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Wang Q, Hui KH, Wang A, Wang X, Sun H, Lau STY, Wang C, Mo PKH. Chinese Mothers' Intent to Disclose Their HIV Status to Their Children: The Role of Positive Outcome Expectations and Reward Responsiveness. Int J Public Health 2023; 68:1605559. [PMID: 37228894 PMCID: PMC10204079 DOI: 10.3389/ijph.2023.1605559] [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: 11/04/2022] [Accepted: 04/12/2023] [Indexed: 05/27/2023] Open
Abstract
Objective: The current study investigated the role of positive outcome expectations and reward responsiveness in intention to disclose HIV status to children among women living with HIV in China. The moderating role of reward responsiveness was also explored. Method: A 1-year longitudinal survey was conducted. 269 women living with HIV who had at least one child aged >5 years and had not yet disclosed their HIV status to their oldest child were selected from a larger sample of women living with HIV at baseline, with a total of 261 respondents completing the follow-up survey. Results: After adjusting for significant socio-demographic and medical variables, positive outcome expectations positively predicted mothers' intention to disclose HIV, while reward responsiveness had a negative effect. A moderation effect of reward responsiveness was found, with further analysis showing that reward responsiveness has strengthened the relationship between positive outcome expectations and intention to disclose HIV. Conclusion: Findings support the relevance of positive outcome expectations and reward responsiveness to intention of disclosure among women living with HIV in China.
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Affiliation(s)
- Qian Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kam Hei Hui
- Department of Psychology, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Ailing Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaoyan Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - He Sun
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Stephanie Tsz Yung Lau
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
| | - Changhe Wang
- National Center for Women and Children’s Health, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Phoenix Kit Han Mo
- Centre for Health Behaviours Research, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, Hong Kong SAR, China
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Sun M, Chen WT, Yang JP, Huang S, Zhang L, Shi M, Li W, Li Y, Bao M, Lu H. Concerns of Parental HIV Disclosure in China. Clin Nurs Res 2020; 30:830-839. [PMID: 32567340 DOI: 10.1177/1054773820932725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although parental HIV disclosure has benefits for parents and children, the disclosure rate among parents remains low. This study aims to qualitatively examine parental concerns regarding disclosure of their HIV status to their children. Eighty parents were enrolled in a randomized controlled trial of a three-session disclosure-support intervention, with forty receiving the intervention and forty receiving treatment as usual. Intervention sessions were audio recorded, and transcriptions were qualitatively coded for content related to concerns of disclosure. Four themes emerged: Intention to disclose, disclosure approach, indicators for disclosure, and fears about disclosure. These themes reveal struggles that parents experience when considering HIV disclosure suggesting that an effective disclosure intervention must help parents assess pros and cons, discuss the emotions of the children after the disclosure, and monitor the impact on children's lives after disclosure over time. Future research is needed to implement interventions supporting HIV-positive parents' disclosure decision-making and actions.
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Affiliation(s)
- Meiyan Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei-Ti Chen
- University of California Los Angeles, Los Angeles, CA, USA
| | - Joyce P Yang
- University of San Francisco, San Francisco, CA, USA
| | | | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Mingfeng Shi
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ye Li
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Meijuan Bao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
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Appiah SCY, Adekunle AO, Oladokun A, Dapaah JM, Nicholas KM. Parental Disclosure of Own HIV Status to Children in Two Ghanaian Regions; Examining the Determinants within a Child Vulnerability Context. Health (London) 2019. [DOI: 10.4236/health.2019.1110104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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DeSilva MB, Penwill N, Sabin L, Gifford AL, Li Z, Fujie Z, Weiwei M, Yongzhen L, Hongyan L, Xuemei Z, Barnoon Y, Gill CJ, Bonawitz R. We don't dare to tell her … we don't know where to begin: Disclosure experiences and challenges among adolescents living with HIV and their caregivers in China. Int J Pediatr Adolesc Med 2018; 5:5-12. [PMID: 30805525 PMCID: PMC6363272 DOI: 10.1016/j.ijpam.2017.11.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES With increasing access to antiretroviral therapy, HIV-infected youth are living longer, but are vulnerable as they navigate the transition to adulthood while managing a highly stigmatized condition. Knowing one's HIV status is critical to assuming responsibility for one's health. The process of disclosure to adolescents living with HIV is not well understood globally, even less so in China. To help address this gap, we explored practices for disclosure to adolescents living with HIV (ALHIV) among Chinese caregivers and clinicians, and the disclosure experiences of the adolescents themselves using qualitative methods. DESIGN AND SETTING The study was conducted in 2014 at the Guangxi Center for Disease Control and Prevention ART (CDC-ART) clinic in Nanning, China. We used a qualitative design, incorporating in-depth interviews (IDIs) and focus group discussions (FGDs). PATIENTS AND METHODS We conducted IDIs with 19 adolescent/caregiver dyads and five FGDs with adolescents and clinicians. Adolescent participants were aged 10-15 years, and had contracted HIV perinatally. Using NVivoTM software, we summarized major themes. RESULTS Only 6/19 caregivers reported disclosing to their child; matched adolescents' statements indicate that 9/19 children knew their HIV status. Caregivers planned to disclose when children were 14 years or older. Concerns about stigma toward children and families were associated with reluctance to disclose. CONCLUSION Disclosure to adolescents living with HIV in China was delayed compared with recommended guidelines. Culturally appropriate disclosure strategies should be developed, focused on supporting caregivers and de-stigmatizing HIV.
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Affiliation(s)
- Mary Bachman DeSilva
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
- Westbrook College of Health Professions, University of New England, Portland, ME, United States
| | - Nicole Penwill
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
| | - Lora Sabin
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Allen L. Gifford
- Departments of Health Policy and Management, Boston University Schools of Public Health and Medicine, Boston University, Boston, MA, United States
- Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, United States
| | | | - Zhang Fujie
- Division of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, China
| | - Mu Weiwei
- Division of Treatment and Care, National Center for AIDS/STD Control and Prevention (NCAIDS), China CDC, Beijing, China
| | - Li Yongzhen
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Lu Hongyan
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Zeng Xuemei
- AIDS Division, Guangxi Centers for Disease Control and Prevention, Guangxi, China
| | - Yiyao Barnoon
- Boston Children's Hospital, 300 Longwood Ave., Boston, MA, United States
| | - Christopher J. Gill
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
| | - Rachael Bonawitz
- Center for Global Health and Development, Boston University School of Public Health, Boston, MA, United States
- Department of Global Health, Boston University School of Public Health, Boston, MA, United States
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Zhang L, Chen WT, Yang JP, Simoni JM, Shiu C, Bao M, Zhang J, Sun M, Qiu Y, Lu H. Disclosing Parental HIV Status to Children in China: Lessons Learned Through an Intervention Study. J Assoc Nurses AIDS Care 2016; 28:130-141. [PMID: 27825559 DOI: 10.1016/j.jana.2016.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 09/13/2016] [Indexed: 11/24/2022]
Abstract
For HIV-infected parents, deciding whether and how to disclose their illness to their children is a major stressor. In China, due to significant HIV stigma, disclosure distress is acute. Our objective was to understand HIV-infected parents' concerns regarding disclosure of their HIV status to their children. HIV-infected parents (N = 10) were recruited to attend a three-session nursing intervention. In our post hoc analysis, progress notes from each session were analyzed for themes to illuminate parental decision-making processes. By the end of the intervention, all parents had considered the importance of HIV disclosure and stated that they felt somewhat prepared to disclose. Primary themes included (a) severe stigma experienced by fathers who were sexually active with men, (b) need for both parents to agree on plans for disclosure, and (c) parents' fears about the consequences of disclosure. Parents living with HIV can benefit from nurse-delivered interventions during parental HIV disclosure decision-making.
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Osingada CP, Okuga M, Nabirye RC, Sewankambo NK, Nakanjako D. Prevalence, barriers and factors associated with parental disclosure of their HIV positive status to children: a cross-sectional study in an urban clinic in Kampala, Uganda. BMC Public Health 2016; 16:547. [PMID: 27401865 PMCID: PMC4940877 DOI: 10.1186/s12889-016-3235-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 06/28/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disclosure of parental HIV status is associated with a number of positive outcomes such as improved adherence to clinic appointments, lower levels of parental anxiety and depression, and mutual emotional support between parents and their children. Very few studies in low-resource settings have addressed the issues of parental disclosure of their HIV status to their children. METHODS A cross-sectional study was conducted among adult parents attending HIV/AIDS prevention, care and treatment clinic at Makerere University Infectious Diseases Institute (IDI), Kampala, Uganda. Participants were interviewed using the Parent Disclosure Interview (PDI) questionnaire which is a standard tool developed specifically for HIV infected parents. Data were analyzed using STATA version 13.1. RESULTS Of 344 participants, only 37 % had told at least one of their children that they were HIV positive. Barriers to disclosure were fear that children may tell other people about the parent's HIV status, desire not to worry or upset children and perceptions that children may not understand. Age of the parent, religion and having someone committed to care of the children were positively associated with parental disclosure of their HIV positives status. Attainment of tertiary level of education was negatively associated with parental disclosure of their HIV status. CONCLUSIONS Parental disclosure of a positive HIVstatus to their children is still low in urban Kampala. There is therefore need to develop locally relevant interventions so as to increase rates of parental disclosure of a positive HIV status to their children and thus promote open and honest discussions about HIV/AIDS at family level.
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Affiliation(s)
- Charles Peter Osingada
- Department of Nursing, Makerere University College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda.
| | - Monica Okuga
- Department of Health Policy planning and Management, Makerere University School of Public Health, P.O. Box 7072, Kampala, Uganda
| | - Rose Chalo Nabirye
- Department of Nursing, Makerere University College of Health Sciences, School of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Nelson Kaulukusi Sewankambo
- Department of Internal Medicine, School of Medicine, Makerere College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Damalie Nakanjako
- Department of Internal Medicine, School of Medicine, Makerere College of Health Sciences, P.O. Box 7072, Kampala, Uganda
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Lin X, Chi P, Zhang L, Zhang Y, Fang X, Qiao S, Li X. Disclosure of HIV Serostatus and Sexual Orientation Among HIV-Positive Men Who Have Sex with Men in China. Community Ment Health J 2016; 52:457-65. [PMID: 26002087 PMCID: PMC6234002 DOI: 10.1007/s10597-015-9879-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Accepted: 02/23/2015] [Indexed: 12/13/2022]
Abstract
This study addressed the issue of disclosing HIV status and sexual orientation, and explored the consequences of such disclosures among HIV-positive men who have sex with men (MSM) in China. In-depth individual interviews were conducted with 37 HIV-positive MSM. Of these participants, 3 (8.1%) disclosed neither their HIV status nor their sexual orientation to anyone; 24 (64.9%) voluntarily disclosed both their HIV-positive status and their sexual orientation; 7 (18.9%) voluntarily disclosed their HIV status only, and 3 (8.1%) involuntarily disclosed their HIV status and sexual orientation. Parents, partners, siblings and close friends were the most common disclosure targets. HIV-positive MSM were less likely to disclose their sexual orientation than their HIV status. The positive consequences of disclosure included receiving support, acquiring family care, reducing stress, improving mood and developing more positive values and beliefs. The negative consequences included the participants' perception of rejection and stigma toward themselves and their families. However, the stigma mainly comes from "outsiders" rather than family members and close friends. We did not find any differences with respect to consequences between participants who disclosed their HIV status only and those who disclosed both their HIV status and sexual orientation. In conclusion, partners, siblings and friends were main disclosure targets, and HIV positive MSM preferred to disclose their HIV serostatus than their sexual orientation. Voluntarily disclosing one's HIV status to significant others resulted in more positive consequences than negative consequences. Theses results were informative for developing mental health and coping interventions.
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Affiliation(s)
- Xiuyun Lin
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, China
| | - Peilian Chi
- Department of Psychology, University of Macau, Macau, China
| | - Liying Zhang
- Department of Pediatrics, Wayne State University, Detroit, MI, USA.
| | - Yan Zhang
- Department of Medical Psychology, Peking University, Beijing, China
| | - Xiaoyi Fang
- Beijing Key Laboratory of Applied Experimental Psychology, School of Psychology, Beijing Normal University, Beijing, China.
| | - Shan Qiao
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
| | - Xiaoming Li
- Department of Pediatrics, Wayne State University, Detroit, MI, USA
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Nurse-delivered counselling intervention for parental HIV disclosure: results from a pilot randomized controlled trial in China. AIDS 2015; 29 Suppl 1:S99-S107. [PMID: 26049544 DOI: 10.1097/qad.0000000000000664] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of this study was to design and conduct a preliminary evaluation of an intervention to assist parents in decision-making about disclosure of their HIV diagnosis to their children. DESIGN This was a pilot randomized controlled trial (RCT) with blinded assessment. Participants were randomized to intervention or treatment-as-usual (TAU) arms. SETTING The study occurred at an outpatient HIV primary care centre in Shanghai, China. PARTICIPANTS Participants were 20 HIV-positive outpatients with at least one child (13-25 years old) who was unaware of the parent's HIV diagnosis. INTERVENTION The nurse-delivered intervention involved three, hour-long, individual sessions over 4 weeks. Intervention content comprised family assessment, discussion of advantages and disadvantages of disclosure, psycho-education about cognitive, social and emotional abilities of children at different developmental stages, and disclosure planning and practicing via role-plays. MAIN OUTCOME MEASURE(S) Primary study outcomes for intervention versus TAU arms were self-reported disclosure distress, self-efficacy, and behaviours along a continuum from no disclosure to full disclosure and open communication about HIV. RESULTS In all cross-sectional (Wald tests) and longitudinal (general estimating equations) analyses, at both postintervention (4 weeks) and follow-up (13 weeks), effects were in the hypothesized directions. Despite the small sample size, most of these between-arm comparisons were statistically significant, with at least one result for each outcome indicating a 'large' effect size. CONCLUSION Our results suggest that nurses are able to deliver a counselling intervention in a clinic setting with the potential to alleviate parental distress around HIV disclosure to their children. Findings warrant future trials powered for efficacy.
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Qiao S, Li X, Stanton B. Practice and perception of parental HIV disclosure to children in Beijing, China. QUALITATIVE HEALTH RESEARCH 2014; 24:1276-86. [PMID: 25079498 PMCID: PMC6320668 DOI: 10.1177/1049732314544967] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
To explore parental disclosure practices and perceptions among HIV-positive parents in urban China, we conducted in-depth interviews with 29 HIV-positive parents in Beijing in 2011. The disclosure rate was low (17%), and unplanned disclosure was common. Most parents chose not to disclose because of concerns regarding their children's young age, concerns about potentially negative psychological impacts on the children, potential secondary disclosure by the children to others, and perceived stigma associated with HIV infection and the causes of such infection (e.g., homosexual behaviors). Parents considered that an appropriate disclosure should be well-planned, cautious, and a gradual process conducted in a comfortable and relaxed environment when both parents and children were calm. We concluded that it was important to (a) provide professional guidance and services about disclosure to children for HIV-positive parents in China, (b) reduce or eliminate HIV-related stigma, (c) set up support groups among HIV-positive parents, and (d) tailor disclosure strategies for different populations of various demographic and socioeconomic characteristics.
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Affiliation(s)
- Shan Qiao
- Wayne State University, Detroit, Michigan, USA
| | - Xiaoming Li
- Wayne State University, Detroit, Michigan, USA
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