BackgroundAlthough HIV self-testing (HIVST) is globally accepted as an important complement to existing HIV testing approaches, South Africa has lagged behind in its adoption. As a result, data on the acceptability and uptake of HIVST testing is limited. The study investigated the acceptability of HIVST among students in Technical Vocational Education and Training (TVET) colleges in two provinces in South Africa.MethodsA cross-sectional survey using a self-administered structured questionnaire was used to collect data among 3,662 students recruited from 13 TVET colleges.ResultsThe mean age of the students was 21.9 years. The majority (80.9%) were sexually active; while 66.1% reported that they had one sexual partner, and 33.9% had two or more sexual partners in the past year, and66.5% used condoms during the last sexual act. Three-quarters tested for HIV in the past year but less than half knew about HIVST prior to the survey. The acceptability of HIVST was high; about three-quarters showed a willingness to purchase a self-test kit and a majority would self-test with partners. Acceptability of HIVST was associated with being sexually active (OR = 1.73, p = 0.02, confidence interval (CI): 1.08–2.75), having ever been tested for HIV (OR = 1.74, p = 0.001, CI: 1.26–2.38), and having multiple sexual partners (OR = 0.61, p = 0.01, CI: 0.42–0.88). Three-quarters would confirm test results at a local health facility. In terms of counselling, telephone hotlines were acceptable to only 39.9%, and less than half felt that test-kit leaflets would provide sufficient information to self-test.InterpretationsThe high acceptability of HIVST among the students calls for extensive planning and preparation for the scaling up of HIVST in South Africa. In addition, campaigns similar to those conducted to promote HIV counselling and testing (HCT) should be considered to educate communities about HIVST.

We used a grounded theory approach to explore how a sample of caregivers of children on antiretroviral treatment (ART) experience HIV disclosure to their infected children. This paper explores caregivers' barriers to disclosing HIV to infected children. Caregivers of children aged 6–13 years who were receiving ART participated in four focus-group interviews. Three main themes, caregiver readiness to tell, right time to tell, and the context of disclosure, emerged. Disclosure was delayed because caregivers had to first deal with personal fears which influenced their readiness to disclose; disclosure was also delayed because caregivers did not know how to tell. Caregivers lacked disclosure skills because they had not been trained on how to tell their children about their diagnosis, on how to talk to their children about HIV, and on how to deal with a child who reacts negatively to the disclosure. Caregivers feared that the child might tell others about the diagnosis and would be discriminated and socially rejected and that children would live in fear of death and dying. Health care providers have a critical role to play in HIV disclosure to infected children, considering the caregivers' expressed desire to be trained and prepared for the disclosure.

BackgroundThe increasing access to antiretroviral therapy (ART) and survival of HIV-infected children has posed challenges to caregivers on disclosing the HIV diagnosis to children.ObjectivesThe objectives of this study was to determine the reasons of caregivers for the disclosure and non-disclosure of the HIV diagnosis to children on ART and to determine the caregivers’ perceptions of children's reaction to disclosure.MethodA cross-sectional study was conducted amongst 149 caregivers of children between 4–17 years who receive ART from a district hospital in South Africa. Descriptive and inferential statistics were used in the analysis of data.ResultsThe prevalence of disclosure was 40% and the mean age of disclosure was 9.3 years. Reasons for disclosure included that the child was not adhering to treatment (n = 59; 39%); the child was consistently asking questions about the treatment and nature of the disease (n = 59; 39%). Reasons for non-disclosure were that the child was too young (n = 90; 72%); the child would tell others about diagnosis (n = 90; 21.1%); the child would be socially rejected (n = 90; 18.6%); fear of negative consequences for the child (n = 90; 13.3%); and caregivers do not know how to tell or approach disclosure (n = 90; 8.9%).ConclusionCaregivers disclosed the diagnosis so that their child would adhere to ART medication; non-disclosing caregivers delayed disclosure because their children were too young to understand the HIV diagnosis. Disclosure of HIV to children should be integrated into regular discussions with caregivers of children in ART settings to improve their knowledge and skills to manage disclosure.

The introduction of routine HIV counselling and testing (HCT) has increased the number of pregnant women being tested and receiving prevention of mother to child transmission of HIV (PMTCT) interventions in South Africa. While many women may enroll in PMTCT, there are barriers that hinder the success of PMTCT programmes. The success of the PMTCT is dependent on the optimal utilization of PMTCT interventions which require the support of the woman's partner, and other members of her family. We conducted focus groups interviews with 25 HIV-positive post-natal women enrolled in PMTCT, in the City of Tshwane, South Africa. The study explored HIV-positive status disclosure to partners and significant family members and assessed the effect of nondisclosure on exclusive infant feeding. Most women disclosed to partners while few disclosed to significant family members. Most women initiated mixed feeding practices as early as one month and reported that they were pressurized by the family to mix feed. Mixed feeding was common among women who had not disclosed their HIV-positive status to families, and women who had limited understanding of mother to child transmission of HIV. Women who disclosed to partners and family were supported to adhere to the feeding option of choice. Health providers have a critical role to play in developing interventions to support HIV pregnant women to disclose in order to avoid mixed feeding. Improving the quality of information provided to HIV-positive pregnant women during counselling will also reduce mixed feeding.

The perspectives and practices of health care workers (HCWs) regarding disclosure to HIV-infected children have not been adequately investigated ten years after the roll-out of pediatrics antiretroviral therapy (ART). The aim of the study was to examine the opinions of HCWs about disclosure to HIV-infected children and determine their role in disclosure to children accessing ART in health centers in South Africa. This was a cross-sectional survey using a semi-structured questionnaire among HCWs in ART centers at three hospitals and 48 primary health facilities in two provinces in South Africa. Of the 206 HCWs, 140 (68.2%) were nurses, 44 (21.5%) were lay counsellors, and 4 (2%) were doctors. The majority (n = 183, 89.3%) felt that disclosure benefits children and they should be told about their HIV status. Over half (n = 93, 51.4%) recommended 11–18 years as the appropriate age to disclose. Half (n = 99, 48.5%) said that caregivers should take the lead to disclose, 87 (42.7%) said that disclosure is a shared responsibility of caregivers and HCWs, and 18 (8.8%) said HCWs should lead disclosure. HCWs perceived their role as that of preparing the caregiver for disclosure and the child to understand the disease. However, the lack of guidelines and training on disclosure counselling for children affects their ability to fully participate in disclosure to children. There is a need to adopt the World Health Organizations’ disclosure guidelines for children and adapt them to the local cultural and community contexts and train HCWs to guide, support, and assist caregivers in their disclosure to HIV-infected children.