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

This abstract was presented at the 2018 Society for Prevention Research Annual Meeting which was held May 29 – June 1, 2018 in Washington, DC, US.

Kim H. Dam The Johns Hopkins University

Michelle R. Kaufman The Johns Hopkins University; Eshan U. Patel The Johns Hopkins University; Lynn M. Van Lith The Johns Hopkins University; Karin Hatzold Population Services International; Arik V. Marcell The Johns Hopkins University; Webster Mavhu Centre for Sexual Health & HIV/AIDS Research; Catherine Kahabuka CSK Research Solutions Ltd.; Lusanda Mahlasela Centre for Communication Impact; Emmanuel Njeuhmeli United States Agency for International Development Washington/Global Health Bureau/Office of HIV/AIDS; Kim Seifert Ahanda United States Agency for International Development Washington/Global Health Bureau/Office of HIV/AIDS; Getrude Ncube Zimbabwe Ministry of Health and Child Care; Gissenge Lija Tanzania Ministry of Health, Community, Development, Gender, Elderly; Collen Bonnecwe South Africa National Department of Health; Aaron A. R. TobianThe Johns Hopkins University

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.