demographic data were used to describe factors associated with mortality. Individuals aged 50 years and over (n = 4085) answered a health and quality of life questionnaire in 2006 and were followed for 3 years thereafter. Additional vital events and socio-demographic data were extracted from the Agincourt Health and Demographic Surveillance System from 1993 to 2010, to provide longer-term trends in mortality. Cox regression analysis was used to determine factors related to survival. In 10 967 person-years of follow-up between August 2006 and August 2009, 377 deaths occurred. Women had lower mortality {hazard ratio [HR] 0.35 [95% confidence interval (CI) 0.28-0.45]}. Higher mortality was associated with being single [HR 1.48 (95% CI 1.16-1.88)], having lower household assets score [HR 1.79 (95% CI 1.28-2.51)], reporting greater disability [HR 2.40 (95% CI 1.68-3.42)] and poorer quality of life [HR 1.59 (95% CI 1.09-2.31)]. There was higher mortality in those aged under 69 as compared with those 70 to 79 years old. Census data and cause specific regression models confirmed that this was due to deaths from HIV/TB in the younger age group. Mortality due to HIV/TB is increasing in men, and to some extent women, aged over 50. Policy makers and practitioners should consider the needs of this growing and often overlooked group.

Social conditions and disability related to the mortality of older people in rural South Africa.

Background: South Africa is experiencing a health and social transition including an ageing population and an HIV epidemic. We report mortality experience of an older rural South African population.Methods: Individual survey data and longer-term demographic data were used to describe factors associated with mortality. Individuals aged 50 years and over (n = 4085) answered a health and quality of life questionnaire in 2006 and were followed for 3 years thereafter. Additional vital events and socio-demographic data were extracted from the Agincourt Health and Demographic Surveillance System from 1993 to 2010, to provide longer-term trends in mortality. Cox regression analysis was used to determine factors related to survival.Results: In 10 967 person-years of follow-up between August 2006 and August 2009, 377 deaths occurred. Women had lower mortality {hazard ratio [HR] 0.35 [95% confidence interval (CI) 0.28–0.45]}. Higher mortality was associated with being single [HR 1.48 (95% CI 1.16–1.88)], having lower household assets score [HR 1.79 (95% CI 1.28–2.51)], reporting greater disability [HR 2.40 (95% CI 1.68–3.42)] and poorer quality of life [HR 1.59 (95% CI 1.09–2.31)]. There was higher mortality in those aged under 69 as compared with those 70 to 79 years old. Census data and cause specific regression models confirmed that this was due to deaths from HIV/TB in the younger age group.Conclusions: Mortality due to HIV/TB is increasing in men, and to some extent women, aged over 50. Policy makers and practitioners should consider the needs of this growing and often overlooked group.

Prevalence and correlates of depression among HIV-infected and -affected older people in rural South Africa

BackgroundLittle is known about depression in older people in sub-Saharan Africa, the associated impact of HIV, and the influence on health perceptions. ObjectivesExamine the prevalence and correlates of depression; explore the relationship between depression and health perceptions in HIV-infected and -affected older people. MethodsIn 2010, 422 HIV-infected and -affected participants aged 50+ were recruited into a cross-sectional study. Nurse professionals interviewed participants and a diagnosis of depressive episode was derived from the Composite International Diagnostic Interview (Depression module) using the International Classification of Diseases diagnostic criteria and categorised as major (MDE) or brief (BDE). ResultsOverall, 42.4% (n=179) had a depressive episode (MDE: 22.7%, n=96; BDE: 19.7%, n=83). Prevalence of MDE was significantly higher in HIV-affected (30.1%, 95% CI 24.0–36.2%) than HIV-infected (14.8%, 95% CI 9.9–19.7%) participants; BDE was higher in HIV-infected (24.6%, 95% CI 18.7–30.6%) than in HIV-affected (15.1%, 95% CI 10.3–19.8%) participants. Being female (aOR 3.04, 95% CI 1.73–5.36), receiving a government grant (aOR 0.34, 95% CI 0.15–0.75), urban residency (aOR 1.86, 95% CI 1.16–2.96) and adult care-giving (aOR 2.37, 95% CI 1.37–4.12) were significantly associated with any depressive episode. Participants with a depressive episode were 2–3 times more likely to report poor health perceptions. LimitationsStudy limitations include the cross-sectional design, limited sample size and possible selection biases. ConclusionsPrevalence of depressive episodes was high. Major depressive episodes were higher in HIV-affected than HIV-infected participants. Psycho-social support similar to that of HIV treatment programmes around HIV-affected older people may be useful in reducing their vulnerability to depression.

An investigation of factors associated with the health and well-being of HIV-infected or HIV-affected older people in rural South Africa

BackgroundDespite the severe impact of HIV in sub-Saharan Africa, the health of older people aged 50+ is often overlooked owing to the dearth of data on the direct and indirect effects of HIV on older people’s health status and well-being. The aim of this study was to examine correlates of health and well-being of HIV-infected older people relative to HIV-affected people in rural South Africa, defined as participants with an HIV-infected or death of an adult child due to HIV-related cause.MethodsData were collected within the Africa Centre surveillance area using instruments adapted from the World Health Organization (WHO) Study on global AGEing and adult health (SAGE). A stratified random sample of 422 people aged 50+ participated. We compared the health correlates of HIV-infected to HIV-affected participants using ordered logistic regressions. Health status was measured using three instruments: disability index, quality of life and composite health score.ResultsMedian age of the sample was 60 years (range 50–94). Women HIV-infected (aOR 0.15, 95% confidence interval (CI) 0.08–0.29) and HIV-affected (aOR 0.20, 95% CI 0.08–0.50), were significantly less likely than men to be in good functional ability. Women’s adjusted odds of being in good overall health state were similarly lower than men’s; while income and household wealth status were stronger correlates of quality of life. HIV-infected participants reported better functional ability, quality of life and overall health state than HIV-affected participants.Discussion and conclusionsThe enhanced healthcare received as part of anti-retroviral treatment as well as the considerable resources devoted to HIV care appear to benefit the overall well-being of HIV-infected older people; whereas similar resources have not been devoted to the general health needs of HIV uninfected older people. Given increasing numbers of older people, policy and programme interventions are urgently needed to holistically meet the health and well-being needs of older people beyond the HIV-related care system.

Towards understanding the contextual role of traditional leadership in the establishment of cyber communities amongst rural people in South Africa: The case of Dr J.S. Moroka Municipality

ICT policies instituted over a number of years by the South African government have failed manifestly in establishing cyber communities amongst rural people in South Africa. The authors of this article argue that for rural South African communities to reap the benefits of ‘cyber citizenship’ and Information and Communication Technologies for Development (ICT4D) initiatives, it will be necessary for communities to enable themselves and to take ownership of initiatives to participate in the anticipated South African information society. The authors argue that the success of ICT4D initiatives depends very strongly on an understanding of the interaction of such initiatives with the social context at the local community level. One of the significant aspects of the social context at community level is the role of traditional leaders in these communities. This article examines the role of traditional leadership, with specific reference to the literature on traditional leadership in South Africa and the literature on the role of traditional leadership in ICT4D initiatives, as well as empirical findings from a case study that serves as an example of a ‘typical’ rural community in Mpumalanga, South Africa.

The effect of the HIV epidemic and other factors on mortality in older people in rural South Africa

BackgroundPopulations in subSaharan Africa are ageing, despite the devastating effect of the Human immunodeficiency virus (HIV) epidemic in many countries. In South Africa the ageing population and the consequent increase...

Assessing health and well-being among older people in rural South Africa

Background: The population in developing countries is ageing, which is likely to increase the burden of non-communicable diseases and disability.Objective: To describe factors associated with self-reported health, disability and quality of life (QoL) of older people in the rural northeast of South Africa.Design: Cross-sectional survey of 6,206 individuals aged 50 and over. We used multivariate analysis to examine relationships between demographic variables and measures of self-reported health (Health Status), functional ability (WHODASi) and quality of life (WHOQoL).Results: About 4,085 of 6,206 people eligible (65.8%) completed the interview. Women (Odds Ratio (OR)=1.30, 95% CI 1.09, 1.55), older age (OR=2.59, 95% CI 1.97, 3.40), lower education (OR=1.62, 95% CI 1.31, 2.00), single status (OR=1.18, 95% CI 1.01, 1.37) and not working at present (OR=1.29, 95% CI 1.06, 1.59) were associated with a low health status. Women were also more likely to report a higher level of disability (OR=1.38, 95% CI 1.14, 1.66), as were older people (OR=2.92, 95% CI 2.25, 3.78), those with no education (OR=1.57, 95% CI 1.26, 1.97), with single status (OR=1.25, 95% CI 1.06, 1.46) and not working at present (OR=1.33, 95% CI 1.06, 1.66). Older age (OR=1.35, 95% CI 1.06, 1.74), no education (OR=1.39, 95% CI 1.11, 1.73), single status (OR=1.28, 95% CI 1.10, 1.49), a low household asset score (OR=1.52, 95% CI 1.19, 1.94) and not working at present (OR=1.32; 95% CI 1.07, 1.64) were all associated with lower quality of life.Conclusions: This study presents the first population-based data from South Africa on health status, functional ability and quality of life among older people. Health and social services will need to be restructured to provide effective care for older people living in rural South Africa with impaired functionality and other health problems.Access the supplementary material to this article: INDEPTH WHO-SAGE questionnaire (including variants of vignettes), a data dictionary and a password-protected dataset (see Supplementary files under Reading Tools online). To obtain a password for the dataset, please send a request with ‘SAGE data’ as its subject, detailing how you propose to use the data, to global.health@epiph.umu.se

Characteristics of sexual partnerships, not just of individuals, are associated with condom use and recent HIV infection in rural South Africa

Characteristics of sexual partnerships, as well as those of the individuals involved, might influence the use of condoms and risk of HIV transmission. We set out to identify characteristics of non-spousal sexual partnerships associated with condom use at last sex in the previous year and HIV infection in the previous three years among sexually active young people in rural South Africa. We conducted an analysis of follow-up data (collected in 2004) from a cohort of 14–35-year old men and women recruited to a cluster-randomised trial. Data on 1647 non-spousal sexual partnerships during the previous year were reported in 2004 and analysed alongside new HIV infections over the previous three years among 762 individuals who were HIV-negative in 2001. Structured interviews elicited information on sexual behaviour. HIV serostatus was assessed through oral-fluid ELISA. Condom use at last sex was reported for 615/1647 non-spousal sexual partnerships (37.3%) and was more commonly reported by individuals who were younger, more educated and aware of their HIV status. Condom use was more common in casual partnerships, those where the male partner was younger, where sex was less frequent and where the respondent believed the partner to have other sexual contacts. New HIV infection in the last three years was identified for 87/762 individuals (11.4%) and was more common among females and those out of school. Infection risk was associated with the age of the partners and was less common among individuals reporting less frequent intercourse in the previous year. Characteristics of sexual partnerships, as well as those of individuals, are important determinants of condom use and risk of HIV infection. Male characteristics may be particularly important because of their greater capacity to make decisions about HIV prevention. Established non-spousal sexual partnerships are an increasingly important context for HIV transmission in this setting.

“They Have Opened Our Mouths”: Increasing Women's Skills and Motivation for Sexual Communication With Young People in Rural South Africa

Communication between parents and young people about sex has been identified as a positive influence on young people's sexual behavior. This article presents findings from South Africa, where a social intervention to reduce levels of HIV and intimate partner violence actively promoted sexual communication between adults and young people. We assessed this component of the program using quantitative and qualitative methods, collecting data through surveys, direct observation, interviews, and focus group discussions. Women participating in intervention activities reported sexual communication with children significantly more often than matched women in the control group (80.3% vs. 49.4%, adjusted risk ratio 1.59 (1.31-1.93). The content of communication with young people also appears to have shifted from vague admonitions about the dangers of sex to concrete messages about reducing risks. The congruence between these findings and existing literature on parent-child sexual communication suggests that conceptual frameworks and programs from developed settings can be adapted effectively for resource-poor contexts.

The association between school attendance, HIV infection and sexual behaviour among young people in rural South Africa

Objectives:To investigate whether the prevalence of HIV infection among young people, and sexual behaviours associated with increased HIV risk, are differentially distributed between students and those not attending school or...