Positive Prevention with Youth Living with HIV/AIDS in Kinshasa, Democratic Republic of the Congo Public Deposited

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  • March 22, 2019
Creator
  • Parker, Lisa
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • This dissertation aims to help develop a Positive Prevention program for Youth Living with HIV/AIDS (YLWH) ages 15-24 in the Democratic Republic of the Congo. To address Aim 1, the systematic adaptation, implementation, and feasibility analysis of a U.S.-developed Evidence Based Intervention (EBI) using the Centers for Disease Control and Prevention Map of Adaption Process was conducted. The adapted intervention, Supporting Youth and Motivating Positive Action or SYMPA, a six-session risk reduction intervention targeted for YLWH in Kinshasa, was adapted from the Healthy Living Project and guided by Social Action Theory. The adapted intervention was found to be acceptable to program facilitators (n=4) and participants (n=13) and able to be implemented effectively. It performed well with a new population and showed preliminary efficacy. However, certain aspects of the intervention were identified during the feasibility analysis that must be addressed prior to wider implementation. This study has shown that an EBI developed and implemented in the U.S. can be adapted and implemented successfully for a different target population in a low-resource context. To address Aim 2, In-depth interviews were conducted with providers (n=14) working at the study clinic in order to understand providers' roles in delivering prevention counseling to YLWH. Providers' lack of knowledge and comfort in talking to youth about sex because of cultural and religious beliefs about sexuality, coupled with confusion about their legal obligations related to youth and contraception, made it difficult for them to effectively counsel youth or create an environment where youth felt comfortable talking with their providers about HIV or sexual health. As a result, the counseling that was provided may have been ineffective. In order for providers to deliver effective prevention counseling to YLWH, clinics should follow adolescent-friendly clinic standards, provide counseling in an adolescent-friendly style, and institute an effective referral system for additional prevention services. Future research should examine the efficacy of a complementary positive prevention program that incorporates: 1) institutionalized adolescent-friendly clinic standards; 2) brief provider-delivered counseling and screening for risk behaviors with an effective referral system for prevention services; and 3) peer group implementation of the SYMPA intervention for higher risk youth.
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  • In Copyright
Advisor
  • Maman, Suzanne
Degree
  • Doctor of Philosophy
Graduation year
  • 2012
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