HIV Disclosure in Children in This Millenium – Should It still be an Issue?

Background: As more children with HIV survive into adolescence and adulthood, one of the most difficult issues that families with HIV-infected children face is disclosure of their children’s status to them.

Objective: To explore factors associated with disclosure or none disclosure and whether disclosure is beneficial or not.

Methods: The mothers of HIV positive children who brought their children aged 5-18 years to the Paediatric Infectious Disease Clinic of the University of Port Harcourt Teaching Hospital from January to December 2015 were interviewed using a structured investigator administered questionnaire.

Results: Of the 100 caregivers interviewed, 26.0% have disclosed the HIV status to the children. The mean age at disclosure was 14.42 ± 2.45 years. Care givers that have disclosed were significantly older (45.58±8.32 years vs 38.18±9.2 years; p = .0002). The mean age of children whose status have been disclosed was significantly higher than those who were yet to be aware of their status (14.42±2.45years vs 10.97±3.11 years; p = 0.00001). There was no significant difference in the mode of transmission and orphan status between the two groups. Disclosure was significantly more among children who were diagnosed between 5-10 years of age (14; 53.8%) (p=0.013), have taken antiretroviral drugs for over 24 months (22; 84.6%) (p= 0.003) and had at least one HIV-infected sibling (21; 80.8%) (p=0.00001). Among 13 (50.0%) whose status have been disclosed and 59 (79.7%) whose status had not been disclosed, the caregiver had disclosed the child’s status to others (p= 0.004). The major reason for disclosing was because the child was either asking questions on why he/she is taking drugs or he/she is refusing to take drugs (15; 57.7%) respectively. Only 6 (23.1%) caregivers disclosed because they felt the child has a right to know. Most difficult question asked by the children during disclosure was how they got the HIV (22; 84.6%). Reasons given for non-disclosure included fear of disclosure to others (74; 100%), child too young to understand (70; 94.5%) and fear of impact on child’s emotional health (42; 56.7%). Majority 20 (76.9%) of the care givers felt relieved after disclosure. Twenty-four (92.3%) caregivers felt disclosure had improved child’s adherence to antiretroviral therapy and determination to survive (22; 84.6%).

Conclusion: Disclosure is beneficial to both the child and caregiver. Healthcare providers should encourage caregivers to disclose HIV status to their children as soon as possible.