The perceived impact of a skills training workshop supported by the book, HIV & AIDS, on grandmothers' communication with pre-adolescent and adolescent grandchildren in their care about sex, sexuality and HIV and AIDS in Alexandra

Abstract

HIV continues to be a major public health issue in South Africa with young people still a high risk. Evidence suggests that children who have lost one or both parents are at greater risk of acquiring HIV. South African grandmothers, and other older family members, are increasingly responsible for' raising grandchildren in the absence of parents. Conversations about sex, sexuality and HIV and AIDS need to be part of growing up.Sexual reproductive health (SRH) communication between parents and their children has been shown to promote safer sexual choices.Where grandmothers, and other older family members,are the primary caregivers,this responsibility is shifting to them.There are a number of barriers, including cultural beliefs, selfZefficacy, age and gender that impede SRH conversations between older caregivers and the children they care for.The overall aim of this study was to explore the phenomenon of an group of grandmothers in Alexandra in communicating about sex, sexuality and HIV and AIDS with the pre-adolescent and adolescent children that they care for, before and subsequent to a skills training workshop on sex, sexuality and HIV and AIDS. Materials and methods: This was a qualitative evaluation study that explored the experiences of grandmothers or older caregivers when talking to their grandchildren or children in their care about sex, sexuality and HIV and AIDS before and after a brief intervention over seven months. This study drew on a phenomenological approach using content analysis. The intervention consisted of a two-hour training workshop using the book,HIV & AIDS by Marina Appelbaum as a tool to facilitate SRH communication.Data collection occurred at three points in time.The study used convenience sampling and ten grandmothers or older female caregivers who were the primary caregivers of pre-adolescent and adolescent grandchildren aged 10 to 18 years volunteered to participate in the study.Of the ten participants, six women participated in a focus group three weeks after the skills training workshop. Five of the ten women from the baseline interviews were interviewed a second time three to six months after the skills training workshop. Data was collected utilising individual inZdepth interviews pre- and three to seven months post intervention,and through a focus group discussion three weeks post intervention.Thematic analysis was conducted and inductive codes and themes were identified from the interviews. Results: Grandmother and older caregiver conversations about SRH matters with pre-adolescent and adolescent grandchildren and children in their care were hindered by a number of factors. These included taboo and cultural issues; the personal experiences of the grandmothers with SRH communication during their childhood; the generation gap; gender; the lack of selfZefficacy regarding SRH content; knowledge about HIV and AIDS and how to actually speak about sex, sexuality and HIV and AIDS. In addition, a number of other hardships in the grandmothers and older caregivers lives were barriers to making having these SRH conversations a priority.The intervention highlighted that grandmothers and older caregivers appreciated the need to have these conversations with their grandchildren and children in their care and were prepared to overcome these barriers in order to promote safer sexual behaviour for the grandchildren.The skills training workshop helped to shift the fears about SRH communication and the participants responded very positively to the skills training workshop expressing how much more confident they felt about addressing SRH topics after the intervention. In addition, selfZefficacy was strengthened with participants reporting that they had attempted SRH conversations with the children in their care after the skills training workshop.However, the grandmothers and older women felt that further training was required for them. In addition, they felt that skills training workshops for their grandchildren were also needed. Conclusions: Overall, the findings in this study demonstrated the value and need for interventions to facilitate SRH communication between grandmothers and older caregivers and the grandchildren and children in their care. As grandmothers and older women are committed and involved primary caregivers of the children in their care, and in spite of numerous barriers to SRH conversations, they are prepared to speak to their grandchildren about this topic. In addition, they recognise the value of this communication in keeping their grandchildren and children in their care healthy and promoting safer sexual choices. In light of the active role played by grandmother in raising grandchildren, SRH interventions are needed to assist the role of grandmothers in talking about sex,sexuality and HIV and AIDS. The skills training workshop made a significant contribution to increasing SRH communication although participants recommended that additional workshops were required for themselves and the grandchildren and children that they care for.In addition,interventions need to recognise the day-to-day difficulties experienced by grandmothers and older women in bringing up third generation children.