Disclosure of human immunodeficiency virus status to children in South Africa : a comprehensive analysis
Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
AOSIS Publishing
Abstract
Background: The extent of disclosure of HIV status to children and adolescents and the context
facilitating their disclosure process have received little attention.
Objectives: To assess disclosure and provide a comprehensive analysis of characteristics
associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a South
African semi-urban clinic.
Methods: This cross-sectional study used structured interview administered questionnaires
which were supplemented with medical record data. Predictors included child, caregiver,
clinical and socio-economic characteristics, viral suppression, immune response, adherence,
health-related quality of life and family functioning.
Results: We included 190 children of whom 45 (23.7%) received disclosure about their HIV
status, of whom 28 (14.7%) were partially disclosed and 17 (8.9%) were fully disclosed. Older
age of the child and higher education of the caregiver were strongly associated with disclosure.
Female caregivers, detectable viral load, syrup formulation, protease inhibitor (PI) regimens
with stavudine and didanosine, and self-reported non-adherence were strongly associated
with non-disclosure.
Conclusion: When children do well on treatment, caregivers feel less stringent need to disclose.
Well-functioning families, higher educated caregivers and better socio-economic status
enabled and promoted disclosure. Non-disclosure can indicate a sub-optimal social structure
which could negatively affect adherence and viral suppression. There is an urgent need to
address disclosure thoughtfully and proactively in the long-term disease management. For the
disclosure process to be beneficial, an enabling supportive context is important, which will
provide a great opportunity for future interventions.
Description
CITATION: Van Elsland, S. L., et. al. 2019. Disclosure of human immunodeficiency virus status to children in South Africa : a comprehensive analysis. Southern African Journal of HIV Medicine, (20(1):a884, doi:10.4102/sajhivmed.v20i1.884.
The original publication is available at http://www.sajhivmed.org.za/
The original publication is available at http://www.sajhivmed.org.za/
Keywords
Paediatric, Disclosure of information, HIV (Viruses), Information processing in children, HIV-positive children
Citation
Van Elsland, S. L., et. al. 2019. Disclosure of human immunodeficiency virus status to children in South Africa : a comprehensive analysis. Southern African Journal of HIV Medicine, (20(1):a884, doi:10.4102/sajhivmed.v20i1.884