Socio-demographic, clinical, and psychosocial factors associated with primary caregivers’ decisions regarding HIV disclosure to their child aged between 6 and 12 years living with HIV in Malawi

Abstract

The World Health Organisation (WHO) recommends that children living with HIV should be informed about their HIV status within the ages of 6 to 12 years using age-appropriate resources. The aim of this study was to assess the socio-demographic, clinical and psychosocial factors associated with primary caregivers’ decisions to disclose HIV to children living with HIV aged 6 to 12 years in Malawi. A cross-sectional study of 429 primary caregivers of children living with HIV were systematically recruited from all regions of the country. Information on HIV disclosure, family and child socio-demographic characteristics, child clinical characteristics, and child and family psychosocial characteristics was collected using validated instruments. Logistic regression was used to analyse data. The prevalence of non-disclosure of HIV status to children was 64 per cent. Concerns about the child’s inability to cope with the news (29%), a lack of knowledge on how to disclose HIV status (19%), and fear of stigma and discrimination (17%) were the main reasons for non-disclosure. On multivariate analysis, the odds of non-disclosure were higher among primary caregivers who were farmers (aOR 3.0; 95% CI: 1.1–8.4), in younger children (6–8 years) (aOR 4.1; 95% CI: 2.3–7.4), in children who were in WHO HIV clinical stage one (aOR 3.8; 95% CI: 1.4–10.2), and in children who were not asking why they were taking ARVs (aOR 2.9; 95% CI: 1.8–4.8). On the other hand, nondisclosure of HIV status was less likely in underweight children (aOR 0.6; 95% CI: 0.3–0.9). Many children living with HIV in Malawi are unaware of their HIV status. Non-disclosure is associated with a number of clinical and demographic characteristics. The findings highlight the need to provide guidance and support to primary caregivers to help them to effectively disclose HIV status to their children.

HIV Stigma and Status Disclosure in Three Municipalities in Ghana

“…Other studies have reported similar factors inhibiting HIV status disclosure in Ghana [ 3 13 ]. Similar findings in addition to the age of children and the inability to cope with disclosure news have been reported elsewhere [ 14 15 25 ]. An analysis of all the reasons provided in the numerous research findings on factors comes to one overarching factor, HIV-related stigma, and all the different forms in which it occurs.…”

“…However, stigma and discrimination against PLWHA are widespread and constitute major drawbacks in fighting HIV/AIDS including testing and HIV status disclosure [ 11 12 ]. Researchers have reported HIV-related stigma, both internalized and experienced or expected, as a major challenge in HIV status disclosure in Ghana and elsewhere including guilt, shame, fear of abuse, and rejection among others [ 3 13 14 15 ]. Stigmatization and discrimination of PLWHA take many forms including rejection by their communities and family members, refusal to eat with, share bed, shake hands, blaming, and ostracism [ 12 16 ].…”

Prevalence, socio-demographics and service use determinants associated with disclosure of HIV/AIDS status to infected children: a systematic review and meta-analysis by 1985–2021

“…Thirty-four studies [ 5 , 9 , 31 – 41 , 43 , 44 , 46 – 59 , 61 – 64 ] reported the prevalence rate of disclosure of HIV/AIDS status to infected children. Thirteen studies were from a low income country setting [ 5 , 32 – 34 , 38 – 40 , 46 , 49 , 51 , 59 , 62 , 63 ], fourteen studies were in a lower middle income country setting [ 31 , 35 – 37 , 41 , 44 , 47 , 48 , 52 , 53 , 55 , 56 , 58 , 61 ] and eight were from a upper-middle-income country [ 9 , 43 , 50 , 54 , 57 , 64 , 65 ]. The studies were published between 2008 and 2021, and the sample sizes ranged from 39 to 10,673.…”

“…Seventeen of the studies [ 5 , 38 , 41 , 44 , 45 , 48 – 50 , 53 , 55 , 58 – 60 , 62 – 65 ] examined the association of being aged older than 10 years and disclosure of HIV/AIDS status. Three studies were from a upper-middle-income country [ 50 , 64 , 65 ], six studies were conducted in a lower middle income country setting [ 41 , 44 , 48 , 53 , 55 , 58 ] and eight of the published studies used data from a low income country seating [ 5 , 38 , 45 , 49 , 59 , 60 , 62 , 63 ]. The studies were published between 2008 and 2021, and the sample sizes ranged from 174 to 449.…”

Content validation to support the monitoring of disclosure of HIV diagnosis in childhood

“…In the professional context, the health service must offer working conditions to achieve an adequate organization, since each area has a particular perception regarding communication (32) . It should also provide moments of discussion, training courses for the team and a private place for communication (32)(33) .…”