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.

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.

Examining HIV-positive parents' disclosure to their children: a biopsychosocial approach

In the post HAART era, the biopsychosocial issues now facing HIV-positive parents concerning disclosure of their status to their children need to be understood in the context of chronic disease. This article describes the experiences of 101 adult HIV-positive urban in-treatment mothers and fathers of school-age children on disclosure, psychological distress, social support, and symptom severity. Key variables associated with parents' HIV disclosure were the age of parent and of children in the household, parents' HIV-related symptoms, and parent ethnicity. Cultural and maturational, rather than psychological or social factors were significantly related to parents' HIV disclosure.

Disrupted caregiving and maternal HIV disease: a proposed model for evaluating HIV-affected children's psychosocial adjustment

A current concern among social science researchers is the impact of human immunodeficiency virus (HIV) disease on the family, especially on the parenting abilities of mothers with HIV. Beginning research suggests that the children of HIV-positive parents are vulnerable, pointing to the impact of HIV disease on children's social and emotional adjustment. The objective of this article is to propose a model of the HIV disease-related disruption of care on children's psychosocial adjustment. The schematic model can be used to evaluate the mechanisms by which maternal HIV disease may influence the psychosocial adjustment of elementary school-age children.

Deconstructing stigma: perceptions of HIV-seropositive mothers and their disclosure to children

This study addressed the perceptions of stigma and disclosure behavior of HIV-seropositive mothers. Eighty-eight HIV-seropositive women in New York City completed two independent measures of stigma, the Perceived Stigma Scale and the Devaluation-Discrimination Measure. Disclosers (67%) and nondisclosers (33%) were similar in most sociodemographic characteristics-marital status, race, religion and employment, with the exception of age and education. Significant differences were found between disclosure groups in the use of secrecy as a stigmamanagement tool and in perceived devaluation-discrimination associated with an HIV diagnosis. Nondisclosers to children were significantly more likely than disclosers to use secrecy as a stigma management tool (t =-2.76; p =.01), and to feel devalued and discriminated against as a result of HIV serostatus (t = 3.11; p =.01). Disclosure of parental HIV serostatus to children is an important aspect of continuous care and custody planning. Secrecy and perceptions of devaluation and discrimination related to HIV diagnosis should be seen as barriers to disclosure of serostatus to children.

Key emotional issues for couples of mixed HIV status

With more effective treatment advances, long term HIV survivors are turning their attention back towards career and relationship. Based on a research study (N = 82) this article provides a preliminary overview of the key emotional experiences of being in a primary relationship of mixed HIV status. The article reviews relevant literature on emotional stresses and challenges facing the individual in such a relationship and reports on the study's quantitative and qualitative findings on the subject. Regardless of serostatus, sexual orientation or gender, key issues clearly emerged for this population. They are fearful of HIV transmission, impact of uncertainty, an increase in emotional closeness due to HIV as well as an inevitable emotional distance due to the difference in HIV status. Secondary issues included reproductive dilemmas and struggles given one partner's HIV status and difficulty with disclosing a partner's HIV positive status to others. Implications for social workers in health care are provided.