Parental/caregiver influence on sexual risk behaviors among HIV-positive young people in Kinshasa, the Democratic Republic of the Congo

Young people make up more than 60% of the population in the Democratic Republic of the Congo (DRC) and have an HIV prevalence of over 1%. Parents/caregivers of HIV-positive young people play an important role in helping their children understand how their decisions affect their health and the health of others. The first aim of this research was to examine the relationships between parental/caregiver monitoring, social support, and sexual risk behaviors for young people living with HIV (YPLWH) in Kinshasa, DRC. Quantitative data collected from 103 YPLWH, age 14-24 and who reported ever having sex, were analyzed. The second aim was to describe the norms and patterns of communication about sex between parents/caregivers and their HIV-positive child through 52 semi-structured interviews of caregivers. In the first aim, the majority of participants reported low parental/caregiver monitoring (68%) and low social support (68%). Among all young people, 55 (53.4%) reported no sex in the past 12 months, 29 (28.2%) reported protected sex at last intercourse, and 19 (18.4%) reported unprotected sex at last intercourse. Social support was an effect modifier in the relationship between monitoring and sexual behavior, with marginal significance (OR = 1.7, 95%CI: 0.98-2.79). This interaction effect weakened when adjusted for time-since-HIV-diagnosis (OR=1.6, 95%CI: 0.91-2.75). In the second aim, reasons for communication about sex, including HIV disclosure and child attributes and content of communication, including sexual risk, HIV status disclosure and other risk behaviors, were identified. Reasons for communication were similar for parents/caregivers with children who knew their HIV status compared to those with children who did not know; however, most parents/caregivers waited until after puberty or until the child already started having sex to talk about sex. Parents/caregivers focused their conversations on the risks associated with sex, though males were told to be more careful compared to females, who were told to avoid sexual contact. For children who did not know their status, some parents/caregivers used scare tactics to influence their child's sexual behavior, even mentioning that they could contract HIV. These findings can inform culturally sensitive strategies for transmission risk interventions among young people living with HIV