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Osayi EO, Ajayi O, Onyeji J, Isichei M, Sagay AS, Anderson A. The prevalence of internalized stigma and its association with HIV viral suppression among fully disclosed adolescents and young adults living with HIV (AYLHIV) receiving HIV care in an HIV clinic in Plateau State, Nigeria. PLoS One 2024; 19:e0303360. [PMID: 38739598 PMCID: PMC11090324 DOI: 10.1371/journal.pone.0303360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 04/23/2024] [Indexed: 05/16/2024] Open
Abstract
Internalized stigma, a condition characterized by negative self-stereotyping and social alienation, recently impacted the adolescents and young adults living with HIV (AYLHIV) epidemic curve and treatment adherence. While prior research has focused on the impact of internalized stigma among adults living with HIV, few studies focused on this AYLHIV. The study aims to determine internalized stigma proportion and its relationship to HIV viral suppression in AYLHIV. A cross-sectional study involved 93 fully disclosed AYLHIV receiving HIV care in Faith Alive Foundation in Jos North, Plateau State, from January to March 2023. Internalized stigma was measured using the adapted Berger HIV Stigma Scale under the domains personalized stigma (18 item questions) and negative self-image subscales (13 item questions), measured on a 4-scale of strongly disagree (1), disagree (2), agree (3), and strongly agree (4). Scores summed up to give the domain composite score with a maximum obtainable score of 72 for personalized stigma and 52 for negative self-image. A total of 93 respondents, female-63 (68%) and male-30 (32%), were involved in the study and their mean age at full disclosure was 15.7 ± 2.8 years. During the study their mean age was 19.5 ± 5.4 years, with 62% (58) ages 10-19 years and 38% (35) ages 20-26 years. Furthermore, 70% of the participants had secondary educational status, 77% had viral load results <1000 copies/ml), and 57% were on ART for up to 6 years. The average scores for personalized and negative self-image were 36.3 and 28.9, with 53% (49/93) and 52% (48/93) scoring higher than the average respectively. Further subclassification of the participants by the presence of internalized stigma domains reported 62% (58/93) with both domains, 20% (19/93) with at least one domain, and 38% (35/93) with none of the domains. Negative self-image stigma was reported more among participants 10-19 years (63%), male (31%), of secondary educational level (71%), virally unsuppressed (23%), and ≤ 6 years on ART (42%). On the other hand, personalized stigma was more among the female participants (73%), ages 20-29 years (41%), educational level (6% and 27% had primary and tertiary level of education respectively), virally suppressed (80%), and up to 6 years on ART (63%). The correlation between the internalized stigma domains and suppressed viral load using a binary multivariate regression method at 95% CI and a p-value of 0.05 was not statistically significant with personalized stigma (p = 0.73) and negative self-image (p = 0.92). The adjusted odds ratio of having internalized stigma among the virally suppressed were personalized stigmas [OR; 1.21, 95% CI; 0.42-3.47] and that of negative self-image [OR; 1.06, 95% CI; 0.38-2.95]. This study showed a high proportion of internalized stigma among females, ages 10-19 years, and virally suppressed with more odds for personalized stigma domain. However, the study reported no statistically significant association between internalized stigma domains and viral suppression.
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Affiliation(s)
- Emmanuel O. Osayi
- Directorate of Clinical Services, APIN Public Health Initiatives Jos, Plateau, Nigeria
| | - Oluseye Ajayi
- Directorate of Prevention, APIN Public Health Initiatives FCT-Abuja, Abuja, Nigeria
| | - John Onyeji
- Department of Obstetrics and Gynaecology, Bingham University Teaching Hospital, Jos, Plateau, Nigeria
| | - Mercy Isichei
- Department of Surgery, Jos University Teaching Hospital, Jos, Plateau, Nigeria
| | - Atiene S. Sagay
- Department of Obstetrics and Gynaecology, Jos University Teaching Hospital, Jos, Plateau, Nigeria
| | - Albert Anderson
- Grady Health System, Emory School of Medicine, Atlanta, GA, United States of America
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Puffer ES, Finnegan A, Schenk K, Langhaug L, Rusakaniko S, Choi Y, Mahaso S, Simmons R, Green EP. Comparing fears about paediatric HIV disclosure to the lived experiences of parents and guardians: a prospective cohort study. Psychol Health 2023; 38:1587-1605. [PMID: 35188010 PMCID: PMC9392813 DOI: 10.1080/08870446.2022.2041637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 12/16/2021] [Accepted: 02/04/2022] [Indexed: 10/19/2022]
Abstract
OBJECTIVE We aimed to: (1) follow parents and guardians through the process of paediatric HIV disclosure to understand how often pre-disclosure worries are realised; and (2) estimate the effects of disclosure on child, caregiver, and family well-being. DESIGN We conducted a 12-month prospective cohort study in Zimbabwe with 123 primary caregivers of children ages 9 to 15 years who were HIV positive but did not know their serostatus at baseline. By the end of the study period 65 caregivers reported that their child learned his or her HIV-positive status. MAIN OUTCOME MEASURES We used three waves of data to compare caregivers' pre-disclosure worries to post-disclosure reports and to characterise associations between disclosure and well-being of the child (Strengths and Difficulties Questionnaire), caregiver (Patient Health Questionnaire-9), and family (Family Relationship Quality) over time. RESULTS Caregivers' pre-disclosure worries and fears about how their child would react to disclosure of their HIV status largely went unrealised. Furthermore, we did not find strong evidence of clinically-important increases in problems on average following disclosure. CONCLUSION Findings support the call to identify supportive intervention strategies that address caregiver fears at the beginning of the disclosure process.
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Affiliation(s)
- Eve S. Puffer
- Duke University, Department of Psychology and Neuroscience, Durham, NC, USA
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | - Amy Finnegan
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | | | - Lisa Langhaug
- Regional Psychosocial Support Initiative, Harare, Zimbabwe
| | | | - Yujung Choi
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | | | - Ryan Simmons
- Duke University, Duke Global Health Institute, Durham, NC, USA
| | - Eric P. Green
- Duke University, Duke Global Health Institute, Durham, NC, USA
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Wu M, Shiau S, Strehlau R, Liberty A, Patel F, Burke M, Murnane PM, Violari A, Yin MT, Abrams EJ, Kuhn L, Arpadi S. Disclosure to South African children about their own HIV status over time. AIDS Care 2023; 35:334-340. [PMID: 34930060 PMCID: PMC9209585 DOI: 10.1080/09540121.2021.2017397] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 12/07/2021] [Indexed: 10/19/2022]
Abstract
Disclosure to children living with HIV (CLHIV) about their own status is associated with positive outcomes such as treatment adherence, but prior cross-sectional studies in sub-Saharan Africa report disclosure rates of <50%. This study aims to assess pediatric disclosure over time. 548 CLHIV were followed from 2/2013-4/2018 in Johannesburg, South Africa. Cumulative incidence of disclosure was calculated with Kaplan-Meier analysis, and disclosure characteristics assessed with a Cox model. By end of follow-up, cumulative disclosure was 70.3% (95% confidence interval: 60.0-79.9). Median age at disclosure was 9 years (range: 3-13). Baseline predictors of disclosure included older child age and the child having a history of going hungry. Prior to disclosure, 98.0% of caregivers who disclosed had conversed with their child about their illness or an HIV-related topic, or their child had asked about HIV, versus 88.6% of caregivers who never disclosed. While many children did not receive disclosure during this relatively large, longitudinal study of South African CLHIV, caregivers who had not yet disclosed may have been preparing to do so by discussing their child's health or HIV generally with their child. This highlights the need for clinicians to consistently support caregivers throughout the incremental disclosure process.
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Affiliation(s)
- Melody Wu
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Stephanie Shiau
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Faeezah Patel
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Pamela M. Murnane
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, USA
| | - Avy Violari
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Michael T. Yin
- HIV Center for Clinical and Behavioral Studies, New York Psychiatric Institute and Columbia University, New York, NY, USA
- Department of Medicine, Columbia University Medical Center, New York, NY, USA
| | - Elaine J. Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- ICAP, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Louise Kuhn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Stephen Arpadi
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, NY, USA
- Gertrude H. Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA
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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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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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Bubadué RDM, Cabral IE, Carnevale F. Nurses' patterns of knowing about HIV disclosure to children. Rev Bras Enferm 2022; 75Suppl 2:e20210103. [PMID: 35858020 DOI: 10.1590/0034-7167-2021-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES to identify and analyze nurses' patterns of knowing and experiences with the preparation of families for disclosure to children living with HIV seropositivity. METHODS thirteen pediatric nurses from Rio de Janeiro participated in the research using the sensitive creative method. Data were treated with Orlandi's discourse analysis and Carper's patterns of knowing. RESULTS nurses' speeches revealed socioculturally constructed imaginary and ideological formations. The personal pattern of knowing, under the influence of negative media about the disease in the 1980s, generated stigma and prejudice. Empirical, esthetic, and ethical patterns were built on training and professional practice of the 1990s-2010s. They composed a context of (in)security about competence, to contribute to preparing families to disclose HIV to children. FINAL CONSIDERATIONS nurses' experience demonstrates knowledge to intervene and many challenges for their practical appropriation.
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Armoon B, Fleury MJ, Higgs P, Bayat AH, Bayani A, Mohammadi R, Ahounbar E. Prevalence, socio-demographics and service use determinants associated with disclosure of HIV/AIDS status to infected children: a systematic review and meta-analysis by 1985-2021. Arch Public Health 2022; 80:154. [PMID: 35681146 PMCID: PMC9178876 DOI: 10.1186/s13690-022-00910-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 06/03/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Human immunodeficiency virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) is a public health issue of global importance. To our knowledge, no previous meta-analysis documenting the prevalence, socio-demographic, and service use determinants associated with HIV/AIDS disclosure to infected children has been conducted. The present study aimed to determine the prevalence, socio-demographics and service use determinants associated with the disclosure of HIV/AIDS status to infected children. METHODS Studies in English published between 01 January 1985 and 01 November 2021, and available on PubMed, Scopus, Web of Science, and Cochrane electronic databases were searched. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria. We used fixed and random-effects meta-analysis models to estimate the pooled prevalence, pooled odds ratio (OR), and 95% confidence intervals. RESULTS After article duplicates were excluded, assessments of abstracts were completed, and full-text papers evaluated, 37 studies were included in this meta-analysis. The prevalence of the disclosure of HIV status to children was measured to be 41% in this research. The odds that a child of 10 years and older is informed that they are HIV-positive is 3.01 time the odds that younger children are informed. Those children who had primary or lower schooling level were 2.41 times more likely to be informed of their HIV-positive status than children with higher levels of schooling. Children who had a non-biological parents were 3.17 times more likely to have been disclose being HIV-positive; social support (OR = 8.29, 95%CI = 2.34, 29.42), children who had higher levels of social supports were 8.29 times more likely to disclose HIV-positive; the primary educational level of caregivers (OR = 2.03, 95%CI = 1.43, 2.89), respondents who had caregivers with primary education level were 2.03 times more likely to disclose HIV-positive; antiretroviral treatment (ART) adherence (OR = 2.59, 95%CI = 1.96, 3.42), participants who adhered to ART were 2.59 times more likely to disclose HIV-positive and hospital follow-up (OR = 2.82, 95%CI = 1.85, 4.29), those who had hospital follow-up were 2.82 times more likely to disclose HIV-positive; were all significantly associated with the disclosure of HIV/AIDS status to infected children. CONCLUSION Such data are of importance for healthcare pediatrics HIV care professionals. Facilitating HIV diagnosis and disclosure to the infected children and ensuring access to HIV treatment will likely prevent secondary HIV transmission. Healthcare professionals are expected to provide age-appropriate counseling services to this population.
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Affiliation(s)
- Bahram Armoon
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada.
- Department of Psychiatry, McGill University, Montreal, QC, Canada.
| | - Marie-Josée Fleury
- Douglas Mental Health University Institute, Research Centre, 6875 LaSalle Boulevard, Montreal, QC, H4H 1R3, Canada
- Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Peter Higgs
- Department of Public Health, La Trobe University, Melbourne, Australia
- Burnet Institute, Melbourne, VIC, Australia
| | - Amir-Hossien Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Azadeh Bayani
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Opondo H, Lindo NA, Morris HB, Chen H. Counsellors’ experiences of HIV status disclosure to children living with HIV in Uganda. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2022. [DOI: 10.1080/03069885.2022.2051430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Harriet Opondo
- Department of Pediatrics, University of Minnesota, Twin Cities, Min, USA
| | - Natalya Ann Lindo
- Department of Counseling and Higher education, University of North Texas, Denton, TX, USA
| | - Hailey B. Morris
- Department of Counseling and Higher education, University of North Texas, Denton, TX, USA
| | - Huan Chen
- Department of Counseling and Higher education, University of North Texas, Denton, TX, USA
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Bubadué RDM, Cabral IE, Carnevale F. Padrões do conhecer de enfermeiras sobre revelação do HIV à criança. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0103pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivos: identificar e analisar os padrões do conhecer e as experiências de enfermeiras com a preparação de familiares para a revelação à criança que (con)vive com a soropositividade pelo HIV. Métodos: 13 enfermeiras pediátricas do Rio de Janeiro participaram da pesquisa com o método criativo sensível. Dados foram tratados com análise de discurso de Orlandi e padrões do conhecer de Carper. Resultados: os discursos das enfermeiras revelaram formações imaginárias e ideológicas socioculturalmente construídas. O padrão de conhecer pessoal, sob influência da mídia negativa da doença na década de 1980, gerou estigma e preconceito. Os padrões empírico, estético e ético foram construídos nas capacitações e prática profissional das décadas de 1990-2010. Eles compuseram um contexto de (in)segurança sobre a competência, para contribuir na preparação de familiares para a revelação do HIV à criança. Considerações Finais: a experiência das enfermeiras demonstra conhecimentos para intervir e muitos desafios para sua apropriação prática.
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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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Tucho WA, Tekelehaimanot AN, Habte MB. Disclosure Status and Associated Factors Among Children on Antiretroviral Therapy in Ethiopia. PEDIATRIC HEALTH MEDICINE AND THERAPEUTICS 2021; 12:299-306. [PMID: 34211313 PMCID: PMC8242142 DOI: 10.2147/phmt.s314259] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 06/17/2021] [Indexed: 11/23/2022]
Abstract
Background The World Health Organization recommends that children should be informed of their HIV status at age 6–12 years. However, disclosure of HIV status among children is very low in resource-limited areas, particularly in Ethiopia. So, the aim of this study was to determine the prevalence of disclosure and associated factors among a cohort of HIV-infected children in southwest Ethiopia. Methods A facility-based cross-sectional study design was employed among caregivers of HIV-positive children aged 6–15 in Bench sheko and West Omo zone Southwest Ethiopia, from March 1 to April 20, 2020. Study participants were included using a consecutive sampling technique. Data were collected using a pretested interviewer administered questionnaire and checklist. A multivariable logistic regressions model was used to identify independent predictors of disclosure. The significance of association was declared by AOR at 95% confidence and a p-value <0.05. Results A total of 327 participants were involved in the study yielding a 95% response rate. The prevalence of HIV-positive status disclosure was 45.6% (95% CI=41.01–51.02). Caregiver secondary education and above (AOR=3.16, 95% CI=1.07–9.34), caregiver discussed about disclosure with health professionals (AOR= 9.56, 95% CI=4.88–18.74), child age 10–15 year old (AOR=3.64, 95% CI=1.64–8.08), duration on ART >5 years (AOR=5.08, 95% CI=1.57–16.37), treatment follow-up at hospital (AOR=2.23, 95% CI=1.27–5.01) and having treatment support for Children (AOR=3.84, 95% CI=1.88–7.85) were independent predictors of HIV-positive status disclosure. Conclusion Disclosure of HIV status to children is low. Caregivers educational status, caregivers discussion with health professional, older child, duration on ART of more than 5 year, getting treatment service from hospital, and having a treatment support group are factors that enable disclosure. Therefore, concerted efforts based on the findings of this study will be required to improve the disclosure status among HIV-positive children.
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Affiliation(s)
- Walelign Atomsa Tucho
- Department of Disease Prevention and Control, Bench Sheko Zone Health Office, Mizan-Aman, Southwest Ethiopia
| | | | - Mahilet Berhanu Habte
- Department of Population and Family Health, Faculty of Public Health, Jimma University, Jimma, Ethiopia
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Klutsey DA, Amankwah‐Poku M, Oppong Asante K. To disclose or not to disclose? Caregivers experiences of disclosure of HIV status of children living with HIV in Accra, Ghana. LIFESTYLE MEDICINE 2021. [DOI: 10.1002/lim2.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
| | | | - Kwaku Oppong Asante
- Department of Psychology University of Ghana, Legon Accra Ghana
- Department of Psychology University of the Free State Bloemfontein South Africa
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Amankwah-Poku M, Klutsey DA, Asante KO. Disclosure and health-related outcomes among children living with HIV and their caregivers. AIDS Res Ther 2021; 18:13. [PMID: 33879193 PMCID: PMC8056491 DOI: 10.1186/s12981-021-00337-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 04/08/2021] [Indexed: 11/10/2022] Open
Abstract
Background The prevalence of disclosure of status to children living with the Human Immunodeficiency Virus (HIV) is low in most sub-Saharan African countries, leading to poor compliance and adverse psychological outcomes in these children. This study examined the influence of disclosure on health outcomes in children living with HIV and their caregivers. Methods Using a cross-sectional design, 155 HIV-positive children between age 6–15 years and their caregivers were administered standardized questionnaires measuring adherence to medication, children's psychological well-being, caregiver burden, and caregivers’ psychological health. Results Results indicated that only 33.5% of the children sampled knew their status. Disclosure of HIV status was significantly related to medication adherence, psychological wellbeing, the burden of caregiving, and the length of the disclosure. A child’s age and level of education were the only demographic variables that significantly predicted disclosure of HIV status. In a hierarchical analysis, after controlling for all demographic variables medication adherence, psychological well-being and burden of caregiving were found to be significant predictors of disclosure of status in children living with HIV. Conclusions Findings suggest the need for disclosure of status among children living with HIV for a positive impact on their medication adherence and psychological health. These findings underscore the need for the development of context-specific interventions that will guide and encourage disclosure of status by caregivers to children living with HIV.
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Factors Associated with HIV Status Disclosure to Orphans and Vulnerable Children Living with HIV: Results from a Longitudinal Study in Tanzania. AIDS Res Treat 2021; 2020:6663596. [PMID: 33425383 PMCID: PMC7781714 DOI: 10.1155/2020/6663596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/28/2020] [Accepted: 12/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background The Tanzanian national guideline for pediatric HIV disclosure recommends beginning disclosure as early as age 4–6 years; full disclosure is recommended at the age of 8–10 years. Despite clear procedures, the disclosure rate in Tanzania remains relatively low. This study assessed the factors associated with HIV status disclosure to orphans and vulnerable children living with HIV (OVCLHIV). Methods Data for this analysis come from the USAID-funded Kizazi Kipya program in Tanzania that provides health and social services to OVC and caregivers of HIV-affected households. Data were collected between January 2018 and March 2019. Disclosure status was self-reported by caregivers of children aged 8 years or above. Beneficiary characteristics were included as independent variables. Generalized estimating equations took into account the clustering effect of the study design. Results Of the 10673 OVCLHIV, most were females (52.43%), and 80.67% were enrolled in school. More than half (54.89%) were from households in rural areas. Caregivers were mostly females (70.66%), three quarters were between 31 and 60 years old and had a complete primary education (67.15%), and 57.75% were HIV-infected. Most of the OVCLHIV (87.31%) had a disclosed HIV status. Greater OVCLHIV age (p < 0.001), school enrollment (OR = 1.22; 95% CI 1.06, 1.41), urban location of household (OR = 1.64; 95% CI 1.44, 1.86), caregivers' higher education level (p < 0.001), and caregiver HIV-positive status (OR = 1.25; 95% CI 1.09, 1.43) were positively associated with disclosure status. OVCLHIV of female caregivers were 27% less likely to have been disclosed than those of male caregivers. Conclusion The disclosure rate among OVCLHIV in this study was high. Disclosure of HIV status is crucial and beneficial for OVCLHIV continuum of care. Caregivers should be supported for the disclosure process through community-based programs and involvement of health volunteers. Policymakers should take into consideration the characteristics of children, their caregivers, and location of households in making disclosure guidelines as adaptable as possible.
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Langhaug L, Finnegan A, Schenk K, Puffer ES, Rusakaniko S, Green EP. Caregiver self-efficacy to talk about sex predicts conversations about HIV transmission risk with perinatally infected young people in Zimbabwe. AIDS Care 2020; 32:1524-1528. [PMID: 32093483 PMCID: PMC9942532 DOI: 10.1080/09540121.2020.1724253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Given advances in care and treatment for HIV, perinatally infected young people are surviving into adolescence. These young people are making decisions about engaging in sexual relationships and it is critical to ensure they have the information they need to engage responsibly in sexual activity, particularly in an era where adherence to treatment could make their virus undetectable. The main objective of this analysis was to examine whether an HIV-positive young person's knowledge about forward transmission is associated with caregiver self-efficacy to talk about sex and general caregiver communication. Using data from a 12-month prospective cohort of caregivers of HIV-positive children aged 9-15 on ART and pre-ART in rural Zimbabwe, we found that caregiver self-efficacy to talk about sex predicted whether conversations about HIV transmission would occur between caregiver and the young person. However, by the end of 12-months, nearly two-thirds of caregivers of HIV-positive teenagers in our sample had still not explained how their adolescents could spread the virus to others despite these caregivers saying their adolescent should know this information at baseline. We discuss the implications for designing sexual and reproductive health (SRH) programs among populations of young people perinatally infected with HIV to ensure that this breakthrough generation receives the SRH support they need.
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Affiliation(s)
| | - A. Finnegan
- Duke Global Health Institute, Box 90519, Durham, North
Carolina 27708, USA,IntraHealth International, 6340 Quadrangle Dr #200, Chapel
Hill, North Carolina 27517, USA,Please address correspondence to Amy Finnegan
()
| | - K. Schenk
- George Mason University, College of Health and Human
Services, Department of Global and Community Health, MS: 5B7, 4400 University Drive,
Fairfax, Virginia 22030-4444, USA,American University, Department of Health Studies, 4400
Massachusetts Avenue NW, Washington, DC 20016
| | - E. S. Puffer
- Duke Global Health Institute, Box 90519, Durham, North
Carolina 27708, USA,Duke University, Department of Psychology and Neuroscience,
Box 90086, 417 Chapel Drive, Durham, NC 27708-0086, USA
| | - S. Rusakaniko
- University of Zimbabwe, Faculty of Medicine, Department of
Community Medicine, P.O.Box MP167, Mount Pleasant, Harare, Zimbabwe
| | - E. P. Green
- Duke Global Health Institute, Box 90519, Durham, North
Carolina 27708, USA
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Kodyalamoole NK, Badiger SB, Dodderi SK, Shetty AK. Determinants of HIV status disclosure to children living with HIV in coastal Karnataka, India. AIDS Care 2020; 33:1052-1058. [PMID: 33233927 DOI: 10.1080/09540121.2020.1851018] [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: 10/22/2022]
Abstract
The caregivers of HIV-positive children either delay or avoid disclosure of HIV status to the child due to several reasons. Keeping the child's HIV status a secret puts them at considerable risk of stopping therapy and transmitting HIV to others. Hence this study was conducted to assess the determinants of disclosure of HIV status to infected children in coastal Karnataka. A cross-sectional study was conducted in a District Hospital in Coastal Karnataka from October 2014 to July 2015. One hundred eighty-five caregivers were recruited for the study purposively and interviewed using a pre-tested, semi-structured questionnaire after written informed consent. Of the 185 caregivers interviewed, 78 (42%) caregivers had not disclosed the HIV status to the child. The child being too young was the most common reason for non-disclosure of HIV status. The majority of the caregivers intended to disclose the HIV status fully to the child after the child attained ten years of age. Nearly two-thirds of the caregivers wanted to disclose it themselves in their own homes. The significant determinants of disclosure of HIV status were the age of the child, and person involved in childcare, and the venue of the disclosure.
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Affiliation(s)
- Nishanth Krishna Kodyalamoole
- Former: Department of Community Medicine, K.S.Hegde Medical Academy, Nitte (Deemed to be) University, Deralakatte, Mangalore, India
| | - Sanjeev B Badiger
- Former: Department of Community Medicine, K.S.Hegde Medical Academy, Nitte (Deemed to be) University, Deralakatte, Mangalore, India
| | - Sunil Kumar Dodderi
- Former Regional Coordinator- Care, Support and Treatment Division, Karnataka State AIDS Prevention Society, National AIDS Control Organisation, Ministry of Health and Family Welfare, Govt of India, Bangalore, India
| | - Avinash K Shetty
- Department of Pediatrics and Office of Global Health, Wake Forest School of Medicine and Brenner Children's Hospital, Winston- Salem, NC, USA
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Shiau S, Arpadi SM, Burke M, Liberty A, Thurman C, Patel F, Strehlau R, Abrams EJ, Coovadia A, Violari A, Kuhn L. Educational delays among children living with perinatally-acquired HIV in Johannesburg, South Africa. AIDS Care 2019; 32:438-444. [PMID: 31288549 DOI: 10.1080/09540121.2019.1640854] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Little is known about how growing up with HIV impacts educational outcomes in sub-Saharan African children. We evaluated if South African children living with HIV (CLWH) were in the appropriate school grade-for-age compared to uninfected control children. We observed higher rates of not being in the correct grade-for-age in CLWH compared with controls (OR 3.32, 95% CI: 2.07-5.34), adjusted for study site, sex, whether the child's biological father was alive, and caregiver education. Initiation of ART before 6 months of age reduced but did not eliminate this association. Whether these associations are due to biological factors or other social and environmental determinants, and how best to support CLWH to achieve educational goals, warrants further investigation.
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Affiliation(s)
- Stephanie Shiau
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Stephen M Arpadi
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Megan Burke
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Afaaf Liberty
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Cara Thurman
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA
| | - Faeezah Patel
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Renate Strehlau
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elaine J Abrams
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York.,Department of Pediatrics, Vagelos College of Physicians and Surgeons, Columbia University, New York, USA
| | - Ashraf Coovadia
- Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Avy Violari
- Perinatal HIV Research Unit, Chris Hani Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Louise Kuhn
- G.H. Sergievsky Center, Vagelos College of Physicians & Surgeons, Columbia University, New York, USA.,Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA.,Empilweni Services and Research Unit, Rahima Moosa Mother and Child Hospital, Department of Paediatrics and Child Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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