Thesis (PhD)--Stellenbosch University, 2015 / ENGLISH ABSTRACT : In 2010, young people aged 15–24 years accounted for 42% of new HIV infections globally. In 2009,
about five million (10%) of the total South African population was estimated to be aged 15–19 years.
Current South African national sero-prevalence data estimate the prevalence of HIV to be 5.6% and
0.7% among adolescent girls and boys aged 15–19 years, respectively. HIV infections are mainly
transmitted via sexual transmission. Adolescent sexuality is multi-faceted and influenced at multiple
levels. In preparing to enroll adolescents in future biomedical HIV prevention trials, particularly
prophylactic HIV vaccine trials, it is critical to provide counseling services appropriate to their needs.
At the time of writing, there was no developed psychosocial intervention in South Africa for use among
adolescent vaccine trial participants.
Thus, the aim of the present study is to adapt and pilot-test a psychosocial intervention, namely,
the Centers for Disease Control and Prevention (CDC) risk reduction counseling intervention of Project
Respect, an intervention tasked at being developmentally and contextually appropriate among potential
adolescent participants in HIV biomedical trials in the future. To achieve this overall aim, I
qualitatively explored adolescent sexuality and risk factors for HIV among a diverse sample of
participants aged 16–18 from Soweto. Thereafter, I developed a composite HIV risk scale in order to
measure the variance in HIV risk among the sample of adolescents studied.
The study followed a two-phased, mixed method research design and was informed by
ecological systems theory and integrative model of behavioral prediction. The aim of Phase 1, split into
phases 1a and b, was to conduct focus group discussions (FGDs) and to undertake a cross-sectional
survey, respectively, to determine psychological (for example, self-esteem and depression), behavioral
(specifically, sexual behavior) and social (specifically, social support, parent-adolescent
communication) contexts that placed adolescents at risk for HIV infection. Phase 1a was qualitative, with data collected via nine FGDs: three involved parents of adolescents, four involved adolescents
aged 16–18 years and two counselors. Nine key themes related to adolescent sexuality and risks for
HIV acquisition were identified, namely: (1) dating during adolescence; (2) adolescent girls dating
older men; (3) condom use amongst adolescents; (4) teenage pregnancies; (5) views about
homosexuality; (6) parent-adolescent communication about sexual health; (7) the role of the media; (8)
discipline and perceived government influence; and (9) group sex events. Phase 1b was quantitative
and the data were collected via a cross-sectional survey to investigate the variance of risk for HIV. For
Phase 1b, the sample consisted of 506 adolescents with a mean age of 17 years (interquartile range
[IQR]: 16–18). More than half the participants were female (59%, n = 298). I used a three-step
hierarchical multiple regression model to investigate the variance in risk for HIV. In step 3, the only
significant predictors were “ever threatened to have sex” and “ever forced to have sex”, the
combination of which explained 14% (R2 = 0.14; F (12, 236) = 3.14, p = 0.00). Depression and parentadolescent
communication were added to steps 2 and 3, respectively, with both variables insignificant
in these models.
In Phase 2, I adapted and pilot tested the CDC risk reduction counseling intervention. The
intervention was intended to be developmentally and contextually appropriate among adolescents from
Soweto aged 16–18 years, viewed as potential participants in future HIV biomedical trials. Participants
in Phase 2 were aged 16–18 years; the sample was mainly female (52%, n = 11) and most (91%, n =
19) were secondary school learners in grades 8 to 12. Participants provided feedback about their
experiences of the adapted counseling intervention through in-depth interviews. I identified three main
themes in this regard, namely: benefits of HIV testing services, reasons for seeking counseling and HIV
testing services, and participants’ evaluation of the study visits and counseling sessions. The adapted
CDC risk reduction counseling intervention was found to be acceptable with favorable outcomes for
those adolescents who participated in the piloting phase.
This study adds to the literature on risks for HIV among adolescents in Soweto, South Africa,
by considering multiple levels of influence. Reaching a more complete understanding of ecological
factors contributing to sexual risk behaviors among adolescents in the pilot-study enabled the
development of a tailored counseling intervention. The findings showed the adapted CDC risk
reduction counseling intervention to be feasible and acceptable among adolescents likely to be
participants and eligible to participate in future HIV biomedical prevention trials. Thus, this study
provides a much needed risk reduction counseling intervention that can be used among adolescents, an
age group likely to participate in future HIV vaccine prevention research. / AFRIKAANSE OPSOMMING : In 2010 het jongmense tussen die ouderdomme van 15 en 24 jaar 42% van nuwe MIV-infeksies
wêreldwyd uitgemaak. In 2009 was omtrent 5 miljoen mense (10%) van die Suid-Afrikaanse bevolking
tussen 15 en 19 jaar oud. Volgens data oor die huidige Suid-Afrikaanse nasionale sero-voorkoms, word
die voorkoms van MIV onderskeidelik op 5.6% en 0.7% onder tienermeisies en -seuns tussen die
ouderdomme van 15 tot 19 jaar beraam. MIV-infeksies word hoofsaaklik deur seks oorgedra.
Adolessente seksualiteit het baie fasette en word op verskeie vlakke beïnvloed. Ter voorbereiding van
die werwing van adolessente vir toekomstige biomediese proewe, veral proewe oor profilaktiese MIVentstowwe,
is dit van kritiese belang dat beradingsdienste verskaf word wat geskik is vir hul behoeftes.
Op die tydstip wat hierdie tesis geskryf is, het daar nog geen psigososiale intervensie in Suid-Afrika
bestaan vir gebruik onder adolessente deelnemers aan entstofproewe nie.
Daarom is die doel van hierdie studie om ʼn psigososiale intervensie ‒ die Centers for Disease
Control and Prevention (CDC) se Projek Respek, ʼn beradingsintervensie vir die vermindering van
risiko ‒ aan te pas en met ʼn loodsprojek te toets. Hierdie intervensie is geskik vir die ontwikkelings- en
kontekstuele vlak van adolessente deelnemers aan toekomstige MIV- biomediese proewe. Ten einde
hierdie oorkoepelende doelwit te bereik, het ek adolessente seksualiteit en die risikofaktore vir MIV
onder ʼn diverse steekproef deelnemers tussen die ouderdomme van 16 en 18 jaar van Soweto
kwalitatief ondersoek. Daarna het ek ʼn saamgestelde MIV-risikoskaal ontwikkel om die variansie van
MIV-risiko onder die groep adolessente te meet.
Die studie se navorsingsontwerp het uit twee fases en gemengde metodes bestaan, en is
gebaseer op ekologiesestelsel-teorie en die integrerende gedragsvoorspellingsmodel. Die doel van fase
1, wat in fases 1a en 1b verdeel is, was om onderskeidelik fokusgroepbesprekings te hou en om ʼn
deursnitopname te doen om die sielkundige kontekste (byvoorbeeld elemente van selfbeeld en depressie), gedragskontekste (spesifiek seksuele gedrag) en sosiale kontekste (spesifiek sosiale
ondersteuning en ouer-adolessent-kommunikasie) te bepaal waarin adolessente die risiko loop om
MIV-infeksie op te doen. Fase 1a was kwalitatief en data is deur middel van nege
fokusgroepbesprekings ingesamel: drie met die ouers van adolessente, vier met adolessente tussen 16
en 18 jaar oud en twee met beraders. Nege sleuteltemas is geïdentifiseer wat verband hou met
adolessente seksualiteit en risiko’s om MIV op te doen: (1) verhoudings tydens adolessensie, (2)
tienermeisies wat verhoudings met ouer mans het, (3) die gebruik van kondome onder adolessente, (4)
tienerswangerskappe, (5) sienings oor homoseksualiteit, (6) ouer-adolessent-kommunikasie oor
seksuele gesondheid, (7) die rol van die media, (8) dissipline en die ervaarde regeringsinvloed en
(9) groepseksgeleenthede. Fase 1b was kwantitatief en data is deur middel van ’n deursnitopname
ingesamel om die variansie van risiko vir MIV te ondersoek. Vir Fase 1b het die steekproef bestaan uit
506 adolessente met ’n gemiddelde ouderdom van 17 jaar (interkwartielwydte [IKW]: 16–18). Meer as
die helfte van die deelnemers was vroulik (59%, n = 298). Ek het ’n hiërargiese meervoudige
regressiemodel met drie stappe gebruik om die variansie van risiko vir MIV te ondersoek. Die enigste
beduidende voorspellers in stap 3 was “ooit gedreig om seks te hê” en “ooit geforseer om seks te hê”.
Die kombinasie hiervan het 14% (R2 = 0.14; F (12, 236) = 3.14, p = 0.00) verklaar. Depressie en oueradolessent-
kommunikasie is onderskeidelik in stappe 2 en 3 bygevoeg, en albei veranderlikes was
onbeduidend in hierdie modelle.
In Fase 2 het ek die CDC se intervensie vir die verlaging van risiko aangepas en met ’n
loodsprojek getoets. Die intervensie was bedoel om geskik te wees vir die ontwikkelings- en
kontekstuele vlakke van 16- tot 18-jarige adolessente van Soweto wat beskou is as potensiële
deelnemers aan toekomstige MIV- biomediese proewe. Deelnemers in Fase 2 was 16 tot 18 jaar oud,
die steekproef was hoofsaaklik vroulik (52%, n = 11) en die meeste van die deelnemers (91%, n = 19)
was in grade 8 tot 12 op hoërskool. Deelnemers het tydens indringende onderhoude terugvoering oor hulle ervarings van die aangepaste beradingsintervensie verskaf. Ek het drie hooftemas in hierdie
verband geïdentifiseer, wat die volgende insluit: voordele van MIV-toetsingsdienste, redes waarom
berading en MIV-toetsingsdienste verlang word, en die deelnemers se evaluering van die studiebesoeke
en beradingsessies. Daar is bevind dat die aangepaste beradingsintervensie van die CDC aanvaarbaar
was en gunstige uitkomste gelewer het vir die adolessente wat aan die loodsfase deelgeneem het.
Hierdie studie dra by tot die literatuur oor MIV-risiko’s vir adolessente in Soweto, Suid-Afrika,
deur meervoudige invloedsvlakke te oorweeg. Die feit dat ’n meer volledige begrip tydens die
loodsondersoek verkry is van die interaksie van die ekologiese faktore wat tot seksuele risikogedrag
onder adolessente bydra, het die ontwikkeling van ʼn doelgemaakte intervensie deur berading moontlik
gemaak. Die bevindings het getoon dat die aangepaste beradingsintervensie van die CDC
lewensvatbaar en aanvaarbaar is vir gebruik onder adolessente wat waarskynlik geskikte deelnemers
aan toekomstige biomediese proewe oor MIV-voorkoming kan wees. Hierdie studie verskaf dus ʼn
noodsaaklike beradingsintervensie om die MIV-risiko onder adolessente ‒ ʼn ouderdomsgroep wat
waarskynlik aan toekomstige biomediese navorsing oor MIV-voorkoming sal deelneem ‒ te verminder.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/97046 |
| Date | 03 1900 |
| Creators | Dietrich, Janan Janine |
| Contributors | Kagee, Ashraf, Stellenbosch University. Faculty of Arts and Social Sciences. Department of Psychology |
| Publisher | Stellenbosch : Stellenbosch University |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | Unknown |
| Type | Thesis |
| Format | xxv, 447 pages : illustrations (some colour) |
| Rights | Stellenbosch University |
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