Abstract:
Let’s Talk is a structured, family-centered adolescent HIV prevention program developed for use in
South Africa using key components adapted from programs successfully implemented in the US
and South Africa. It is designed to address individual HIV transmission risk factors common
among orphaned and vulnerable adolescents, including elevated risk for poor psychological
health and sexual risk behavior. These efforts are accentuated through parallel programing to
support caregivers’ mental health and parenting skills. Twelve Let’s Talk groups, each serving
approximately 10 families, were piloted by two local community-based organizations in Gauteng
and Kwa-Zulu Natal provinces, South Africa. Face-to-face interviews were conducted among
participating caregivers and adolescents at baseline and three months post-intervention to
explore the potential effects of the program on intermediate outcomes that may support HIV
preventive behavior. Specifically, generalized estimation equations were used to estimate
average change on HIV prevention knowledge and self-efficacy, caregiver and adolescent mental
health, and family dynamics. Among the 105 adolescents and their 95 caregivers who
participated in Let’s Talk and completed both surveys, statistically significant improvements were
found for adolescents’ HIV and condom use knowledge as well as condom negotiation selfefficacy,
but not sexual refusal self-efficacy. Both caregivers and adolescents demonstrated
significantly better mental health at post-test. Adolescent/caregiver connection and
communication about healthy sexuality also improved. These preliminary results highlight the
potential of HIV prevention interventions that engage caregivers alongside the vulnerable
adolescents in their care to mitigate adolescent HIV risk factors. A more rigorous evaluation is
warranted to substantiate these effects and identify their impact on adolescents’ risk behavior
and HIV incidence.
