Why Tell Children: A Synthesis of the Global Literature on Reasons for Disclosing or Not Disclosing an HIV Diagnosis to Children 12 and under

While the psychological and health benefits of knowing one's HIV diagnosis have been documented for adults and adolescents, practice is still in development for younger children. Moderating conditions for whether or not to tell a child he/she has HIV vary by region and local context. They include accessibility of treatment, consideration of HIV as a stigmatizing condition, prevalence of HIV, and an accompanying presumption that any illness is HIV-related, parent or caregiver concerns about child reactions, child's worsening health, assumptions about childhood and child readiness to know a diagnosis, and lack of policies such as those that would prevent bullying of affected children in schools. In this systematic review of the global literature, we summarize the reasons caregivers give for telling or not telling children 12 and under their HIV diagnosis. We also include articles in which children reflect on their desires for being told. While a broad number of reasons are given for telling a child - e.g., to aid in prevention, adaptation to illness (e.g., primarily to promote treatment adherence), understanding social reactions, and maintaining the child-adult relationship - a narrower range of reasons, often related to immediate child or caregiver well-being or discomfort, are given for not telling. Recommendations are made to improve the context for disclosure by providing supports before, during, and after disclosure and to advance the research agenda by broadening samples and refining approaches.

Predictor variables for NCLEX-RN readiness exam performance

AIM

To understand the relationship among NLCLEX-RN readiness exam scores and influencing variables.

BACKGROUND

First-time NCLEX-RN pass rates are a visible measure of program quality.Therefore, schools have adopted aggressive prediction and remediation measures to improve NCLEX-RN pass rate success and therefore the number of licensed and practicing nurses.

METHOD

This descriptive correlational study used regression analysis to investigate multivariate relationship between NCLEX-RN readiness exam scores and predictors.

RESULTS

This study's findings suggest that while the input variables measured by grades in prerequisites initially appear predictive, only the presence of transfer credits, a potential marker for age and motivation, remains significant.

CONCLUSION

Most transfer students are nontraditional adult learners.Therefore, it can be theorized that student personal system has a significant impact on the outcome. The first nursing course, adult health nursing plus maternal-child health nursing, appears foundational for the NCLEX readiness exam.

Caregiver's HIV disclosure to children 12 years and under: a review and analysis of the evidence

A systematic review and analysis of the empirical evidence through June 2010 on HIV disclosure to children 12 and under was conducted using methods validated by the Cochrane group. Fifteen articles focusing on caregiver disclosure (255 total) were analyzed using GradePro 3 software. Results suggest that there is evidence of health and future care planning benefit for HIV+ and healthy children (12 and under) of HIV+ caregivers if the caregiver discloses his/her HIV status to them. Children of the maturity of school age youth (e.g., beginning at 6 years and continuing through 12) can be told of their caregivers' HIV status, while younger children may be informed partially in an age-appropriate manner.

Prevalence and correlates of heterosexual anal intercourse among Black and Latina female adolescents

Anal intercourse (AI) is a recognized HIV risk behavior, yet little is known about AI among adolescent girls and young women. The authors studied the prevalence and correlates of heterosexual AI (HAI) among Black and Latina adolescent girls and young women. The data come from two randomized clinical trials (RCTs) of HIV prevention interventions with Black and Latina adolescent girls and young women. In the second RCT, a Sexual Relationship Power Scale was added to the questionnaire. Thirty-five percent of participants in the first RCT (N =244) and 23% of those in the second RCT (N =101) reported engaging in HAI, most without a condom. Significant correlations existed between HAI and a high-risk sexual history. HAI is prevalent in this population. Nurses must educate female adolescent patients about risks associated with HAI.

Who wins in the status games? Violence, sexual violence, and an emerging single standard among adolescent women

Throughout U.S. history, women have changed their sexual behaviors in response to, or as actors affecting, economic, political, and legal imperatives; to preserve health; to promote new relationship, identity or career paths; to assert a set of values; as a result of new reproductive technologies; or to gain status. In adjusting to pressures or goals, women have not always acted, or been able to act, in the interests of their own health, identity, or status. As this article will demonstrate, women, in the short or long run, may attempt to preserve status at the cost of other values such as health. This may occur through conscious and critical choice or through less conscious processes in reaction to relatively larger forces whose impact has not been critically analyzed. With the awareness in the 1980s in the United States of an emergent and incurable sexually transmissible infection, HIV, it would have been anticipated that a new sexual caution may have appeared. Yet, across several research projects in the late 1990s and into the 21st century, as our research team interviewed youth in a high HIV seroprevalence neighborhood in New York City about HIV prevention, we began to hear that a substantial minority of young women and men were participating in social settings for sexual behavior that (1) put youth at risk for HIV; (2) appeared to be motivated by acquisition of status ("props," "points"); and (3) offered few ways for women to win in these status games. We estimate from one random dwelling unit sample that about one in eight youth have been present in these settings and half of them have participated in risky sexual behavior in such settings. The settings are often characterized by men's publicly offhand attitudes toward sexual encounters, are organized around men's status maintenance, and evidence peer pressures that are poorly understood by both young men and women participants. To regain status, some women participants have adopted attitudes more characteristic of men.

Hugging my uncle: the impact of a parent training on children's comfort interacting with persons living with HIV

OBJECTIVE

HIV-related stigma affects not only persons living with HIV (PLwHIV) but also their communities and families including children. This study aimed to determine whether an interactive training administered to community parents significantly increases their children's reported comfort interacting with PLwHIV.

METHODS

A randomized clinical trial with random-quota dwelling unit sampling and a random invitation to treatment had 238 parent and 238 child participants.

RESULTS

For children of trained parents, significant increases in comfort were obtained, baseline to 6-month follow-up, on 14 of 22 reported daily activities with PLwHIV. For children who recently interacted with a person living with HIV, this comfort predicted the number of recent activities, even after controlling for closeness to the person living with HIV and for the number of persons with HIV known, living or deceased.

CONCLUSIONS

Training parents to be HIV health educators of their children significantly impacts youth and shows promise for reducing HIV-related stigma and social isolation.

Pretest assessment as a component of safer sex intervention: a pilot study of brief one-session interventions for women partners of male injection drug users in New York City

This pilot study evaluated whether brief safer sex interventions for women partners of male injection drug users significantly influenced perceptions of partner risk, human immunodeficiency virus (HIV) knowledge, correct condom usage, and self-reported consistent safer sex (abstinence or 100% of vaginal-penile intercourse acts protected by male or female condoms). The study also examined the impact of pretest assessment on those variables since pretest assessment may challenge participants' current knowledge, safer sex practices, and partner communication techniques. The study randomly assigned participants to pretest or no pretest assessment. Each group was also assigned randomly to a presentation modality: (1) safer sex pamphlet review only, (2) pamphlet review with demonstration of several safer sex alternatives, or (3) pamphlet review with skills practice to mastery with one safer sex alternative of the woman's choice. For the last two conditions, a 35-minute interactive session covered prevention efficacy of safer sex methods for HIV, sexually transmitted infections, pregnancy, correct use, eroticization, local cost and availability, and partner objections. At 7 weeks postintervention, a higher proportion of women who took pretest assessment reported consistent safer sex (66.7%) compared to those without pretests (55.6%). Assignment to the interactive interventions (skills or demonstration) had little additional impact over pretest assessment for these women. Among women who did not take pretests, the interactive interventions had strong effects; 76.9% reported consistent safer sex versus 33.3% in the pamphlet review group. There were additional specific effects for pretest assessment on HIV knowledge and partner risk perception and for interactive intervention on correct condom usage. Brief interventions appear to have some positive short-term effects. Pretest assessment may be an important component of brief interventions.

Women find their voices. The success of community outreach and case finding

Families in transition (FIT), a joint program between Beth Israel Medical Center (BIMC) and National Development and Research Institutes, Inc., uses indigenous neighborhood women, Compañeras (companions), to conduct street outreach in a New York City neighborhood where HIV infection is rampant. The outreach workers inform people that, not only will they be assisted in talking about HIV and guardianship for their children, but that they will be provided information concerning access to food stamps, housing, health care, and other basic needs. Through community participation, the Compañeras empower themselves through knowledge making and sharing and, in the process, create conditions in which other women can began to effect changes in their individual lives and families. The ultimate goal of the project is to support HIV-infected women in finding their voices so that they can talk with their children and plan for their futures.

A randomized trial using videotape to present consent information for colonoscopy

A randomized controlled trial was conducted to determine if a videotaped presentation by a physician conveys information more effectively than an in-person discussion by the same physician using the identical script. Two hundred one patients undergoing colonoscopy were enrolled in the study. Patients were randomly assigned to one of three groups: video plus discussion, video alone, and discussion alone. A validated, 13-item knowledge test and the State-Trait Anxiety Inventory were administered to all patients. Mean number of correct test answers for video plus discussion was 11.04; for video alone, 10.70; and for discussion alone, 9.61. ANOVA with planned orthogonal comparisons showed that the patients in the two video groups had significantly better scores (p < 0.001) than those in the discussion-only group. No difference was noted between the two video groups (p = 0.32). Anxiety did not increase with increased understanding of the risks and benefits of colonoscopy. This approach may work as well for other invasive medical procedures and could save physician time while laying a foundation for a more personalized discussion.

Reporting recent sexual practices: gay men's disclosure of HIV risk by questionnaire and interview

AIDS-related research relies primarily on self-reports of sexual practices. Therefore, determining which data collection methods yield more candid information is critical. Data from a study of gay men's sexual adaptations to the AIDS epidemic provided an opportunity to explore the congruence of data collected using a self-administered questionnaire with data from an unstructured face-to-face interview designed to facilitate report of sexual risk behavior. We examined (i) the concordance of questionnaire and unstructured interview risk ratings when the two data sources are scored for the same 16 sexual behaviors; (ii) the concordance of questionnaire ratings and ratings obtained when all information on recent sexual practices available from the unstructured interview is considered; (iii) the relationship between serostatus and both concordance patterns between methods; and (iv) the difference by serostatus of reported risk level within method. Riskiest behaviors were reported on the questionnaire for all serostatus groups. Riskier behaviors were more likely to be reported on the questionnaire while more characteristic, safer behaviors were discussed in interview, regardless of HIV serostatus. The advantages of a combined methods--questionnaire/interview--strategy for sexual practice research are discussed.