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Nabunya P, Namuwonge F, Sensoy Bahar O, Ssentumbwe V, Migadde H, Mugisha J, Ssewamala FM. Stigma by Association, Parenting Stress, and the Mental Health of Caregivers of Adolescents Living With HIV in Uganda. J Adolesc Health 2023; 72:S18-S23. [PMID: 37062579 PMCID: PMC10151126 DOI: 10.1016/j.jadohealth.2022.08.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 07/14/2022] [Accepted: 08/26/2022] [Indexed: 04/18/2023]
Abstract
PURPOSE This study examined the relationship between stigma by association-defined as prejudice and discrimination against individuals who are associated with stigmatized individuals, parenting stress, and the mental health of caregivers of adolescents living with HIV. METHODS Multivariate regression analyses were conducted using baseline data from the Suubi4Stigma study (2020-2022), a pilot study addressing HIV-related stigma among adolescents and their caregivers in southern Uganda. RESULTS The average age was 47 years, 77.5% were female, and 49% identified as the child's biological parent. Stigma by association was associated with poor caregiver mental health (b = 1.346, 95% confidence interval = 0.49, 2.21) and parenting stress (b = 1.431, 95% confidence interval = 0.79, 2.08). Caregiver's gender, biological relatedness, household composition, and family cohesion were uniquely associated with caregiver mental health and parenting stress. DISCUSSION Findings point to the need to incorporate stigma reduction components, not only for adolescents living with HIV, but also their caregivers, to counteract the effects of stigma on their mental health.
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Affiliation(s)
- Proscovia Nabunya
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri.
| | - Flavia Namuwonge
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - Ozge Sensoy Bahar
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Vicent Ssentumbwe
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
| | - Herbert Migadde
- International Center for Child Health and Development (ICHAD), Masaka, Uganda
| | - James Mugisha
- College of Health Sciences, Makerere University, Kampala
| | - Fred M Ssewamala
- International Center for Child Health and Development (ICHAD), Brown School, Washington University in St. Louis, St. Louis, Missouri
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Kairania R, Onyango-Ouma W, Ondicho TG. Socio-Cultural Influencers of Disclosure of HIV Status to Children on Antiretroviral Therapy in the Masaka Region, Uganda: A Qualitative Study. J Int Assoc Provid AIDS Care 2023; 22:23259582231163695. [PMID: 36972496 PMCID: PMC10052469 DOI: 10.1177/23259582231163695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
This study explored sociocultural influencers of disclosure of HIV status to children taking daily antiretroviral therapy (ART) in the Masaka region, Uganda using data collected from 26 key informant interviews with caregivers between October 2020 and July 2021. The findings revealed both positive and negative sociocultural influencers of disclosure. Beliefs that disclosure cultivates responsibility in the child to improve ART adherence and the culture of routine sexual health education conversations with children were positive socio-cultural influencers. Beliefs that disclosure increases children's loss of hope in life and breaks confidentiality with children inadvertently disclosing their HIV status to others leading to discrimination and social rejection, were key negative sociocultural influencers. These findings suggest a need for socio-culturally informed interventions that target caregiver negative socio-cultural disclosure influencers in this setting through contextualized sensitization and training to prepare children taking daily ART to receive disclosure progressively.
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Affiliation(s)
- Robert Kairania
- Institute of Anthropology, Gender and African Studies, 107854University of Nairobi, Nairobi, Kenya
- Uganda Virus Research Institute, 561068Rakai Health Sciences Program, Entebbe, Uganda
| | - Washington Onyango-Ouma
- Institute of Anthropology, Gender and African Studies, 107854University of Nairobi, Nairobi, Kenya
| | - Tom G Ondicho
- Institute of Anthropology, Gender and African Studies, 107854University of Nairobi, Nairobi, Kenya
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Magill EB, Nyandiko W, Baum A, Aluoch J, Chory A, Ashimoshi C, Lidweye J, Njoroge T, Sang F, Nyagaya J, Scanlon M, Hogan J, Vreeman R. Factors associated with caregiver compliance to an HIV disclosure intervention and its effect on HIV and mental health outcomes among children living with HIV: post-hoc instrumental variable-based analysis of a cluster randomized trial in Eldoret, Kenya. Front Public Health 2023; 11:1150744. [PMID: 37213654 PMCID: PMC10196043 DOI: 10.3389/fpubh.2023.1150744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 04/03/2023] [Indexed: 05/23/2023] Open
Abstract
Background The HADITHI study is a cluster-randomized trial of children living with HIV and their caregivers in Kenya that aimed to increase rates of caregiver disclosure of their child's HIV status, encourage earlier status disclosure, and improve pediatric mental health and HIV outcomes. This analysis identified characteristics predicting caregiver non-responsiveness and compared outcomes among children based on disclosure status. Methods A penalized logistic regression model with lasso regularization identified the most important predictors of disclosure. The two-stage least squares instrumental variable approach was used to assess outcomes accounting for non-compliance to disclosure. Results Caregiver non-isolation and shorter time on antiretroviral therapy were predictive of HIV status disclosure. There were no statistically significant differences found in CD4 percentage, depression status, or mental and emotional status based on disclosure status up to 24 months-post intervention. Conclusion These findings have implications for specialists seeking to tailor disclosure interventions to improve caregiver-child dyad responsiveness.
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Affiliation(s)
- Elizabeth B. Magill
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Elizabeth B. Magill
| | - Winstone Nyandiko
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Child Health and Pediatrics, School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
| | - Aaron Baum
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Josephine Aluoch
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Ashley Chory
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Janet Lidweye
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Tabitha Njoroge
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Festus Sang
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Jack Nyagaya
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
| | - Michael Scanlon
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Center for Global Health, Indiana School of Medicine, Bloomington, IN, United States
| | - Joseph Hogan
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- Department of Biostatistics, Brown University School of Public Health, Providence, RI, United States
| | - Rachel Vreeman
- Department of Health Systems Design and Global Health, Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York, NY, United States
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- *Correspondence: Rachel Vreeman
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Desai N, Jenkins CA, Zanoni B, Nmoh A, Patel N, Shepherd BE, Hussen S, Doraivelu K, Pierce L, Carlucci JG, Ahonkhai AA. High Rates of Viral Suppression and Care Retention Among Youth Born Outside of the United States with Perinatally Acquired HIV. Pediatr Infect Dis J 2022; 41:970-975. [PMID: 36102695 PMCID: PMC9669206 DOI: 10.1097/inf.0000000000003698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Youth born outside of the US with perinatally acquired HIV infection (YBoUS-PHIV) account for most children living with HIV in the US, but there are few data characterizing their care outcomes. METHODS We conducted a retrospective study of YBoUS-PHIV receiving care across 3 HIV clinics in the Southeastern US between October 2018 and 2019. Primary outcomes were retention in care and viral suppression defined as (1) proportion of suppressed viral loads (VLs) and (2) having all VLs suppressed (definition 1 presented in the abstract). Primary predictors were age, adoption and disclosure status (full, partial and none/unknown). Multivariable logistic regression and χ 2 tests were used to test for associations with care outcomes. Analysis of disclosure status was restricted to youth greater than or equal to 12 years. RESULTS The cohort included 111 YBoUS-PHIV. Median age was 14 years (interquartile range, 12-18), 59% were female, and 79% were international adoptees. Overall, 84% of patients were retained in care, and 88% were virally suppressed at each VL measurement. Adopted youth were more likely to be virally suppressed than nonadopted youth [odds ratio (OR), 7.08; P < 0.01] although the association was not statistically significant in adjusted analysis (adjusted OR, 4.26; P = 0.07). Neither age nor adoption status was significantly associated with retention. Among 89 patients greater than or equal to 12 years, 74% were fully disclosed of their HIV status, 12% were partially disclosed, and 13% had not started the disclosure process. There was no significant difference in retention or viral suppression by disclosure status. CONCLUSIONS YBoUS-PHIV achieved high rates of retention and viral suppression. Adopted youth may be more likely to achieve viral suppression which may reflect the need for tailored interventions for nonadopted youth.
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Affiliation(s)
- Neerav Desai
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Cathy A. Jenkins
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Brian Zanoni
- Department of Pediatrics, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
| | - Ashley Nmoh
- Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Nehali Patel
- Division of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Bryan E. Shepherd
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sophia Hussen
- Department of Global Health, Emory University Rollins School of Public Health, Atlanta, Georgia, USA
- Division of Infectious Diseases, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Kamini Doraivelu
- Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Leslie Pierce
- Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - James G Carlucci
- Ryan White Center for Pediatric Infectious Diseases and Global Health, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Aima A. Ahonkhai
- Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Medicine, Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Joyce C, Ramsammy C, Galvin L, Leshabane G, Liberty A, Otwombe K, Buckley J, Milovanovic M, Violari A. Experiences of South African caregivers disclosing to their children living with HIV: Qualitative investigations. PLoS One 2022; 17:e0277202. [PMID: 36445899 PMCID: PMC9707749 DOI: 10.1371/journal.pone.0277202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/21/2022] [Indexed: 12/03/2022] Open
Abstract
Awareness of Human Immunodeficiency Virus (HIV) status improves health outcomes in children living with HIV, yet caregivers often delay disclosure. This qualitative investigation explored, through observation, how 30 caregivers responded to a HIV Disclosure study conducted between 2017 and 2020 at Chris Hani Baragwanath Academic Hospital, Soweto, South Africa. Caregivers were assisted in disclosing to their children, aged 7-13 years; followed by a sub-sample of caregivers providing in-depth interviews to elaborate on findings.1) Barriers to disclosure included: caregivers being ill equipped, the fear of negative consequences and children considered lacking emotional or cognitive readiness. 2) Deflecting diagnosis from their children and the need for medication, motivated caregivers to disclosure. 3) Apprehension was evident during disclosure; however, overall disclosure was a positive experience with the support of the healthcare providers. These results highlight the significant role healthcare providers' play in supporting caregivers through the disclosure process.
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Affiliation(s)
- Celeste Joyce
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice Ramsammy
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lisa Galvin
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Given Leshabane
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Janice Buckley
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Psychiatry, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Minja Milovanovic
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- African Potential Management Consultancy, Kyalami, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Arnold EA, Campbell CK, Koester KA. The innovative use of qualitative and mixed methods research to advance improvements along the HIV prevention and care continua. Curr Opin HIV AIDS 2022; 17:106-111. [PMID: 35067594 DOI: 10.1097/coh.0000000000000720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Despite enormous advances in prevention and care modalities, HIV continues to burden populations around the globe and is largely driven by social and behavioral processes. Mixed methods and qualitative research endeavors are best suited to uncovering and making sense of these dynamics, producing unique and actionable findings to alleviate the burden of HIV. We reviewed the global literature published on PubMed from 2020 to 2021 to identify studies that produced new insights into the social and behavioral dynamics that drive the HIV epidemic, focusing on mixed methods or purely qualitative study designs. RECENT FINDINGS Mixed methods and qualitative studies have revealed important nuances in the social and behavioral dynamics associated with the HIV prevention and care continua, from preexposure prophylaxis uptake and adherence to engagement in HIV care and treatment, and have important implications for attaining goals for controlling the epidemic. SUMMARY Articles reviewed contribute to advancing our understanding of complex social dynamics, structural level factors such as healthcare systems and policy, as well as the research endeavor itself and the need to diversify and sustain research to truly represent the perspectives of those most impacted by HIV. Numerous studies represent the unique ability of qualitative and mixed methods research to expand our understanding of and empathy for individuals living with and affected by HIV, offering new insights to help alleviate the burden of HIV.
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Affiliation(s)
- Emily A Arnold
- Center for AIDS Prevention Studies, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Zanon BP, Paula CCD, Ribeiro AC, Padoin SMDM. Content validation to support the monitoring of disclosure of HIV diagnosis in childhood. Rev Bras Enferm 2021; 75Suppl 2:e20210027. [PMID: 34787279 DOI: 10.1590/0034-7167-2021-0027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to create and validate the content of a guide for monitoring the communication of the HIV diagnosis in childhood. METHODS methodological study, with a design guided by the Knowledge-to-Action (KTA) Framework, supported by a participatory approach. The guide's content was structured according to the communication elements proposed by Lasswel from review studies. RESULTS the content was validated by 26 experts from nursing, medicine, psychology and pedagogy, using a Likert-type scale for relevance, clarity and precision. Data collection took place online and achieved a Content Validity Index of 0.94. CONCLUSIONS the guide can contribute to the practice of professionals who care for children living with HIV, to support the family in communication and to the child's right to know their diagnosis. For further research, it is recommended to create and validate the face of the technology in order to implement it.
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Affiliation(s)
- Bruna Pase Zanon
- Faculdade Integrada de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil.,Universidade Federal de Santa Maria. Santa Maria, Rio Grande do Sul, Brazil
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Molokwane M, Madiba S. Truth, Deception, and Coercion; Communication Strategies Used by Caregivers of Children with Perinatally Acquired HIV During the Pre-Disclosure and Post-Disclosure Period in Rural Communities in South Africa. Glob Pediatr Health 2021; 8:2333794X211022269. [PMID: 34104705 PMCID: PMC8170273 DOI: 10.1177/2333794x211022269] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
Typically, children with perinatal HIV (PHIV) receive antiretroviral treatment (ART) for a long time prior to receiving disclosure. Communication with children about HIV and treatment is critical for monitoring adherence and retention in care. However, there is a dearth of information on communication between caregivers and their children. This study examines what and how caregivers tell their their children about their illness and medication in the pre-disclosure and post-disclosure period. A qualitative study using semi-structured one-on-one interviews and focus group discussions was conducted with caregivers recruited via purposive sampling from a rural sub-district in South Africa. The interviews were analyzed using thematic analysis. The sample consisted of 38 caregivers, 24 of whom were the children's biological mothers, 20 had disclosed to the children and 18 had not done so. Caregivers who had disclosed had told their children the truth and named the disease as HIV, but communication about HIV was infrequent and focused on pill taking. Those who had not disclosed had lied, deflected illness-related information, and attributed the children's ill health to co-morbid conditions. To enforce adherence, most caregivers used coercion and threats of the grave consequences of non-adherence as a communication strategy. Those who had not disclosed used deception, deflecting, and coercion as strategies for coping through the pre-disclosure period. There is a need for healthcare workers to prepare, support, and empower caregivers to develop appropriate responses to children's questions and to understand the implications of deception on future full disclosure and children's acceptance of their HIV status.
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Affiliation(s)
| | - Sphiwe Madiba
- Sefako Makgatho Health Sciences
University, Pretoria, South Africa
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Atanuriba GA, Apiribu F, Boamah Mensah AB, Dzomeku VM, Afaya RA, Gazari T, Kuunibe JK, Amooba PA. Caregivers' Experiences with Caring for a Child Living with HIV/AIDS: A Qualitative Study in Northern Ghana. Glob Pediatr Health 2021; 8:2333794X211003622. [PMID: 33816712 PMCID: PMC7995303 DOI: 10.1177/2333794x211003622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/16/2022] Open
Abstract
With the advent of Anti-Retroviral Therapy, Human Immune Virus, and Acquire Immuno-Deficiency Syndrome is increasingly becoming a chronic disease as life expectancy among People Living With HIV/AIDS has increased. For Children Living With HIV/AIDS the role of the caregivers becomes essential as caregivers' decisions affect CLWH health. However, the experiences of these caregivers are often unnoticed while all interventions are directed at PLWH. This study aimed at exploring the experiences of caregivers of CLWH in some selected hospitals in northern Ghana. This study employed a qualitative descriptive phenomenological approach. Purposive sampling technique was used to recruit 9 participants from 3 public hospitals in the Tamale Metropolis of Ghana. Data was manually analyzed using the approach of Collaizi and the findings were presented in themes and sub-themes. We conducted individual face to face interviews in English and Dagbani from September to November 2019. These interviews were conducted at the convenience of the participants in hospitals and at their homes. They were introduced to the study while awaiting to take antivirals for their CLWH. Five themes emerged: changed family dynamics, discovery of diagnosis, reaction to diagnosis, disclosure, stigma and discrimination, and burden and challenges of care. Caregivers were severely impacted by caring for CLWH and traumatized by changed family dynamics which exposed them to many difficulties. Stigma was widely perpetrated by immediate family members and majority reacted badly to their children HIV-positive status with fear, shame, guilt and even suicidal ideation.
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Affiliation(s)
| | - Felix Apiribu
- Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | | | | | - Richard Adongo Afaya
- University for Development Studies, School of Nursing and Midwifery, Tamale, Ghana
| | - Timothy Gazari
- University for Development Studies, School of Nursing and Midwifery, Tamale, Ghana
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The Consequences of Delaying Telling Children with Perinatal HIV About Their Diagnosis as Perceived by Healthcare Workers in the Eastern Cape; A Qualitative Study. CHILDREN-BASEL 2020; 7:children7120289. [PMID: 33322497 PMCID: PMC7763355 DOI: 10.3390/children7120289] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/16/2020] [Accepted: 12/03/2020] [Indexed: 12/14/2022]
Abstract
Although the benefits of disclosure are considerable, informing children with perinatal HIV of their own HIV status is often delayed to late adolescence. This study examined the social and contextual challenges that influence delaying disclosure to children and assessed the outcomes of delayed disclosure on the psychosocial health of children as perceived by the healthcare workers (HCWs) providing care to these children. Data were collected from HCWs via focus group discussions. Nurses, lay counsellors, social workers, and dieticians were selected from facilities in a rural South African health district. Thematic analysis was performed. The caregivers’ social context was the main barrier against informing children timely about their HIV diagnosis. The extent of the internalised HIV stigma influenced the delay in disclosing to the children. Delaying disclosure contributes to children’s refusing to take their medication, leads to the accidental disclosure of HIV, give rise to anger and resentment towards the caregiver, increase the risk of secondary transmitting of HIV, and poor health outcomes. It is essential to train HCWs to support caregivers and children through the disclosure process to ensure that caregivers realise the benefits of disclosure. Strategies to encourage caregivers to disclose early should be sensitive to their concerns about the negative impacts of disclosure.
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