Family perceptions about adolescents’ vulnerability to HIV/AIDS

The second theme that emerged from the focus groups focused on the extent to which families perceived that adolescents were vulnerable to HIV/AIDS. In general, adolescents did not believe that HIV/AIDS was something that directly affected them. Although a small number of boys indicated that HIV/AIDS could occur outside of urban areas, the majority believed that HIV/AIDS occurred mostly in cities.

One boy explained how there are “bad” boys in the city and “good” boys in the village. This feeling was summarized by one male adolescent who said that he felt there was limited possibility of HIV spreading in the local community. In both the male and female focus groups, youth reported that they did not know anyone who was living with HIV/AIDS.

Like their adolescent children, mothers did not readily identify knowing anyone with HIV/AIDS. Although several mothers stated that HIV/AIDS could affect “anyone”, another stated, “Where it [HIV/AIDS] is where it is not, we do not have any idea.” In addition, mothers echoed the sentiments of their adolescent children about who became infected with HIV/AIDS. One mother said, “One who goes ‘wrong’ will get the disease.”

In contrast to the mother and adolescent focus groups, a number of fathers spoke about their personal experiences knowing people affected by HIV/AIDS. One father shared the story of a friend who had contracted HIV via a sexual relationship with a woman:

There was someone I knew who visited another women and he started getting fever regularly. Later on we came to know that he has AIDS and he died. I know this because this happened in front of us.

Still another shared the story of a friend who had travelled from the village to Mumbai:

There was a friend of mine, he used to roam around, used to go to Mumbai. He must have been doing such things there so he got AIDS. Later, doctor told that he had got AIDS. After that, for some time he tried, but later he passed away.

Finally, another father shared his familiarity with HIV/AIDS via his work as a truck driver, “I am a driver and these things [AIDS] happen earlier to us.”

Unlike their adolescent children, both mothers and fathers believed that their children were at risk for HIV. Perceptions of adolescent vulnerability were most often discussed in the context of economic constraints that forced children to seek work in neighbouring villages or cities.

Mothers recognized that they could not effectively monitor their children’s whereabouts when they left home for work and believed this opened the door for sexual behaviour that could expose their children to HIV. Fathers, who had also discussed their own experiences migrating for work or knowing other adults who had migrated for work, believed that travelling to other villages and cities for economic opportunities placed their children at risk for HIV, “They are outside and they feel it is a need so they have sexual relationships.” one father said.

Feasibility of a family-based programme

All four groups of stakeholders indicated that a family-based intervention was a feasible and culturally acceptable way to prevent HIV transmission among adolescents. For example, both adolescent males and females indicated that they were interested in participating in a family-based intervention that would provide them with comprehensive skills and information to reduce their risk of acquiring HIV. When asked to elaborate, adolescent males indicated that they listened to their parents and respected their beliefs and opinions more than they would an “outsider”.

Related to this, adolescent males also recognized that a comprehensive family-based approach could be easily integrated into their daily life. As one adolescent male stated, “It is beneficial if information and skill are given by families because someone who comes from outside will only be there for one day but if you err then family is there every day to tell.”

Similarly, adolescent girls believed it would be beneficial to have their parents talk to them about HIV/AIDS and that their parents could be a good source of knowledge and skills. Family-based approaches were praised by girls for their inclusiveness. As one girl said, “We don’t feel that anybody should be excluded like girls, boys, mothers, fathers. All should come together for the programme.”

In addition, adolescent girls believed that their parents could be effective teachers, especially if given correct information and skills about HIV/AIDS.

Mothers and fathers were open to participating in a family-based programme and believed that a comprehensive family-based programme was feasible. All of the parents were concerned about their child’s health and wellbeing, and many were aware that HIV/AIDS posed a serious health risk. Like their adolescent children, parents recognized that a family-based approach might be more successful than other types of programmes. As one father stated:

Parents will say and children will listen, but when an outsider comes and talks then there are many things that children will feel shy to speak to you as an outsider, they will not talk the way we are talking to you ... they will feel shy. That’s why it is important for parents to explain to them.

Without exception, parents wanted to talk with their children about HIV/AIDS. As one mother stated, “It is the duty of parents to speak to their daughters and sons about these issues. We should only make them understand and if we don’t tell them how will they know?”

At the same time, only a small number of parents said that they had actually talked with their children about topics like HIV/AIDS and sexual behaviour. Overall, both mothers and fathers felt that they lacked the necessary information and skills to communicate effectively with their children. In particular, parents felt they lacked adequate information related to correct and consistent condom use, and would need additional help if they were to instruct their teens on this topic. For their part, mothers wanted factual information and believed that their children would listen to them if given proper information. One mother said, “You should teach us. What all we don’t know, you must tell us. You should give information to parents as well as children. Then even we will be able to speak.”

Similarly, fathers believed that they should speak with their children about sexual behaviour and HIV/AIDS, but needed additional support to have effective conversations. Fathers believed that a family-based HIV prevention programme would be especially useful as it could “give us advice which we can give our children”.