Interpersonal Distance and Coping in Children With HIV and Cancer

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.

Decisional Capacity among Minors with HIV: A Model for Balancing Autonomy Rights with the Need for Protection

The purpose of this paper is threefold: (1) to describe the relevant ethical and legal issues associated with decisional capacity among minors and to discuss the importance of these concepts for children and adolescents living with HIV; (2) to provide a framework for assessing the decisional capacity of children and adolescents with HIV; and (3) to present a model for thinking about how to use this assessment data to guide action along the protection-autonomy continuum.

Disclosure of an HIV diagnosis to children: history, current research, and future directions

Disclosing the diagnosis of human immunodeficiency virus (HIV) or AIDS to a child is a controversial and emotionally charged issue among both the health care communities and parents and caregivers of these children. This paper provides a systematic review of research on disclosure of pediatric HIV infection. It begins with a brief discussion of disclosure drawing from research on pediatric cancer. Next, we review the available research including patterns of disclosure, factors associated with disclosure and nondisclosure, and the effect of disclosure on psychological health and adherence. A review of published intervention studies is also included. While no consensus on when the diagnosis of HIV should be disclosed to a child or the psychological outcomes associated with disclosure was found, clinical consensus on several issues related to working with families was identified. We apply this literature to clinical practice and suggest avenues and directions for future research.

Fatherhood and HIV-positive heterosexual men

OBJECTIVES

The study of HIV and issues of reproduction is women-focused. HIV-positive men are overlooked and understudied. This study examined views on reproduction of heterosexual HIV-positive men.

METHODS

Systematic questionnaire data were gathered from HIV-positive men (n=32) attending an HIV clinic in London.

RESULTS

Heterosexual men were rarely given medical advice on reproduction (only 9.4%). Few felt fully informed (21.9%), while many felt uninformed (46.9%) or needed more information (28.1%). Over half would value fertility/fathering consultations, up-to-date information and quick referral to fertility clinics. Nearly half (43.8%) had considered having children and 37.5% had had a child prior to HIV diagnosis. HIV status affected views on fathering, and the advent of new treatments changed views in over half of the men. Almost half (41%) believed they would experience discrimination if they conceived a baby and a quarter would withhold their HIV status when attending antenatal clinics. The majority (81%) believed that a child gave meaning to life and something to live for - only 3.1% felt a child would be a burden. Most men overestimated potential vertical transmission and would value time to discuss fathering and fatherhood.

CONCLUSIONS

There are gaps in provision. The majority of men felt that children gave meaning to life and a reason to live. Reproduction issues are not raised with HIV-positive men who are uninformed and unclear where to turn for information. Fatherhood should not be shunned as an issue for all HIV-positive men.

Social support in children with cancer: a review of the literature

Families experiencing childhood cancer are confronted with many stressors throughout the course of illness. For children with cancer, such stressors may be especially challenging. The extent to which they are able to deal with such challenges appears to be partly contingent on the support available from others. Positive social relations are considered to improve the quality of life of individuals in general and to help protect or buffer them from stressful life events such as cancer. This article presents a critical review and synthesis of research examining social support in children with cancer. Recommendations for research that will provide a foundation for understanding social support in children with cancer are outlined. These recommendations include the need to investigate (a) social support as a guiding, central construct, (b) social support from a family socio-cultural perspective, (c) social support from a developmental perspective, and (d) social support as a process. Implications for pediatric oncology nursing practice are discussed.