Parent-Child Communication in Disorganized Neighborhoods: Helping South African Caregivers Talk to Their Children to Reduce Risk Behaviors

Background:  HIV infection is one of the greatest threats to the health and well-being of young people worldwide (Bhana et al., 2010; UNAIDS, 2008).  Youths account for an estimated 45% of all new infections globally (Bhana & Petersen, 2009; UNAIDS, 2008). Given the various efforts to stabilize the HIV pandemic both locally and internationally, there remains a high level of new HIV infections and AIDS related deaths for young people in sub-Saharan Africa (Mayosi et al., 2008). They must navigate disorganized communities, gender biases, and poverty related stress. This study is based in KwaZulu-Natal (KZN), a province in South Africa (SA) with the highest HIV prevalence worldwide.  Despite a downward trend in HIV prevalence for children in SA, KZN continues to have an increase in child HIV infection risk (Shisana et al., 2014).  In US research, family relationships predict youth sexual risk behaviors. Findings indicate the availability of caregivers and their level of monitoring protect youth against risk taking, as does communication, transmission of behavioral norms and guiding values.  Focused in SA, this paper explores the relationship between neighborhood chaos and how the frequency of caregiver-child communication can potentially reduce SA youth HIV risk.

Methods:  Baseline data from 290 Black adult caregivers in the  Collaborative HIV Prevention Adolescent Mental Health Program in South Africa (CHAMPSA; R01 MH55701). This is a family-based, HIV prevention intervention to reduce risk behaviors among uninfected SA youth.  Structural Equation Modeling (SEM) was employed to explore the relationship between neighborhood disorganization on caregiver-child frequency of communication (i.e., having sex, HIV, puberty, peer pressure, alcohol use) and whether the relationship is mediated by caregiver socio-emotional well-being.  Socio-emotional well-being was created as a latent variable using twelve items from the General Health Questionnaire (Goldberg, 1979) and the Global Indicator of Well-Being (Bell et al.,  2006). 

Results:  Mediation effects were analyzed, indicated by the joint significance test (MacKinnon et al., 2002).  The results pointed toward good model fit (χ2 = 0.047, df = 1, p-value < .8281; CFI = 1.00, RMSEA = .000, p-value for close fit = 0.880, standardized RMR = .001).  Findings indicated that SA caregiver socio-emotional well-being does not significantly mediate the relationship between neighborhood disorganization and the frequency of communication with their child.  There was a significant direct effect for neighborhood disorganization and frequency of communication.  For every unit increase in neighborhood disorganization, on average, there is an associated 0.991 unit (MOE ± 0.02, CR = -.027, p < 0.001) increase in the frequency of the SA caregiver communication with their child.  It also accounted for 97.3% of the variance for adult to child communication.    

Implications: In light of the apparent disparities experienced by children living in South Africa, adult caregivers can provide a protective shield in protecting children from risky behavior. Given the presence of neighborhood violence and disorganization, supports are needed for these caregivers to communicate with their children in order to shield them from the negative community influences that can make them more susceptible to negative situations.