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Page 9 of 13 Original Research

Maternal and child characteristics, post-disclosure reactions parents are equipped with adequate support, they can
and post-disclosure questions were regressed against the communicate with their children about HIV/AIDS and
outcome of storybook category. No characteristics were sexuality matters. This would, in turn, assist in HIV
8
found to be significant predictors of storybook topic selection, prevention in young people who may also be exposed to
and therefore the results were not included in this article. multiple risks as they enter adolescence, including ill-health,
depression and substance abuse. 38
Discussion
Parent–child communication is a recognised protective factor
This study showed that the mothers found the current during the high-risk developmental stage of adolescence,
Amagugu intervention materials to be useful in leading especially concerning HIV infection, and other sexual and
communication with their preadolescant children around reproductive health outcomes. 8,24,37 The Amagugu evaluation
HIV and health behaviours which may include sex education was shown to increase mother–child communication on
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as part of reproductive health and HIV prevention. These topics, including the risks of bullying from friends, teacher–
results suggest that parents may be able to overcome their child problems, physical abuse and sexual abuse. This finding
expressed discomfort, embarrassment and lack of knowledge is important as these childhood events have been linked to
on how to engage their children in discussions about sex- adverse outcomes, including behavioural problems, mental
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related matters with appropriate and user-friendly health disorders, 41,42,43 substance abuse disorders, sexual risk
materials. 8,15 These results are encouraging because behaviour and increased risk of HIV infection and
discussing sex-related issues with children is often reported interpersonal violence, especially amongst HIV-affected
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to be a taboo in many settings. 8,15,22
children who are particularly vulnerable to bullying and
abuse. 44,45
Building parental capacity for sex education has been
identified in the literature as a key method through which It is encouraging to note that in comparison to baseline,
increased health education and prevention occurs in the mother–child communication increased for all topics.
family context. 8,18 This involves providing parents and Importantly, we also found that there were gender-specific
caregivers with the necessary practical tools for laying the and significant increases amongst mothers with boys,
early foundation in health needed for a positive trajectory towards increased education of the potential risk for sexual
over the life course. The literature suggests that because abuse amongst their boy children. This is an important
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family, especially parents, plays an important role in finding given that a recent national representative cross-
the sexual socialisation of children, their role should sectional study of sexual abuse in South Africa found that
be capitalised upon when designing programmes to 10% of boys and 14% of girls aged between 15 and 17 years
improve the sexual and reproductive health of children reported some sexual victimisation in their lifetime. This
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and adolescents. 37,38 Although research on parent–child risk of early sexual abuse amongst boys has also been
communication regarding sexuality with younger children is shown in longitudinal research in South Africa to start early.
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limited, a multi-site study conducted with adolescents in Thus, intervention such as Amagugu, which encourage
Burkina Faso, Ghana, Malawi and Uganda demonstrated communication with boy children about the risk of sexual
parental influence on adolescents’ sexual and reproductive abuse, has important potential beyond the context of HIV.
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health. It is promising that studies in other parts of the
world have demonstrated that parents also agree that the Conversely, we found no gender differentials in the use of the
basis for sex education should be the home, supplemented by ‘HIV Body Map’ for sex education. This is encouraging as the
external facilities such as schools. In a study conducted in a finding suggests that the distribution of educational resources
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rural area of the United States, 80% of parents believed that has the potential to make sex education more gender-
the family should provide sex education to children; 94% inclusive, and overcome the accepted norm that the education
reported to have talked to their children about sex, and 87% of boys is often regarded as the responsibility of the father or
regarded themselves as the primary source of sexual male caregiver. This is particularly relevant in the context of
information for their adolescents. 39 rural South Africa, not only where patriarchal gender norms
pervade but also where the role of education falls to the
This research is one of the first to demonstrate that South mother because the father may often be absent from the
African HIV-positive mothers are willing and interested in household. A plausible explanation for our finding is that
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being involved in providing such health education (including the age-appropriate resources boost a mother’s confidence
education on HIV and sexuality) to their preadolescent and empowers her to undertake this task. 49
and adolescent children. Most studies on parent–child
communication on sexual issues have been conducted in the An important finding was that a simple tool such as a doll
United States, Europe and Australia. 8,15 According to the could foster parent–child communication and strengthen the
World Health Organization, studies on parent–child parent–child relationship. This is because a doll can
communication on sexual matters in sub-Saharan Africa are build parental capacity by providing an opportunity for
limited, but there is a growing literature on this issue. Our interactive play, and insight into a child’s emotions and
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findings align with existing research which suggests that if thoughts, fundamental to capacitating mothers as agents of

http://www.sajhivmed.org.za 401 Open Access