TO DISCLOSE OR NOT TO DISCLOSE THE HIV/AIDS STATUS OF CHILDREN: HEALTH-RELATED OUTCOMES AND EXPERIENCES OF CAREGIVERS.

ABSTRACT It has been shown that disclosure of status to children living with HIV has a beneficial effect on health outcomes in children living with HIV. In most sub-Saharan African nations, however, the prevalence of disclosure remains low, leading to poor compliance or adherence and adverse psychological results in these children. This study explored the disclosure experiences among caregivers of children living with HIV and the influence of disclosure on health outcomes in both children and their caregivers. Using an exploratory sequential mixed method design, 15 caregivers between the ages of 27 and 55 years comprising 4 males and 11 females with a mean age of 41 years (SD= 6.23) were interviewed in the qualitative stage, while 155 HIV-positive children between 6 – 15 years of age with a mean age of 9.55 years (SD=2.72) and their caregivers with mean age of 41.60 years (SD= 10.38) were administered standardized questionnaires measuring adherence to medication, children's psychological well-being, caregiver burden, and caregivers’ psychological health. Results indicated that age/maturity, stigma, and fear of child telling others about the diagnosis were the main reasons for nondisclosure whereas non-adherence, curiosity, and transition to high or boarding school were some of the factors that prompted disclosure. Disclosure of HIV status led to improved adherence and psychological wellbeing in children living with HIV. However, disclosure did not affect health outcomes in caregivers. Age was an important predictor of disclosure, and duration of disclosure mediated the relationship between disclosure and psychological wellbeing. Inadequate finances, anxieties about lifelong medication for children and high levels of psychological distress and burden were the challenges reported by caregivers. These findings emphasize the need for disclosure of status among children living with HIV using an interdisciplinary approach