“I am not shy anymore”: A qualitative study of the role of an interactive mHealth intervention on sexual health knowledge, attitudes, and behaviors of South African adolescents with perinatal HIV

Reproductive Health

Research

Madeleine H. Goldstein¹  Messaline Fomo²  Nompumelelo Ndlela³  Moherndran Archary³  Thobekile Sibaya³  Mpume Kuzwayo³  Scarlett Bergam⁴  Vincent C. Marconi⁵  Brian C. Zanoni⁶  Jessica E. Haberer⁷ 

[1] Children’s Healthcare of Atlanta, Atlanta, GA, USA;Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA, USA;Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa;Department of Paediatrics, Nelson Mandela School of Medicine, University of KwaZulu Natal, Durban, South Africa;George Washington School of Medicine and Health Sciences, Washington, DC, USA;Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA;Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA, USA;Departments of Medicine and Pediatric Infectious Diseases, Emory University School of Medicine, Atlanta, GA, USA;Department of Global Health, Emory University’s Rollins School of Public Health, Atlanta, GA, USA;Children’s Healthcare of Atlanta, Atlanta, GA, USA;Massachusetts General Hospital, Boston, MA, USA;Harvard Medical School, Boston, MA, USA;

关键词: Adolescent health;    Sex education;    HIV;    Global health;    mHealth;    Gender;    Sexuality;    Reproductive health;   

DOI  :  10.1186/s12978-022-01519-2

 received in 2022-03-04, accepted in 2022-10-21,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundSouth Africa has one of the highest burdens of adolescents with perinatally-acquired HIV (APHIV) in the world. APHIV in South Africa have limited access to sexual and reproductive health (SRH) education and services specific to their HIV status. When lacking comprehensive SRH education, APHIV are prone to sexual risk behaviors that can lead to unintended pregnancy, sexually transmitted infections, and HIV transmission. The use of mHealth interventions has been shown to deliver information, foster social support, and improve decision-making skills. In this study, we evaluate how an mHealth intervention influences sexual health knowledge and behaviors in APHIV.MethodsWe purposively enrolled adolescents from the intervention arm of a randomized clinical trial assessing a multi-module, moderated WhatsApp-based intervention—Interactive Transition Support for Adolescents Living with HIV (InTSHA)—within a government supported clinic in KwaMashu, an urban township of KwaZulu-Natal, South Africa. We conducted in-depth interviews based on World Health Organization guidelines for asking adolescents about SRH. We thematically analyzed data through an iterative, team-based coding approach combining deductive and inductive elements to contextualize SRH attitudes, knowledge, and behaviors before and after receiving the InTSHA intervention.ResultsOf the 21 participants, 13 (61.9%) were female and the mean age was 16.6 years. Most participants reported first learning about SRH as young teenagers in school through non-targeted and negative ways, seeking clarification through peers and the internet rather than clinicians or caregivers. Participants reported that InTSHA provided a holistic perspective on relationships, gender, and sexuality specific to growing up with HIV in South Africa. They praised the ability to give and receive information from peers in a moderated setting through the mHealth intervention, building their confidence, decision-making skills, and communication with partners and caregivers throughout their everyday lives. Despite reporting some technological challenges, adolescents agreed that InTSHA was convenient, confidential, and user-friendly.ConclusionsSouth African APHIV receive incomplete and conflicting sexual education from peers, caregivers, teachers, and technology that can be supplemented by mHealth curricula targeted for the unique needs of APHIV. Future, scaled-up mHealth interventions can lower SRH stigma by expanding access to sexual education and peer support, supplementing adolescents’ existing SRH education.

【 授权许可】

CC BY   
© The Author(s) 2022

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