The HIV-infected child: parental responses and psychosocial implications

HIV-positive status disclosure and associated factors among children in public health facilities in Dire Dawa, Eastern Ethiopia: A cross-sectional study

INTRODUCTION

HIV status disclosure in children is one of acontroversial issue in current health. Over 44,000 children in Ethiopia were living with HIV in the year 2019 with a variable level of disclosure, which ranges from 16.3% to 49%. Therefore, this study aimed to assess HIV-positive status disclosure and associated factors among HIV-infected children.

METHODS

A cross-sectional study was conducted in ten public health facilities providing pediatric antiretroviral therapy services. Systematic random sampling was used to select 221 caregivers of children aged 6-15 years. Face-to-face interviews were employed to generate the data. Binary logistic regression was used to analyze the association between HIV-positive status disclosure to children and independent variables with statistical significance set at p-value <0.05.

RESULTS

Out of the total, 134 (60.6%) of HIV-infected children knew about their HIV status. The mean age at disclosure was 10.71 years. Children aged older than 10 years [AOR = 22, 95% CI: 5.3-79.2], female children [AOR = 3; 95% CI = 1.2-8.7], children lost their family member by HIV [AOR = 3.5, 95% CI: 1.2-10], caregiver's perception of child did not get stigmatized [AOR = 4, 95% CI: 1.6-11], and children's responsible for anti-retroviral therapy [AOR = 16, 95% CI: 5-50] were significantly associated with HIV positive status disclosure compared to their counterpart respectively. Children who stayed on anti-retroviral for 10-15 years were [AOR = 7; 95% CI: 2-27] more likely to know their HIV positive status compared to those staying on anti-retroviral therapy for <6 years.

CONCLUSION

The proportion of disclosure of HIV-positive status among HIV-infected children was low. Factors associated were the age of the child, sex, existence of parent, stigma, ART duration, and responsibility of the child for his/her drugs. HIV care providers should consider these factors while supporting disclosure.

Courage and confidence to stop lying: caregiver perspectives on a video to support paediatric HIV disclosure in Kampala, Uganda

The World Health Organization (WHO) recommends that HIV-positive children are told their diagnosis by age 12 years. However, most perinatally-infected children reach adolescence without being told their HIV status. Effective strategies are needed to promote disclosure, and optimise children's health outcomes as they transition to adolescence and adulthood. This qualitative study explored how caregivers of HIV-positive children aged 7-12 years perceived and related to a video used as part of a larger behavioural intervention to promote full disclosure to children by age 12 years. Eight semi-structured interviews and 3 group reflection sessions with 28 caregivers were analysed thematically. Five themes were generated: courage and confidence; reasoning and empathy; child- caregiver relationship; foreign but relatable; and not reaching everyone. The video was found acceptable and appropriate for fostering readiness to disclose. Through watching it, participants reported they could see people similar to themselves prevail despite challenges, which gave them courage.

Navigating Uncharted Territory: Experiences of Families when a Child is Dying

In this grounded theory study, eight families moved through a process of navigating uncharted territory as they lived with their child who was dying from a neurodegenerative illness. The emotions of fear, uncertainty, and grief gave impetus to the process. Families lived much of their lives on Plateaus of relative stability, where they often felt alone and isolated from health care professionals. Periods of instability led to families dropping off the Plateau. Living with a dying child had profound physical, emotional, and financial effects on families. The process was characterized by four dimensions. Parents used strategies within these dimensions to manage the physical, cognitive, and emotional work arising from the situation. These dimensions and strategies were constrained and facilitated by four intervening conditions. In addition, the process occurred within the broader context of the acute, curative health care system and the sociocultural environment. Suggestions for practice and research are offered to assist health care professionals in providing optimal care to these families.

Socioeconomic Differences in the Effects of Prayer on Physical Symptoms and Quality of Life

The extent to which religiosity is related to well-being may differ as a function of race/ethnicity, education or income. We asked 155 caregivers to complete measures of religiosity, prayer, physical symptoms and quality of life. Lower education and, to a lesser extent, lower income were correlated with religiosity and prayer. There were few direct relationships of religiosity and prayer with quality of life and health symptoms. However, the relationships became significant when education and, to a lesser degree, income were taken into account. Prayer was associated with fewer health symptoms and better quality of life among less educated caregivers.

Caregivers' Attitudes towards HIV Testing and Disclosure of HIV Status to At-Risk Children in Rural Uganda

Caregivers of HIV-positive children were interviewed in the Mbarara and Isingiro districts of Uganda to identify current trends in practices related to HIV testing and the disclosure of HIV status to the child. A total of 28 caregivers of at least one HIV-positive child participated in semi-structured interviews exploring when and why they tested the child for HIV, when the child was informed of their positive status, and what the caregiver did to prepare themselves and the child for status disclosure. For a majority (96%) of respondents, the decision to test the child for HIV was due to existing illness in either the child or a relative. Other common themes identified included the existence of stigma in the caregivers’ communities and doubt that the children truly understood what was being explained to them when their status was disclosed. Most (65%) children were informed of their HIV status between the ages of 5 and 9, with the mean age of disclosure occurring at the age of 7. General provision of HIV information typically began at the same age as disclosure, and as many as two thirds (64%) of the caregivers sought advice from an HIV counsellor prior to disclosure. How a caregiver chose to prepare themselves and the child did not affect the caregiver’s perception of whether the disclosure experience was beneficial or not. These findings suggest that the HIV disclosure experience in Mbarara and Isingiro districts differs from current guidelines, especially with respect to age of disclosure, how caregivers prepare themselves and the child, and approaching disclosure as an ongoing process. The doubts expressed by caregivers regarding the child’s level of HIV understanding following the disclosure experience suggest the children may be insufficiently prepared at the time of the initial disclosure event. The findings also suggest that examining the content of pre-disclosure counselling and HIV education, and how health care professionals are trained to facilitate the disclosure process as important avenues for further research.

Prevalence and Correlates of HIV Disclosure Among Children and Adolescents in Low- and Middle-Income Countries: A Systematic Review

OBJECTIVE

Disclosure of HIV status among children and adolescents living with HIV has both beneficial and challenging aspects. To address existing knowledge gaps and update the literature on childhood disclosure, we conducted a systematic review on caregivers' perceptions and practices of HIV disclosure in low- and middle-income countries (LMICs).

METHODS

Standard databases were searched for studies conducted in LMICs, published in English between 2004 and 2015. Excluded articles were reviews or case reports, and those not reporting childhood disclosure. Data regarding prevalence, correlates and impact of disclosure, were presented as frequencies.

RESULTS

Two authors independently screened 982 articles. After applying eligibility criteria, 22 articles representing 12 countries and 2,843 children were reviewed. The proportion of fully disclosed children ranged from 1.7% to 41.0%. Up to 49.5% children were provided "deflected" information (use of a non-HIV-related reason for explaining illness and health care visits). Factors associated with full disclosure included antiretroviral treatment initiation and caregivers' felt need for maintaining optimal adherence. Barriers to disclosure included fear of negative psychological reactions and inadvertent disclosure to others. Caregivers perceived a strong need for active participation from health care providers to aid the process of disclosure.

CONCLUSIONS

Full disclosure of HIV status was not common among children and adolescents in LMICs, while the practice of deflected disclosure was prominent. Caregivers perceived the need for support from health care providers during the disclosure process. Evidence-based guidelines incorporating the developmental status of the child, locally prevalent cultures, and caregiver perceptions are prerequisite to enhancing disclosure in these settings.

Adolescents living with HIV in India - the clock is ticking

The term "Adolescence" literally means "to emerge" or "to attain identity" and is essentially the period of rapid physical and psychological development starting from the onset of puberty to complete growth. All adolescents go through a myriad of physical, psychological, neurobehavioural, hormonal and social developmental changes. Given the social taboos often surrounding puberty, the lives of millions of adolescents worldwide are at risk because they do not have the information, skills, health services and support they need to go through the enormous, rapid changes that adolescence brings. A HIV infected adolescent particularly presents enormous challenges in the current cultural and social context of India. The distinct groups of adolescents in the context of HIV are those who were infected at birth and survived and those who became infected during adolescence. Risk factors and situations for adolescents contracting HIV infection are life on streets, lack of adult love/care and support, extreme poverty, child trafficking, migrant population, exploitation in terms of sex and labor. HIV-infected adolescents with long standing HIV infection often face considerable physical challenges - delayed growth and development, late puberty, stunting/wasting, malnutrition, etc. Added to this are many other challenges related mainly to disclosure of HIV status, developmental delay, and transition from pediatric to adult care, including the choice of appropriate treatment regimens and adherence. Psychological and social factors deeply impact the ability to deal with the illness and must be addressed at all levels to encourage and support this vulnerable group.

Patterns of disclosure of HIV status to infected children in a Sub-Saharan African setting

OBJECTIVE

Adult caregivers provide children living with HIV with varying amounts and types of information about their health status that may affect their coping and health care behaviors. We aimed to describe patterns of information sharing with children and thoughts around disclosure among caregivers in the Democratic Republic of the Congo.

METHODS

A total of 259 primary caregivers of children aged 5 to 17 years in an HIV pediatric care and treatment program were screened; 8 adult caregivers (3%) had informed their child of the child's HIV status. We conducted structured interviews with 201 caregivers whose children had not yet been told their HIV status.

RESULTS

Nearly 50% of caregivers had provided no information to their child about their health; 15% had given partial information without mentioning HIV, and 33% provided information that deflected attention from HIV, whether deliberately so or otherwise. Almost all caregivers said that the child should be told their status some day, and three-fourths reported having ever thought about what might lead them to tell. However, nearly one-third of caregivers saw no benefits to informing the child of her/his HIV status. A majority of caregivers felt that they themselves were the best to eventually disclose to the child but some wanted support from health care providers.

CONCLUSIONS

HIV-infected children are given limited information about their health. Health care providers may serve as important sources of support to caregivers as they decide when and how to talk candidly with their children about their health.

Telling children they have HIV: lessons learned from findings of a qualitative study in sub-Saharan Africa

HIV-infected children in developing countries are living longer lives as they gain access to antiretroviral treatment programs. As they grow older, their parents/guardians are faced with the difficult decision of if, when, and how to inform their child of his/her HIV status. Both negative and positive social, psychological, and behavioral impacts of disclosure to children have been reported, including improved adherence to medication regimens. Understanding the disclosure process from the perspective of HIV positive children, therefore, is critical to developing these interventions. Through children's experiences we can learn about what works well, what needs to be strengthened, and what is missing in current disclosure practices. We conducted in-depth interviews with eight caregiver-child dyads in Kinshasa, Democratic Republic of the Congo. The children were in a comprehensive HIV pediatric care and treatment program and had already been told their HIV diagnosis. For the analysis we placed particular emphasis on children's reports of communication with their caregivers and health care providers about their illness. Patterns emerged of limited communication between children and their caregivers as well as their providers, before, during, and after disclosure. From the perspective of children in this study, disclosure was largely a discrete event rather than a process. Sociocultural contexts surrounding HIV/AIDS, as well as health status, variations in parent-child communication and the relationships between health providers and children under their care, should inform psychosocial interventions delivered alongside treatment programs.

Disclosure of the HIV infection status in children

OBJECTIVE

To determine the perception of caregivers about the disclosure of the diagnosis of HIV infection in children.

METHODS

Caregivers of fifty HIV-infected children were enrolled in the study after taking written informed consent. They were interviewed using a structured questionnaire. The questionnaire included information on the demographic details, questions about the disclosure status of HIV infection in children and perceptions about the disclosure of status to child.

RESULTS

Only 7 out of the 50 children (14%) were aware of their HIV status while 43/50 (86%) were unaware; as reported by their guardians/ parents. Only 6 percent children (3/50) were given factual information about the disease while 68% (34/50) were given no information. Majority of caregivers felt mid-teenage as the appropriate age for disclosing the HIV infection status and that the parents were the appropriate persons to reveal the infection status (21/50, 42%).

CONCLUSION

There is need to develop and implement guidelines for disclosure of HIV infection status to HIV-infected children in resource limited settings.

Maintaining love and hope: caregiving for Thai children with HIV infection

In this grounded theory study, the author explored how primary caregivers dealt with problems in caring for children with HIV infection in Thailand. A total of 27 family caregivers of HIV-infected children participated in open-ended interviews. Maintaining love and hope represented a condition for the continuing process of caregiving. Caregivers had to deal with the stigma of AIDS while providing care for children with HIV. They had high anxiety and fear of loss, bore much burden of care, and faced many difficulties because of limited resources. The results suggest that psychosocial care and informational support are needed to enable these caregivers to provide better care for children with HIV infection.

Experiences of families in which a child has a prolonged terminal illness: modifying factors

A significant proportion of children requiring palliative care have neurodegenerative life-threatening illnesses (NLTIs). While most of their care is provided at home by their families over many years, there is a paucity of research examining families' experiences when a child with an NLTI is dying at home. In this grounded theory study, data were collected from eight families through observations and audiotaped interviews. Families moved through a process of 'navigating uncharted territory' as they lived with their dying child. The strategies that families used to manage this phenomenon were influenced by four intervening conditions that reflected the broader structural context of the phenomenon; relationships with healthcare providers, availability of information, gender differences, and communication between parents. Each condition facilitated or constrained the strategies that families were able to use. Implications for research, education and practice are discussed.

Long-term goals and normalization strategies of children and families affected by HIV/AIDS

Decreasing morbidity and mortality of HIV/AIDS has created a growing population of parents and children who are long-term survivors. Using symbolic interaction and ethnographic methods, this study explores families' long-term goals and normalization strategies and the relevance of the published attributes of the concept of normalization for families affected by HIV disease. Findings indicate that treatment complexity and the need for stigma management prevent families from defining their lives as normal, but they do deliberately use normalization strategies to achieve the following goals: health maintenance for members with HIV, facilitation of children's school participation, and enhancement of the emotional well-being of all family members.

Caring for the child and family with HIV disease

Caring for children with HIV infection is a much more optimistic process than in the beginning of the epidemic. Antiretroviral therapies are available, and additional drugs are receiving approval from the US Food and Drug Administration. Cautious optimism must be tempered with an understanding that living with the disease is a complicated and daunting process for these children and their families. Although scientific knowledge and medical treatments are moving forward, the social and environmental uncertainties remain for families. Comprehensive care is a balance of health care services and supportive, community-based services offered in a compassionate manner.

Disclosure of illness status to children and adolescents with HIV infection. American Academy of Pediatrics Committee on Pediatrics AIDS

Many children with human immunodeficiency virus (HIV) infection and acquired immunodeficiency syndrome are surviving to middle childhood and adolescence. Studies suggest that children who know their HIV status have higher self-esteem than children who are unaware of their status. Parents who have disclosed the status to their children experience less depression than those who do not. This statement addresses our current knowledge and recommendations for disclosure of HIV infection status to children and adolescents.

The effect of a social support boosting intervention on stress, coping, and social support in caregivers of children with HIV/AIDS

BACKGROUND

Caring for the human immunodeficiency virus (HIV)-infected child is challenging and affects the entire family system. Studies have shown that social support can mitigate caregiver stress and enhance coping; however, social support may not always result in a positive outcome for the recipient.

OBJECTIVES

To measure caregiver stress, coping, and social support, and to test the effect of a social support boosting intervention on levels of stress, coping, and social support among caregivers of children with HIV/acquired immune deficiency syndrome (AIDS).

METHODS

An experimental design was used with monthly social support boosting interventions implemented. The stratified randomized sample included 70 primary caregivers of children with HIV/AIDS. The sample strata were seropositive caregivers (biological parents) and seronegative caregivers (foster parents and extended family members). Study measures included the Derogatis Stress Profile, Family Crisis Oriented Personal Evaluation Scale, and the Tilden Interpersonal Relationship Inventory. Data were analyzed using descriptive statistics and repeated measure MANOVA.

RESULTS

Statistically significant differences between the experimental and control groups were found on changes in the dependent variables over time when caregiver strata were included as a factor in the analysis; no statistically significant results were found when caregiver strata were combined. Univariate Ftests indicated that the level of social support for caregivers who were seronegative in the experimental group was significantly different from seronegative caregivers in the control group and seropositive caregivers in both groups. No significant treatment group differences were found for seropositive caregivers.

CONCLUSIONS

Seronegative caregivers derived substantial benefit from the social support boosting intervention. Seronegative caregivers who acquire a child with HIV/AIDS are confronted with a complex stressful situation; the critical need to enhance their social support is achievable through the intervention tested in this study.

Effects of social support, stress, and level of illness on caregiving of children with AIDS

The purpose of this descriptive correlational study was to explore the relationship between social support, stressors, level of illness, and perceived caregiver burden in caregivers of children with HIV/AIDS. Instruments used were: (1) the Classification System for Human Immunodeficiency Virus (HIV) Infection in Children Under 13 Years of Age (1987), (2) the Daily Hassles Scale, (3) the Tilden Interpersonal Relationship Inventory (IPRI), (4) the Derogatis Stress Profile (DSP), and (5) the Caregiver Appraisal Scale. The sample was drawn from two medical centers in New Jersey. The 49 caregivers of children with perinatally acquired HIV were predominantly HIV-positive biological mothers of African American descent whose education ranged from 8th grade through college. One-half of the children were classified at the CDC P2 level. Descriptive statistics and stepwise multiple regression were used to analyze the data. The results of the DSP indicated subjects were slightly below the 70th percentile for anxiety, depression, hostility, and work stressors and that subjects' social support levels were in the upper end of the low support category. Stepwise regression indicated that depression and anxiety predicted 40% of the variance in caregiver burden (R2 = .399; F = 14,985; p = .000). Hostility and level of social support predicted 37% of the variance in caregiving impact (R2 = .37; F = 13.254; p = .000). Finally, social support predicted 17.5% of the variability in the caregivers' sense of caregiving competency (R2 = .175; F = 9.788; p = .003). The child's level of illness and HIV status of caregiver did not significantly predict variance in caregiving appraisal.