Parental HIV serodiscordance: Implications for the care of the HIV seropositive child in a resource-poor setting

Abstract

This prospective study compared the care and support provided for symptomatic HIV seropositive children of HIV serodiscordant parents (only the mother of the child is HIV infected) with children of seroconcordant parents (both parents are HIV infected) during admission and after discharge from a tertiary health institution in southwestern Nigeria. Information was collected from parents of eligible children by semi-structured questionnaires and observation of the children and their parents while on admission and at home. Of the 51 couples who met the study criteria, there were 27 seroconcordant couples and 24 serodiscordant couples. The children from serodiscordant couples were more frequently discharged against medical advice, abandoned, lost to follow-up, cared for by their mothers alone and were not up-to-date with their immunization schedule when compared with children from seroconcordant parents. These were statistically significant (p < 0.05). There was a higher mortality among these children and their mothers (p < 0.05). Paternal reasons for not providing adequate care for the children from serodiscordant parents included fear of being infected, doubt of child's paternity and waste of family resources on a 'child who is dying'. None of the children from both groups received support from governmental and non-governmental agencies. It is concluded that the care of sick HIV seropositive children of serodiscordant parents poses special challenges for clinicians working in Nigeria where there is no social support system.

Experiences of Inner-City Fathers of Children With Chronic Illness

“…A 2006 study looked at paternal support of children infected with HIV in sero-concordant and sero-discordant families in Nigeria. 29 Children from sero-discordant families, with HIV-positive mothers and HIV-negative fathers, received less paternal care and had a higher mortality rates. Fathers commonly reported spending less family resources for care if they perceived low survival prospects for the child.…”

“…These findings therefore may not be specific to inner-city fathers. Four of these studies did not explicitly comment on research ethics board approval, 24,25,27,29 possibly compromising the integrity of the research. Additionally, it is important to consider the country in which each study was conducted where differences in health care funding structures would likely impact the level of financial stress that low SES fathers would experience.…”

Infant Feeding Intentions and Practices of HIV-Positive Mothers in Southwestern Nigeria

“…In fact, choosing to use replacement feed is tantamount to announcing their HIV status, and the consequences of this are far reaching and could involve violence and divorce. 12 In this study, only about half of the mothers had disclosed their HIV status to their spouses, and even fewer had disclosed their status to other family members. Disclosure of HIV status was associated with the intention to use ERF in this study, in keeping with the reports of other researchers.…”

Infant feeding practice and associated factors of HIV positive mothers attending prevention of mother to child transmission and antiretroviral therapy clinics in Gondar Town health institutions, Northwest Ethiopia

“…Deep-rooted family and community norms make it difficult for mothers in Ethiopia as in most developing countries to choose ERF. In fact, choosing to use replacement feed is equivalent to announcing their HIV status, and the consequences of this are far reaching and could involve violence and divorce [22]. About 87% of the mothers had disclosed their HIV status to their spouses, and 65.6% of the mothers had disclosed their status to their family members.…”