ABSTRACT:
Considerable sexual and reproductive health (SRH) challenges are faced by adolescents in South Africa, including heightened vulnerability to HIV1, early or unplanned pregnancy2, and sexual victimization3. Caregiver-adolescent sexuality communication (CASC) can contribute towards a health-enabling environment for adolescent SRH, while reducing negative SRH outcomes4, contributing to sustainable development goals three, five and ten5. Focusing on early adolescents, aged ten to fourteen years old, within caregiver-based interventions to improve CASC provides an opportunity to strengthen adolescent SRH6, while laying a foundation for future health 7,8. However, CASC in South Africa is constrained 9 by multi-level barriers 10-13. We will describe overarching socio-cultural narratives perceived as facilitating or hindering CASC with early adolescents to support the development of a caregiver-based training intervention to improve CASC. Forty-one individual interviews and eight focus group discussions were conducted with adolescents, caregivers of early adolescents and community leaders from Cape Town in either English or isiXhosa by trained researchers. Topic guides explored the nature and quality of caregiver and adolescent relationships, how caregivers and early adolescents discuss SRH and other sensitive issues, together with socio-cultural norms around these discussions. Thematic narrative analysis was used14, informed by the Theory of Triadic Influence15, to explore interrelated influences. CASC was limited with early adolescents, shaped by narratives framing CASC as inappropriate. Early adolescents, apprehensive of caregiver judgement and lacking open dialogue about sexuality in caregiver-initiated conversations, turned to peers and siblings, often receiving inaccurate sexuality information. Caregivers avoided open discussions due to fears that CASC could encourage sexual activity and low confidence in communication skills and SRH knowledge, using fear-based messaging or focusing on sexual victimization instead. Caregiver-early adolescent sexuality communication is a complex phenomenon in South Africa, constrained by socio-cultural narratives and multi-level barriers, underscoring the need for context sensitive interventions, informed through community engagement.