Disclosure of HIV status to infected children in a Nigerian HIV Care Programme

Abstract

With increasing survival of HIV-infected children, parents face the challenges of disclosure to the children. The aim of this study was to assess the rate of HIV disclosure to children in Ibadan and the factors influencing it in order to guide design of strategies for successful disclosure. A semi-structured questionnaire was administered to consecutive consenting caregivers of HIV-infected children aged ≥6 years attending the Paediatric Infectious Disease Clinic of the University College Hospital, Ibadan, between November 2008 and October 2009. Caregivers of 96 children (46 boys, 50 girls) infected with HIV were interviewed. The ages of the children ranged from 6 to 14 years with a mean (SD) of 8.8 (2.2) years. Disclosure had been done in only 13 (13.5%) of the children; ages at disclosure ranged from 4.5 to 13 years with a mean of 8.7 (SD = 2.2). Disclosure was associated with age above 10 years. Reasons given by carers for non-disclosure in 83 caregivers included inability of the children to understand in 53 (63.9%), fear of disclosure to other children 34 (41.0%), fear of disclosure to family/friends in 28 (33.7%), fear of psychological disturbance of the children in 26 (31.3%) and fear of blaming the parents in 22 (26.5%). Twenty (20.8%) of the children have asked questions relating to their diagnosis and the responses are often evasive. Caregivers felt disclosure had helped adherence to antiretroviral therapy in 7 (63.6%) of the 11 children on antiretroviral drugs in whom there was disclosure but no effect on the remaining. There is a need to assist parents and health care providers in successfully disclosing HIV status to infected children without adverse consequences.

Status Disclosure in HIV Infected Children in Abakaliki, Ebonyi State, Southeast, Nigeria

“…A total of 31 (33.0%) of HIV infected children studied had a form of information about their status. This is higher than 13.0% reported by Brown et al 15 in a study in Ibadan, southwest, Nigeria but consistent with a later study carried out by Ubesie et al 17 (29.0%). This suggests an increase in enlightenment and awareness of the need of disclosing HIV status to infected children.…”

“…Vreemanet al 12 reported level of status disclosure to be between 0 to 69.2%. Mialky et al 14 reported 43% disclosure rate with mean age of nine years, 23% of them have disclosed status to school authority, while Brown et al 15 in a study in Nigeria reported a lower level of status disclosure (13.0%). Common barriers to status disclosure in the review by Vreeman et al 12 were fear that the child would disclose HIV status to others, fear of stigma and concerns of emotional and physical health of child.…”

HIV-positive parents, HIV-positive children, and HIV-negative children’s perspectives on disclosure of a parent’s and child’s illness in Kenya

“…ART adherence has been shown to increase following full disclosure (Bikaako-Kajura et al, 2006;Brown et al, 2011;Fetzer et al, 2011;Hejoaka, 2009;Vaz et al, 2008) with improvements in CD4 counts leading to fewer incidences of disease progression and death (Enzama & Mugyenyi, 2005;Ferris et al, 2007). HCPs should encourage parents of infected children with deteriorating health status and reducing CD4 counts to perform full disclosure to these children.…”

“…HIV disclosure studies in SSA have mainly centered on telling children about their own HIV status, and a few have been on telling children about their parents" HIV statuses. Recent studies on disclosure to HIV-positive children have revealed HIV disclosure rates between 2-50% in Kenya (John-Stewart et al, 2013;Turissini et al, 2013;Vreeman et al, 2010;Vreeman et al, 2014); and 2-38% in other SSA countries (Biadgilign et al, 2011;Bikaako-Kajura et al, 2006;Brown et al, 2011;Feinstein et al, 2010;Fetzer et al, 2011;Hejoaka, 2009;Kallem et al, 2011, Menon et al, 2007Moodley et al, 2006;Vaz et al, 2010). Research suggests that the typical age ranges of HIV-positive children receiving disclosure of their own HIV status was between 3 and 19 years in Kenya (Vreeman et al, 2014); 8 and 18 years in the Democratic Republic of Congo (Vaz et al, 2010;Vaz et al, 2008); and 5 and 15 years in South Africa (Heeren et al, 2012;Moodley et al, 2006).…”

A Couple’s Marital Disharmony and its Psychological Effects on their Children during the HIV Disclosure Process in Kenya

“…This is more so when there are many family members infected, who may include both parents (Republic of Kenya, 2009). When parents delay disclosure, children sense secrets within their households and ask persistent questions in a bid to elicit disclosure (Brown et al, 2011;Gachanja, 2015;Gachanja et al, 2014a;Gachanja et al, 2014b;Kallem et al, 2011;Kouyoumdjian et al, 2005;Petersen et al, 2010;Vaz, Maman, Eng, Barbarin, Tshikandu, & Behets, 2011). Disclosure is a process that moves children from a state where they have no disclosure or no knowledge of their parents' illnesses (Bikaako-Kajura et al, 2006;Kallem et al, 2011;Oberdorfer et al, 2006;Vaz et al, 2011), to partial disclosure where they know that their parents have a chronic illness or are taking medications (Bikaako-Kajura et al, 2006;Rochat, Mkwanazi, & Bland, 2013;Vaz et al, 2011), and finally to full disclosure when the children are told that their parents are infected with HIV (BikaakoKajura et al, 2006;Kallem et al, 2011;Oberdorfer et al, 2006;Rochat et al, 2013).…”