Disclosure of HIV infection by caregivers to children with HIV/AIDS in Thamaga Primary Hospital - Botswana : Reasons and experiences

Abstract

Introduction

With the increased availability of the life-saving ARVs in most Sub-Saharan Africa more HIV -infected children are surviving into their adolescent years and beyond hence giving rise to the question of whether the caregiver should disclose or not disclose the child's HIV diagnosis to child. Little is known of the reasons and experiences that motive or hinder caregivers from disclosing the HIV diagnosis to the child.

Study Aim and objectives

This was aimed at identifying caregivers' reasons for HIV diagnosis disclosure and non-disclosure to HIV-infected children under their care. The study also explores their experience with process of HIV diagnosis disclosure and non-disclosure to the child.

Study methodology

Using qualitative descriptive research approach, twenty (20) caregivers of HIV¬infected children aged between 6 - 16 years receiving ART at Thamaga Primary Hospital IDee with unknown HIV diagnosis disclo~ure status were ~.ubjected to audio-taped in-depth interviews for data capturing. Thematic content analysis was used for data analysis using, Nvivo8 software and 16 themes with their sub categories were identified.

Findings

Both caregivers of disclosed and non-disclosed HIV-infected children perceived disclosure as a good thing to do with majority of the caregivers (60%) having disclosed. Reasons for telling the children their HIV diagnosis were that the child had the right to know his/her status; caregiver tired of keeping child HIV diagnosis a secret; the caregiver's believe that disclosure will improve the child's ART adherence and finally some caregivers felt the child had reached the right age or maturity for disclosure. Non-disclosing caregivers felt that health care workers should assist them in doing disclosure and identified the reasons for non-disclosure as the child being too young and not asking questions about their illness; fear that disclosure might hurt the child psychologically; fear that the child might not keep their HIV

diagnosis a secret leading to discrimination in the community while some caregivers lack of knowledge on how to disclose. Non-disclosing caregivers managed disclosure by not telling the child the truth about their diagnosis and using threats to coerce them to take their ARV drugs.

Conclusions and recommendations

The decision to disclosure or not to disclose the HIV diagnosis to a child by a caregiver is influenced by a number of reasons and their experiences. Caregivers of HIV-infected children need to be assisted by a health care provider when disclosing to the child and further assessment should be made in making disclosure part of the

holistic management of an HIV -infected child.

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