Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa, and Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
BMC Public Health. 2013 Feb 18;13:147. doi: 10.1186/1471-2458-13-147.
As access to treatment increases, large numbers of HIV-positive parents are raising HIV-negative children. Maternal HIV disclosure has been shown to have benefits for mothers and children, however, disclosure rates remain low with between 30-45% of mothers reporting HIV disclosure to their children in both observational and intervention studies. Disclosure of HIV status by parent to an HIV-uninfected child is a complex and challenging psychological and social process. No intervention studies have been designed and tested in Southern Africa to support HIV-positive parents to disclose their status, despite this region being one of the most heavily affected by the HIV epidemic.
This paper describes the development of a family-centred, structured intervention to support mothers to disclose their HIV status to their HIV-negative school-aged children in rural South Africa, an area with high HIV prevalence. The intervention package includes printed materials, therapeutic tools and child-friendly activities and games to support age-appropriate maternal HIV disclosure, and has three main aims: (1) to benefit family relationships by increasing maternal HIV disclosure; (2) to increase children's knowledge about HIV and health; (3) to improve the quality of custody planning for children with HIV-positive mothers. We provide the theoretical framework for the intervention design and report the results of a small pilot study undertaken to test its acceptability in the local context.
The intervention was piloted with 24 Zulu families, all mothers were HIV-positive and had an HIV-negative child aged 6-9 years. Lay counsellors delivered the six session intervention over a six to eight week period. Qualitative data were collected on the acceptability, feasibility and the effectiveness of the intervention in increasing disclosure, health promotion and custody planning. All mothers disclosed something to their children: 11/24 disclosed fully using the words "HIV" while 13/24 disclosed partially using the word "virus".
The pilot study found the intervention was feasible and acceptable to mothers and counsellors, and provides preliminary evidence that participation in the intervention encouraged disclosure and health promotion. The pilot methodology and small sample size has limitations and further research is required to test the potential of this intervention. A larger demonstration project with 300 families is currently underway.
随着治疗机会的增加，越来越多的 HIV 阳性父母正在抚养 HIV 阴性的孩子。母婴 HIV 披露已被证明对母亲和孩子都有好处，但在观察性和干预性研究中，只有 30-45%的母亲报告向孩子披露了 HIV 状况，披露率仍然很低。父母向未感染 HIV 的孩子披露 HIV 状况是一个复杂而具有挑战性的心理和社会过程。尽管南部非洲是受 HIV 疫情影响最严重的地区之一，但尚未设计和测试任何干预研究来支持 HIV 阳性父母披露其状况。
本文描述了一种以家庭为中心、结构化的干预措施的制定，以支持南非农村地区的 HIV 阴性学龄母亲向其子女披露 HIV 状况，该地区 HIV 感染率较高。该干预包包括印刷材料、治疗工具和适合儿童的活动和游戏，以支持适龄的母婴 HIV 披露，主要有三个目标：（1）通过增加母婴 HIV 披露来改善家庭关系；（2）提高儿童对 HIV 和健康的认识；（3）改善 HIV 阳性母亲的子女监护计划质量。我们提供了干预设计的理论框架，并报告了在当地进行的一项小型试点研究的结果，以测试其在当地环境下的可接受性。
该干预措施在 24 个祖鲁家庭中进行了试点，所有母亲均为 HIV 阳性，且有一名 6-9 岁的 HIV 阴性子女。非专业辅导员在六至八周内完成了六次干预课程。收集了关于干预措施的可接受性、可行性和有效性的定性数据，这些数据可增加披露、促进健康和监护计划。所有母亲都向孩子透露了一些信息：24 名母亲中有 11 名使用“HIV”一词完全披露，而 13 名母亲使用“病毒”一词部分披露。
试点研究发现，该干预措施对母亲和辅导员来说是可行和可接受的，并提供了初步证据表明，参与该干预措施鼓励了披露和健康促进。试点方法和小样本量存在局限性，需要进一步研究来检验该干预措施的潜力。目前正在进行一项涉及 300 个家庭的更大示范项目。
