‘A spade was called a spade...it was not called a garden tool...’: Youth and intervention implementers’ perceptions of a resilience-based HIV prevention intervention for reducing risky sexual behaviors among youth in South Africa

Abstract

Background: Youth (15-24 years) in South Africa remain at high risk of HIV infection despite interventional efforts to control the disease. Programs directed at promoting resilience or protective factors in youth have been recommended as a multifaceted approach to mitigate risky sexual behaviors associated with HIV infection among youth. However, limited research exists on how relevant stakeholders, such as youth and intervention implementers perceive resilience-based HIV prevention interventions targeting youth. Views of all relevant stakeholders, including youth and intervention implementers is important to guide future research, intervention design and implementation. This study explored youth and intervention implementers’ perceptions of a resilience-based HIV prevention intervention (You Only Live Once) aimed at reducing risky sexual behaviors among youth in South Africa. Methods: Semi-structured interviews were conducted with 10 youth who participated in the intervention and four intervention implementers at a not-for-profit organization in Maluti-a-Phofung Local Municipality, South Africa. Data were analyzed using thematic analysis. Results: Three main themes emerged from the data: (1) Acceptability and impact of the intervention – the intervention was perceived as important and helpful in fostering positive behavior change among youth and enhancing their sexual health and social skills knowledge; self-confidence; and relationships with parents and peers. (2) Factors influencing intervention implementation – participants reported several multi-level factors which impeded or promoted the implementation of the intervention. (3) Recommendations to improve intervention implementation – participants made suggestions on how intervention implementation could be enhanced. Conclusion: These findings suggest that resilience-based HIV prevention interventions are acceptable to young people in South Africa and have potential to mitigate their vulnerability to HIV. Findings also suggest that several multi-level factors influence implementation of resilience-based HIV prevention interventions for young people. The study contributes to knowledge on the acceptability, impact and barriers and facilitators to implementation of resilience-based HIV prevention interventions targeting youth in South Africa and similar contexts. Approaches to improve future interventions should remove barriers and strengthen facilitators at intervention, intervention recipient, intervention implementer, implementing organization and external context levels to promote successful implementation.