Understanding the role of age in HIV disclosure rates and patterns for HIV-infected children in southwestern Uganda.
Highly active antiretroviral therapy has enabled HIV-infected children to survive into adolescence and adulthood, creating need for their own HIV diagnosis disclosure. Disclosure has numerous social and medical benefits for the child and family; however, disclosure rates tend to be low, especially in developing countries, and further understanding of the barriers is needed. This study describes the patterns and correlates of disclosure among HIV-infected children in southwestern Uganda. A cross-sectional study was conducted in a referral hospital pediatric HIV clinic between February and April 2012. Interviews were administered to caregivers of HIV-infected children aged 5-17 years. Data collected included socio-demographic characteristics of the child and caregiver, reported disclosure status, and caregivers' reasons for full disclosure or non-full disclosure of HIV status to their children. Bivariate and multivariate analysis was done to establish the socio-demographic correlates of disclosure. Caregivers provided data for 307 children; the median age was eight years (interquartile range [IQR] 7-11) and 52% were males. Ninety-five (31%) children had received full disclosure (48% of whom were >12 years), 22 children (7%) had received partial disclosure, 39 (13%) misinformation, and 151 (49%) no disclosure. Full disclosure was significantly more prevalent among the 9-11 and 12- to 17-year-olds compared to 5- to 8-year-olds (p-value < 0.001). The most frequently stated reason for disclosure was the hope that disclosure would improve medication adherence; the most frequently stated reason for nondisclosure was the belief that the child was too young to understand his/her illness. There was an inverse relationship between age and full disclosure and partial disclosure was rare across all age groups, suggesting a pattern of rapid, late disclosure. Disclosure programs should emphasize the importance of gradual disclosure, starting at younger ages, to maximize the benefits to the child and caregiver.
a Department of Paediatrics and Child Health , Mbarara University of Science and Technology , Mbarara , Uganda.
Barnabas
B
Atwiine
Julius
J
Kiwanuka
Nicholas
N
Musinguzi
Daniel
D
Atwine
Jessica E
JE
Haberer
D000293:Adolescent; D000294:Adolescent Behavior; D000328:Adult; D000367:Age Factors; D023241:Antiretroviral Therapy, Highly Active; D017028:Caregivers / Q000523:psychology*; D002648:Child; D002652:Child Behavior; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D015995:Prevalence; D012944:Social Support; D011795:Surveys and Questionnaires; D014342:Truth Disclosure; D014454:Uganda / Q000453:epidemiology; D016903:Drug Monitoring
AIDS; HIV; Uganda; children; disclosure