Amy Weissman, Regional Adolescent and HIV/AIDS Specialist, The Americas and Caribbean Office, UNICEF

Given recent successes with male circumcision, microbicides, and PrEP, we are turning attention to biomedical interventions for HIV prevention.  As we learn how to implement these important interventions, it is critical that we not abandon other known effective prevention strategies.  Because helping to establish healthy behaviors is easier than changing set patterns, pre-risk interventions—those that reach adolescents before they initiate sex or other risk-related practices—are key to reducing HIV among young people.  One effective pre-risk intervention is to involve parents (or other primary caregivers).

According to UNAIDS’s 2010 report on the global AIDS epidemic, there has been a 50% reduction in infections among young people in South Africa.  Michel Sidibe, executive director of UNAIDS attributes this reduction in part to changes in parent-child communication regarding sexuality.  He says: “Now, more people are willing to talk to their children.” (free New York Times account required)

Does talking to one’s children really make a difference?  According to research, there is a strong link between parent-child sexual communication and decreased adolescent sexual risk behavior—studies have found that adolescents who talked with their parents about sexual issues were more likely to use condoms or have fewer sex partners compared to those who had not.  These conversations are most effective in reducing sexual risk behavior when they take place before the young person initiates sex.

Parents can help their children navigate through sexual, drug-use, and other risk-related decision-making because they can reach their children before risk behaviors start. Parents can also engage their children in continuous and sequential discussions that build upon one another as the child matures, and they can be supportive and involved in their children’s lives more generally. 

Through monitoring and effective communication, caregivers can help adolescents establish healthy sexual behaviors, such as avoiding pregnancy and preventing HIV infection.  Monitoring of children’s social activities (knowing where they are, who they’re with, and ensuring they return home) is associated with less frequent sexual behavior, fewer sexual partners, more consistent contraceptive use, and less drug abuse.

Effective communication by caregivers who are knowledgeable, skilled, comfortable, and confident in communicating with their children about sex-related matters is linked to decreased sexual risk-taking by adolescents, increased condom use, and increased communication between the adolescent and his or her partner.

Although most kids want their parents to talk with them about sex, and although many parents would like to do so, it doesn’t happen as often as it should.  Sexuality tends to be a difficult topic for parents to discuss.  According to parents in Botswana, talking about sexuality with their children “brings shame into the home.” So, what to do?  We should provide opportunities for parents to acquire the necessary comfort and skills to talk with their children.  Doing so ensures that caregivers can play their important role in reaching young people early with HIV prevention messages, helping to shape and form healthy behaviors that will protect their children throughout their lives.

While we should be excited about the advent of pills and microbicides to help prevent HIV transmission—after all, these are critical approaches to achieving a reduction in HIV incidence—they are only part of our toolkit of “combination prevention.”  According to a study published in The Lancet, “new technologies provide substantial opportunities to re-invigorate behavioral approaches to HIV prevention.”  So we should take this opportunity to do so.  And in particular, let us focus on behavioral interventions that not only reduce risk, but also encourage more open, informed communication between parents and children, create a healthier environment, and promote positive outcomes that extend beyond physical health.  Take a moment and imagine a world where parents and children communicate better—how bad could that be?