Makkan Heeran, Wangui Machira Yvonne, Mthembu Funeka, Masibi Omphile, Molefe Thuso, Maenetje Pholo, Muturi-Kioi Vincent, Price Matt A, Edward Vinodh Aroon, Chetty-Makkan Candice
The Aurum Institute, Rustenburg Research Centre, Rustenburg, South Africa.
Department of Interdisciplinary Social Science, Public Health, Utrecht University, Utrecht, The Netherlands.
PLOS Glob Public Health. 2024 Dec 9;4(12):e0003569. doi: 10.1371/journal.pgph.0003569. eCollection 2024.
South African adolescents are at-risk for HIV infection due to engaging in high-risk sexual behaviours. 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, this knowledge did not translate into healthy sexual decision-making. Lack of effective communication and support between caregivers and adolescents in discussing sexual behaviours are a contributing barrier. Although adolescents expressed a strong need to be understood and supported by caregivers regarding sexual behaviours, there was perceived distrust, judgemental attitude from caregivers, poor role models of a father figure, and the traditional taboo nature of having these discussions with caregivers. While female adolescents and female caregivers discussed sexual 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. 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 sexual matters could create enabling environments for adolescents to make informed, healthy decisions regarding their sexual behaviours. Further, future interventions could consider gain-framed messaging to address adolescents translating knowledge of sexual behaviours to making healthy sexual choices. Improving equitable male caregiver role at home, is of particular importance in supporting adolescent sexual decision-making, and should be prioritized.
由于从事高风险性行为，南非青少年面临感染艾滋病毒的风险。了解影响性决策的因素对于制定有效的艾滋病毒预防策略至关重要。我们在南非勒斯滕堡对青少年及其照顾者进行了一项定性研究，以探讨影响青少年性决策的个人和人际因素。2018年4月至7月期间，用英语和塞茨瓦纳语对17名青少年（13名女性和4名男性）和19名照顾者（17名女性和2名男性）进行了焦点小组讨论。主题分析表明，虽然青少年可以从各种来源获得性教育，但这些知识并没有转化为健康的性决策。照顾者和青少年在讨论性行为时缺乏有效的沟通和支持是一个促成障碍。尽管青少年表示非常需要在性行为方面得到照顾者的理解和支持，但他们感觉到照顾者存在不信任、评判态度，缺乏父亲形象的良好榜样，以及与照顾者进行此类讨论具有传统禁忌性质。虽然女性青少年和女性照顾者讨论了性问题，但这种沟通在青少年男性中很有限。男性青少年与任何一方照顾者沟通都感到不舒服，担心照顾者的评判态度和被误解。女性照顾者认为男性照顾者角色缺失且不参与。照顾者希望支持他们的孩子，但他们似乎怀疑自己的能力。关于青少年和照顾者如何就性问题进行沟通的工具和指导可以为青少年创造有利环境，使其就性行为做出明智、健康的决定。此外，未来的干预措施可以考虑采用收益框架信息，以促使青少年将性行为知识转化为做出健康的性选择。改善男性照顾者在家庭中的平等角色对于支持青少年性决策尤为重要，应作为优先事项。
