HIV continues to be a major public health issue in South Africa with young people still at high risk. Evidence suggests that children who have lost one or both parents are at greater risk of acquiring HIV. South African grandmothers, and other older family members, are increasingly responsible for raising grandchildren in the absence of parents. Conversations about sex, sexuality and HIV and AIDS need to be part of growing up. Sexual reproductive health (SRH) communication between parents and their children has been shown to promote safer sexual choices. Where grandmothers, and other older family members, are the primary care givers, this responsibility is shifting to them. There are a number of barriers, including cultural beliefs, self-efficacy, age and gender that impede SRH conversations between older caregivers and the children they care for. The overall aim of this study was to explore the phenomenon of an group of grandmothers in Alexandra in communicating about sex, sexuality and HIV and AIDS with the pre-adolescent and adolescent children that they care for, before and subsequent to a skills training workshop on sex, sexuality and HIV and AIDS.

Materials and methods:

This was a qualitative evaluation study that explored the experiences of grandmothers or older caregivers when talking to their grandchildren or children in their care about sex, sexuality and HIV and AIDS before and after a brief intervention over seven months. This study drew on a phenomenological approach using content analysis.

Data collection occurred at three points in time. The study used convenience sampling and ten grandmothers or older female caregivers who were the primary caregivers of pre-adolescent and adolescent grandchildren aged 10 to 18 years volunteered to participate in the study. Data was collected utilising individual in-depth interviews pre- and three to seven months post intervention, and through a focus group discussion three weeks post intervention. There were ten participants in the pre-intervention, baseline interviews. Six of the ten women from the baseline interviews participated in a focus group three weeks after the skills training workshop and five of the ten women from the baseline interviews were interviewed a second time three to six months after the skills training workshop.. Thematic analysis was conducted and inductive codes and themes were identified from the interviews.

 

Results:

Grandmother and older caregiver conversations about SRH matters with pre-adolescent and adolescent grandchildren and children in their care were hindered by a number of factors. These included taboo and cultural issues; the personal experiences of the grandmothers with SRH communication during their childhood; the generation gap; gender; the lack of self-efficacy regarding SRH content; knowledge about HIV and AIDS and how to actually speak about sex, sexuality and HIV and AIDS. In addition, a number of other hardships in the grandmothers’ and older caregivers’ lives were barriers to making having these SRH conversations a priority. The intervention highlighted that grandmothers and older caregivers appreciated the need to have these conversations with their grandchildren and children in their care and were prepared to overcome these barriers in order to promote safer sexual behaviour for the grandchildren. The skills training workshop helped to shift the fears about SRH communication and the participants responded very positively to the skills training workshop expressing how much more confident they felt about addressing SRH topics after the intervention. In addition, self-efficacy was strengthened with participants reporting that they had attempted SRH conversations with the children in their care after the skills training workshop. However, the grandmothers and older women felt that further training was required for them. In addition, they felt that skills training workshops for their grandchildren were also needed.

Conclusions:

Overall, the findings in this study demonstrated the value and need for interventions to facilitate SRH communication between grandmothers and older caregivers and the grandchildren and children in their care. As grandmothers and older women are committed and involved primary caregivers of the children in their care, and in spite of numerous barriers to SRH conversations, they are prepared to speak to their grandchildren about this topic. In addition, they recognise the value of this communication in keeping their grandchildren and children in their care healthy and promoting safer sexual choices. In light of the active role played by grandmother in raising grandchildren, SRH interventions are needed to assist the role of grandmothers in talking about sex, sexuality and HIV and AIDS. The skills training workshop made a significant contribution to increasing SRH communication although participants recommended that additional workshops were required for themselves and the grandchildren and children that they care for. In addition, interventions need to recognise the day-to-day difficulties experienced by grandmothers and older women in bringing up third generation children.

Ms Jane Simmonds is a dedicated public health specialist and social activist committed to driving community-level change. She holds a Master of Public Health in Social Behaviour Change Communication (SBCC) from the University of the Witwatersrand. Jane currently works at the South African Medical Research Council (SAMRC) and is the Founder and Executive Director of goGOGOgo, a non-profit organisation focused on empowering grandmothers (“gogos”) who are primary caregivers of children.

 

At the SAMRC, Jane has contributed significantly to public health initiatives. She has worked extensively in the older persons sphere as the project manager for a qualitative study on the polypill to address cardiovascular disease in older persons and a hypertension screening study conducted in social grant queues in collaboration with the MRC/Wits Agincourt Research Unit.

 

Through goGOGOgo, Jane leads programmes to promote grandmothers as agents of change improving outcomes for both caregivers and children. Key initiatives include health initiatives for older persons, addressing the “grey divide’ by providing digital technology training and promoting intergenerational conversations related to gender based violence, sexual reproductive health, pregnancy and childcare.

 

Jane’s work reflects a deep commitment to intergenerational health, education, and empowerment, bridging research and community engagement with lasting social impact.