The context and process of pediatric HIV disclosure

This qualitative study sought to elicit the context and process of disclosure to children living with HIV (CLHIV) on antiretroviral treatment in Nigeria. The study, nested in a larger study, involved detailed interviews with 15 parent/caregivers of children ≥6 years, who had been told they were living with HIV. Most children were disclosed to at home by their parents/caregivers. The common reason for disclosure was related to the children taking their drugs. Disclosure was mostly unplanned and a one-off event, even when it was the healthcare worker who disclosed. The conversation about the child’s HIV status took place in private between the child and parent(s)/caregiver. Where several children were living with HIV in the family, parents/caregivers would usually disclose to the children at the same time, rather than individually. Children’s reaction to disclosure ranged from no reaction to shock and crying. Some parents felt they did not have the right skills to disclose. The disclosure decision model provides some insight into the disclosure process.