title: Maternal HIV disclosure to young HIV-uninfected children: an evaluation of a family-centred intervention in South Africa.
abstract: OBJECTIVE
  Sub-Saharan Africa has large populations of HIV-infected parents who need support to raise their HIV-uninfected children. This research evaluates the 'Amagugu Intervention' aimed at supporting mothers to disclose their own HIV diagnosis to their HIV-uninfected children.
  
  
  METHODS
  Uncontrolled pre and post-intervention evaluation.
  
  
  METHODS
  Africa Centre for Health and Population Studies, South Africa.
  
  
  METHODS
  Two hundred and eighty-one HIV-infected women and their HIV-uninfected children aged 6-10 years.
  
  
  METHODS
  This lay counsellor-led intervention included six sessions conducted with mothers at home, providing printed materials and child-friendly activities to support disclosure of their diagnosis.
  
  
  METHODS
  The primary outcome was disclosure to the child (full, partial, none). The secondary outcomes included maternal mental health (General Health Questionnaire) and child mental health (Child Behaviour Checklist).
  
  
  RESULTS
  One hundred and seventy-one (60%) women 'fully' disclosed and 110 (40%) women 'partially' disclosed their HIV status to their child. Women who perceived their health to be excellent were less likely to 'fully' disclose compared to those considering their health to be poorer [adjusted odds ratio 0.50 (0.26-0.98), P = 0.042]. [corrected]. Compared to those not in a current partnership, those with a current partner were almost three times more likely to 'fully' disclose [adjusted odds ratio 2.92 (1.33-6.40), P = 0.008]. Mothers reported that most children reacted calmly to 'full' (79%) or 'partial' disclosure (83%). Compared to 'partial' disclosure, 'full' disclosure was associated with more children asking questions about maternal death (18 versus 8%).
  
  
  CONCLUSIONS
  This intervention is acceptable in resource-limited settings and shows promise. Further research using a controlled design is needed to test this intervention.
authors.affiliation: aAfrica Centre for Health and Population Studies, University of KwaZulu-Natal bDepartment of Psychology, Stellenbosch University, South Africa cDepartment of Psychology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil dSection of Child and Adolescent Psychiatry, Department of Psychiatry, Oxford University, Oxford, UK eSchool of Public Health, University of Witwatersrand, Johannesburg fAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba gSchool of Public Health, University of Witwatersrand, Johannesburg hAfrica Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa iRoyal Hospital for Sick Children, University of Glasgow, Glasgow, UK jSchool of Public Health, University of Witwatersrand, Johannesburg, South Africa.
authors.forename: Tamsen J
authors.initials: TJ
authors.lastname: Rochat
authors.forename: Adriane X
authors.initials: AX
authors.lastname: Arteche
authors.forename: Alan
authors.initials: A
authors.lastname: Stein
authors.forename: Ntombizodumo
authors.initials: N
authors.lastname: Mkwanazi
authors.forename: Ruth M
authors.initials: RM
authors.lastname: Bland
mesh_terms: D000328:Adult; D002648:Child; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000517:prevention & control* / Q000523:psychology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009034:Mother-Child Relations / Q000523:psychology*; D011247:Pregnancy; D013019:South Africa; D055815:Young Adult