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Research
Sources of social support and sexual behaviour advice for young adults in rural South Africa
  1. Guy Harling1,2,
  2. Dumile Gumede2,
  3. Maryam Shahmanesh1,2,
  4. Deenan Pillay2,3,
  5. Till W Bärnighausen1,2,4,5,
  6. Frank Tanser2,6,7
  1. 1 Institute for Global Health, University College London, London, UK
  2. 2 Africa Health Research Institute (AHRI), KwaZulu-Natal, South Africa
  3. 3 Division of Infection and Immunity, University College London, London, UK
  4. 4 Department of Global Health and Development, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
  5. 5 Institute of Public Health, University of Heidelberg, Heidelberg, Germany
  6. 6 School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
  7. 7 Centre for the AIDS Programme of Research in South Africa – CAPRISA, University of KwaZulu-Natal, Congella, South Africa
  1. Correspondence to Dr Guy Harling; g.harling{at}ucl.ac.uk

Abstract

Introduction While young people in sub-Saharan Africa (SSA) are at greatest risk of HIV acquisition, uptake of HIV prevention interventions among them has been limited. Interventions delivered through social connections have changed behaviour in many settings, but not to date in SSA. There is little systematic evidence on whom young SSA adults turn to for advice. We therefore conducted an exploratory cross-sectional study from whom young rural South Africans received support and sexual behaviour-specific advice.

Methods We asked 119 18–34  year olds in rural KwaZulu-Natal about the important people in their lives who provided emotional, informational, financial, physical, social or other support. We also asked whether they had discussed sex or HIV prevention with each contact named. We used descriptive statistics and logistic regression to analyse support and advice provision patterns.

Results Respondents named 394 important contacts, each providing a mean of 1.7 types of support. Most contacts were relatives, same-gender friends or romantic partners. Relatives provided most informational, financial and physical support; friends and partners more social support and sexual advice. Respondents reported discussing sexual matters with 60% of contacts. Sources of support changed with age, from friends and parents, towards siblings and partners.

Discussion Sexual health interventions for young adults in rural South Africa may be able to harness friend and same-generation kin social ties through which sex is already discussed, and parental ties through which other forms of support are transmitted. The gender-segregated nature of social connections may require separate interventions for men and women.

  • South Africa
  • social support
  • advice
  • sexual behaviour
  • youth

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

https://doi.org/10.1136/bmjgh-2018-000955

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    Footnotes

    • Handling editor Seye Abimbola

    • Contributors GH: conceptualised the study with support from FT and TB. GH, DG: oversaw the data collection process. GH: conducted the quantitative analyses, summarised the results in tables and graphs and wrote the first draft of the paper. All authors contributed to the study design, data interpretation and revisions to the text and approved the final version.

    • Funding This study was supported by Wellcome Trust grant 082384/Z/07/Z. GH, TB and FT were additionally supported by the NIH National Institute of Child Health and Development grant R01-HD084233. TB was also supported by the Alexander von Humboldt Foundation through the endowed Alexander von Humboldt Professorship funded by the German Federal Ministry of Education and Research, the Marsilius Fellowship in Interdisciplinary Research funded by the German Excellence Initiative, the European Commission, the Clinton Health Access Initiative (CHAI), the International Initiative on Impact Evaluation (3ie), NIH National Institute of Allergy and Infectious Diseases grant R01-AI112339, NIH National Institute of Aging grant P01-AG041710 and NIH Fogarty International Center grant D43-TW009775. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval This study was reviewed and approved by the Institutional Review Board (IRB) of the Harvard T.H. Chan School of Public Health (IRB15-455) and the Biomedical Research Ethics Committee of the University of KwaZulu-Natal (BE176-15).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement The data for the study from which this analysis was conducted may be accessed via the Africa Health Research Institute (AHRI), subject to compliance with internal AHRI and ethical review board requirements. The process can be started via the AHRI data respository page on https://www.ahri.org/. The corresponding author can be contacted to aid in this process.