Family-Centered Youth HIV Prevention: Journey of the Families Matter Program from the US to Sub-Saharan Africa Kim S. Miller, PhD Senior Advisor for Youth Prevention Division of Global HIV/AIDS Center for Global Health Division of Global HIV/AIDS

Realization Information seeking about sex and sexuality begins early Information seeking about sex and sexuality begins early Formation of attitudes, beliefs and behaviors about sex and sexuality is a life-long process Formation of attitudes, beliefs and behaviors about sex and sexuality is a life-long process Some are better prepared than others with knowledge, comfort, skills and confidence to talk about sex issues Some are better prepared than others with knowledge, comfort, skills and confidence to talk about sex issues Early communications about sex and sexuality would shape how these kinds of questions were or were not talked about in the future Early communications about sex and sexuality would shape how these kinds of questions were or were not talked about in the future

Conceptual Framework Conceptual Framework

Identification and Development of a Science Base Sexual risk begins early Sexual risk begins early Barriers to effective parenting and parent-child communication Barriers to effective parenting and parent-child communication Parenting practices related to sexual risk reduction Parenting practices related to sexual risk reduction  Monitoring children’s social activities  Having a strong parent-child relationship Communication related to sexual risk reduction Communication related to sexual risk reduction  Giving comprehensive information  Giving accurate information early  Being a skilled and responsive communicator

Why Focus on Parents Appropriate Venue for Early Prevention Delivery Appropriate Venue for Early Prevention Delivery Adolescents want to hear from parents Adolescents want to hear from parents Early Early Continual Continual Sequential Sequential Time-sensitive Time-sensitive Shape and form healthy attitudes, beliefs and behaviors Shape and form healthy attitudes, beliefs and behaviors

Parents Matter Program (PMP) Five session intervention for parents /caregivers of 9-12 y olds  Helps parents understand:  The risks their children face  Their unique role in helping their children make decisions about sex and communicating their own values to their children  Enhances positive parenting skills to:  Strengthen relationships  Monitoring  Protect children from health risks and peer pressure  Builds skills to:  Give parents the knowledge, skills, comfort and confidence to talk with their children early, often, comprehensively, and effectively about sex and sexuality.

Program Delivery Delivered to primary caregivers of pre-adolescents ages 9-12 Delivered to primary caregivers of pre-adolescents ages 9-12 Delivered to groups of Delivered to groups of Male and female local facilitators Male and female local facilitators 5 session program delivered over 5 consecutive weeks 5 session program delivered over 5 consecutive weeks 3 hour sessions 3 hour sessions Delivered at local community venues Delivered at local community venues Child participates in the last session Child participates in the last session

Science of Parents Matter Program Parents Matter was evaluated with a randomized control trial RCT (enhanced, brief and control arm) 1,2 : Parents Matter was evaluated with a randomized control trial RCT (enhanced, brief and control arm) 1,2 :  Higher levels of parent and pre-adolescent reports of communication for participants in enhanced arm (frequency, # topics, concordance)  Higher levels of parent and pre-adolescent reports of comfort and confidence to communicate about sexuality for participants in the enhanced intervention arm  Increased perception of child readiness to learn about sex by participants in the enhanced arm. 1Forehand et. al, Efficacy of a Parent-Based Sexual-Risk Prevention Program for African American Preadolescents. Archives of Pediatric and Adolescent Medicine, 161 (12), Dec Miller KS, Lin CY, Poulsen M, Fasula AM, Wyckoff SC, Forehand R, Long N, Armistead L. Enhancing HIV Communication Between Parents and Children: Efficacy of the Parents Matter! Program. AIDS Education and Prevention.

From USA to Africa

From Parents Matter to Families Matter In 2004, Parents Matter! was introduced to Kenya at the request of a youth-led advisory board  2001: Youth needs assessment in Nyanza  Early sexual exposure and negative peer pressure  Poor communication between adults and adolescents  Lack of access to information and youth friendly services  2004: Cross-sectional baseline survey in Asembo  Sexual debut by age 13 among adolescents: 14%  Women, years: 8.5% HIV +

Findings from Nyanza Province Barriers to parent-child communication are similar Barriers to parent-child communication are similar Adaptation (Poulsen et al., 2010) Adaptation (Poulsen et al., 2010)  Modification to program delivery  Cultural tailoring (e.g. local proverbs, drivers of epidemic)  Inclusion of information on PMTCT, MMC, linkages to HTC Evaluation (Vandenhoudt et al., 2010) Evaluation (Vandenhoudt et al., 2010)  Parents and children each separately reported significant increases in parental monitoring, sexuality and sexual risk communication topics, and parental communication skill  Intervention highly acceptable to the community

5-Step FMP Capacity Building Plan 1. Community Needs Assessment 2. Program Adaptation/Tailoring 3. Facilitator Identification, Training and Certification 4. Pilot-testing and Monitoring 5. Implementation and M&E

Dissemination: Kenya Over 500 facilitators trained Over 500 facilitators trained More than 50 NGOs, CBOs and FBOs as implementing partners More than 50 NGOs, CBOs and FBOs as implementing partners Over 150,000 families reached with FMP Over 150,000 families reached with FMP

Dissemination: Africa Families Matter! is now being implemented throughout Africa: Families Matter! is now being implemented throughout Africa: Kenya Kenya Tanzania Tanzania Cote d’Ivoire Cote d’Ivoire Botswana Botswana Zambia Zambia South Africa South Africa Mozambique Mozambique Namibia Namibia  FMP materials translated into 15 languages

FMP in Sub-Saharan Africa (as of June, 2012) Country # of families reached % retention of participants across all 5 sessions Botswana Ivory Coast Tanzania Zambia South Africa Mozambique Namibia----

New Ventures for 2012 Session 6: Understanding Child Sexual Abuse Session 6: Understanding Child Sexual Abuse Session 7: Gender and Gender-based Violence Session 7: Gender and Gender-based Violence FMP 2: Adaptation for parents and caregivers of older adolescents (13-19 year olds) FMP 2: Adaptation for parents and caregivers of older adolescents (13-19 year olds) Randomized control trial to assess longitudinal impact of FMP Randomized control trial to assess longitudinal impact of FMP

Kim S. Miller Ph.D. Senior Advisor for Youth Prevention Centers for Disease Control and Prevention Center for Global Health Division of Global HIV/AIDS Kim S. Miller Ph.D. Senior Advisor for Youth Prevention Centers for Disease Control and Prevention Center for Global Health Division of Global HIV/AIDS Center for Global Health Division of Global HIV/AIDS