HIV testing for pregnant women: a rights-based analysis of national policies.

Ethical and human rights concerns have been expressed regarding the global shift in policies on HIV testing of pregnant women. The main purpose of this research was to conduct a policy analysis using a human rights-based approach of national policies for HIV testing of pregnant women. We collected HIV testing policies from 19 countries including: Cambodia, China, Guyana, Haiti, India, Jamaica, Kenya, Moldova, Papua New Guinea, Russian Federation, South Africa, Sudan, Swaziland, Tanzania, Ukraine, United States, Uzbekistan, Zambia and Zimbabwe. We analysed the HIV testing policies using a standardised framework that focused on government obligations to respect, protect and fulfil. Our results highlight the need for more attention to issues of pregnant women's autonomy in consenting to HIV testing, confidentiality in antenatal care settings and provision of counselling and care services. We conclude with a discussion about potential implications of the current testing policies and provide recommendations for ways that HIV testing policies can more effectively uphold the human rights of pregnant women.

Enhancing HIV communication between parents and children: efficacy of the Parents Matter! Program.

We examine efficacy of the Parents Matter! Program (PMP), a program to teach African-American parents of preadolescents sexual communication and HIV-prevention skills, through a multicenter, randomized control trial. A total of 1115 parent-child participants were randomized to one of three intervention arms (enhanced, brief, control). Percentages and 95% confidence intervals compare parents' perception of child readiness to learn about sexual issues, communication effectiveness, and dyad concordance from baseline to 12 months postintervention. Wilcoxon rank sum tests compare the changes in scores measuring communication content in HIV/AIDS, abstinence, and condom use. Compared to control, parents in the enhanced arm increased perception of child readiness to learn about sex (16% vs. 29%; p < .001), and a greater proportion of parent-child dyads reported concordant responses on communication topics: HIV/AIDS (15%, 95% CI = 8-21%; p < .001), abstinence (13%, 95% CI = 7-20%; p < .001), condoms (15%, 95% CI = 9-22%; p < .001). Increases in communication scores in HIV/AIDS, abstinence, and condom use were greater in the enhanced arm than control (p < 0.01). We conclude that the enhanced PMP can help parents educate children about HIV and prepare children to avoid sexual risk.

Testing public health ethics: why the CDC's HIV screening recommendations may violate the least infringement principle.

The CDC's HIV screening recommendations for health care settings advocate abandoning two important autonomy protections: (1) pretest counseling and (2) the requirement that providers obtain affirmative agreement from patients prior to testing. The recommendations may violate the least infringement principle because there is insufficient evidence to conclude that abandoning pretest counseling or affirmative agreement requirements will further the CDC's stated public health goals.

Making HIV prevention programming count: identifying predictors of success in a parent-based HIV prevention program for youth.

Predictors of change in the number of sexual topics parents discussed and responsiveness during sex communication with their preadolescent after participating in a five-session sexual risk reduction intervention for parents were examined. Data were from 339 African American parents of preadolescents enrolled in the intervention arm of a randomized-controlled trial of the Parents' Matter! Program (PMP). Four categories of predictors of success were examined: time and resource constraints, personal characteristics, the parent-child relationship, and parent perceptions of child readiness for sex communication. There were only sporadic associations between success and time and resource constraints for either outcome. Parent perception of child readiness for sex communication was positively associated with discussions of sex topics (b = 1.11, confidence interval [CI]: 0.24-1.97) and parental responsiveness (b = .68, CI:0.22-1.15). Although parents face time and resource constraints, most attended at least four sessions, and demographics such as income had limited effects on program success.

Cultural adaptation of a U.S. evidence-based parenting intervention for rural Western Kenya: from parents matter! To families matter!

Evidence-based interventions (EBIs) are critical for effective HIV prevention, but time and resources required to develop and evaluate new interventions are limited. Alternatively, existing EBIs can be adapted for new settings if core elements remain intact. We describe the process of adapting the Parents Matter! Program, an EBI originally developed for African American parents to promote effective parent-child communication about sexual risk reduction and parenting skills, for use in rural Kenya. A systematic process was used to assess the community's needs, identify potential EBIs, identify and make adaptations, pilot-test the adapted intervention, and implement and monitor the adapted EBI. Evaluation results showed the adapted EBI retained its effectiveness, successfully increasing parent-child sexual communication and parenting skills. Our experience suggests an EBI can be successfully adapted for a new context if it is relevant to local needs, the process is led by a multidisciplinary team with community representation, and pilot-testing and early implementation are well monitored.

Evaluation of a U.S. evidence-based parenting intervention in rural Western Kenya: from parents matter! To families matter!

We evaluated Families Matter! Program (FMP), an intervention designed to improve parent-child communication about sexual risk reduction and parenting skills. Parents of 10- to 12-year-olds were recruited in western Kenya. We aimed to assess community acceptability and FMP's effect on parenting practices and effective parent-child communication. Data were collected from parents and their children at baseline and 1 year postintervention. The intervention's effect was measured on six parenting and parent-child communication composite scores reported separately for parents and children. Of 375 parents, 351 (94%) attended all five intervention sessions. Parents' attitudes regarding sexuality education changed positively. Five of the six composite parenting scores reported by parents, and six of six reported by children, increased significantly at 1 year postintervention. Through careful adaptation of this U.S. intervention, FMP was well accepted in rural Kenya and enhanced parenting skills and parent-child sexuality communication. Parents are in a unique position to deliver primary prevention to youth before their sexual debut as shown in this Kenyan program.

Pre-risk HIV-prevention paradigm shift: the feasibility and acceptability of the parents matter! Program in HIV risk communities.

OBJECTIVES: Many youth begin human immunodeficiency virus (HIV) sexual risk behaviors in preadolescence, yet risk-reduction programs are typically implemented in middle or late adolescence, missing an important window for prevention. Parent-based programming may play an important role in reaching youth early with prevention messages. One such program is the Parents Matter! Program (PMP), a five-session theory- and evidence-based intervention for parents of children aged 9 to 12 years. A randomized controlled trial showed PMP to be efficacious in promoting effective parent-child communication about sexuality and sexual risk reduction. We assessed the feasibility and acceptability of PMP when implemented under typical programmatic circumstances in communities at high risk for HIV infection. METHODS: We selected 15 sites (including health departments, local education agencies, community-based organizations, and faith-based organizations) throughout the U.S. and Puerto Rico to participate in delivering PMP. Sites were provided training, program materials, and ongoing technical assistance. We collected multilevel data to assess the feasibility of program implementation and delivery, program relevance, and satisfaction with PMP activities and materials. RESULTS: PMP was successfully implemented and evaluated in 13 of 15 sites; 76% of parents attended at least four of five sessions. Organization-, facilitator-, and parent-level data indicated the feasibility and acceptability of PMP, and overall high satisfaction with PMP activities and materials. CONCLUSION: The results of this project demonstrate that HIV pre-risk prevention programs for parents can be implemented and embraced by a variety of community organizations in HIV at-risk communities. The time to embrace parents as partners in public health HIV-prevention efforts has come.

Factors associated with parent-child communication about HIV/AIDS in the United States and Kenya: a cross-cultural comparison.

This study explored parent-child communication about HIV/AIDS among two populations disproportionately affected by HIV. Similar computer-assisted surveys were completed by parents of pre-teens, including 1,115 African American parents of 9-12-year-old children in southeastern US and 403 parents of 10-12-year-old children in Nyanza Province, Kenya. Multivariate analyses identified factors associated with parental report of ever talking to their child about HIV/AIDS. Twenty-nine percent of US parents and 40% in Kenya had never talked to their pre-teen about HIV/AIDS. In both countries, communication was more likely if parents perceived their child to be ready to learn about sex topics, had gotten information to educate their child about sex, and had greater sexual communication responsiveness (skill, comfort, and confidence communicating about sexuality). Programs are needed that help parents assess children's readiness to learn about sexual issues; access accurate information about adolescent sexual risks; and acquire the responsiveness needed to discuss sexual issues, including HIV/AIDS.

Barriers and facilitators to maternal communication with preadolescents about age-relevant sexual topics.

The present study examined factors that promote parent-child discussions about sex topics. A sample of 1,066 dyads of African American mothers and their 9-12-year-old children participated completing computer-administered surveys. After controlling for all other covariates, mother's sexual communication responsiveness (i.e., knowledge, comfort, skills, and confidence) was the most consistent predictor of discussions. Mothers with higher responsiveness had significantly increased odds of discussions about abstinence, puberty, and reproduction, based on both mother and child reports. In addition, child's age, pubertal development, readiness to learn about sex, and being female were positively associated with an increase in the odds of discussions in most models. Findings indicate that encouraging parents to talk with their children early may not be sufficient to promote parent-child sex discussions. Parents also need the knowledge, comfort, skills, and confidence to communicate effectively and keep them from avoiding these often difficult and emotional conversations with their children.

Pediatricians' role and practices regarding provision of guidance about sexual risk reduction to parents.

A randomly selected nationally representative sample of 508 practicing pediatricians was surveyed in order to identify factors associated with physician delivery of primary prevention to parents about sexual risk reduction (SRR). A full 86% (n = 435) reported that provision of SRR guidance is equally or more important than other guidance provided to parents. Among the 435, only 121 (28%) provided SRR guidance to >75% of parents of their adolescent patients. Multivariate analyses revealed barriers of: lack of training, lack of request from parents, and awkwardness. To promote parent-child communication, physicians suggested high-quality brochures for parents (84%); a list of resources (74%); and tools to facilitate parent-child discussions (63%). Pediatricians and parents are important components of sexual risk prevention efforts for adolescents. Editors' Strategic Implications: The findings related to the perceived importance-but infrequent delivery-of SRR communication between pediatricians and parents of adolescents have implications for training and information dissemination in pediatric practices, as well as other health and reproductive health settings.

Efficacy of a parent-based sexual-risk prevention program for African American preadolescents: a randomized controlled trial.

OBJECTIVE: To evaluate the efficacy of a parent-based sexual-risk prevention program for African American preadolescents. DESIGN: Randomized controlled trial. SETTING: Community-based study conducted in Athens, Georgia; Atlanta, Georgia; and Little Rock, Arkansas from 2001 to 2004. PARTICIPANTS: From 1545 inquiries, 1115 African American parent-preadolescent dyads (child, aged 9-12 years) formed the analytic sample. INTERVENTION: Participants were randomized into 1 of 3 study arms: enhanced communication intervention (five 2 1/2-hour sessions), single-session communication intervention (one 2 1/2-hour session), and general health intervention (control, one 2 1/2-hour session). OUTCOME MEASURES: Continuous measures of parent-preadolescent sexual communication and parental responsiveness to sex-related questions at preintervention, postintervention, and at 6- and 12-month follow-ups; and dichotomous measure of preadolescent sexual risk (having engaged in or intending to engage in sexual intercourse at 12-month follow-up). RESULTS: Using intent-to-treat participants, differences of mean change from baseline for continuous measures and relative risk for the dichotomous measure of sexual risk were calculated. Participants in the enhanced intervention had higher mean changes from baseline scores, indicating more sexual communication and responsiveness to sexual communication at each assessment after intervention for all continuous measures than those in the control intervention and single-session intervention. Preadolescents whose parents attended all 5 sessions of the enhanced intervention had a likelihood of sexual risk at the 12-month follow-up of less than 1.00 relative to those whose parents attended the control (relative risk, 0.65; 95% confidence interval, 0.41-1.03) and single-session (relative risk, 0.62; 95% confidence interval, 0.40-0.97) interventions. CONCLUSIONS: These results provide preliminary evidence for the efficacy of a parenting program designed to teach sexual communication skills to prevent sexual risk in preadolescents. TRIAL REGISTRATION; clinicaltrials.gov Identifier: NCT00137943.