BACKGROUND: In 2023, an estimated 39.0 million people globally were living with HIV, with young people aged 15-24 disproportionately accounting for 40% of new adult infections concentrated in sub-Saharan Africa, highlighting significant SRH challenges and risky sexual behaviors among youth worldwide. Parental communication plays a pivotal role in fostering positive sexual and reproductive health (SRH) outcomes, including HIV/AIDS. This study, conducted among rural South Ethiopian secondary schools, aimed to measure the extent of parental communication on HIV/AIDS-related matters and identify the factors influencing it. METHODS: Using a cross-sectional, school-based design, data were gathered through a self-administered questionnaire, employing a clustering-based technique to select 577 youths from different schools. The analysis involved descriptive statistics, binary analysis, and multivariable logistic regression. Variables with a significance level of p-value ≤ 0.25 in the binary analysis were included in the logistic regression model. The adjusted odds ratio (AOR) at a 95% confidence interval (CI) was utilized to indicate independent factors. RESULTS: The study revealed that 39% (95% CI = 35.02% to 42.98%) of youths experienced poor communication on HIV/AIDS related issues with their parents. Youths whose mothers could only read and write were 2.7 times more likely (AOR = 2.77
95% CI: 1.23-6.25), and those whose mothers had only attended primary school were 4.6 times more likely (AOR = 4.63
95% CI: 1.97-10.9) to have had poor communication compared to youths whose mothers had a secondary school education or higher. Additionally, youths whose mothers were housewives (AOR = 0.34
95% CI: 0.16-0.71), merchants (AOR = 0.22
95% CI: 0.09-0.50), or farmers (AOR = 0.23
95% CI: 0.10-0.53) were 66%, 78%, and 77%, respectively, less likely to experience poor communication compared to youths whose mothers were daily laborers. CONCLUSION: This study underscores that a considerable proportion of youths in South Ethiopia face challenges in HIV/AIDS related communication. The findings advocate for targeted literacy interventions, particularly addressing mothers with lower educational status and those employed as daily laborers, to enhance SRH outcomes among rural adolescents. HIV/AIDS related information dissemination and co-production of literacy materials should be emphasized among rural settings.