Mweemba Mable, Musheke Maurice M, Michelo Charles, Halwiindi Hikabasa, Mweemba Oliver, Zulu Joseph M
Department of Public Health, School of Medicine, University of Zambia, Lusaka, P.O. Box 50110, Zambia.
Ministry of Community Development, Mother and Child Health, Lusaka, Zambia.
BMC Public Health. 2015 Oct 7;15:1028. doi: 10.1186/s12889-015-2372-3.
Disclosure of adolescents' own HIV status by caregivers is not only challenging but low. The reasons for this remain unclear despite efforts to examine and seek to understand disclosure patterns or factors that may either facilitate or inhibit this disclosure. This study explored the enablers, barriers and processes of disclosure of HIV status to adolescents by their caregivers in Kafue district of Zambia.
A case study method was used to understand factors that facilitate or inhibit caregiver's ability to disclose the HIV status of adolescents aged 10-15 years. Data collected through in-depth interviews with 30 caregivers as well as 6 key informants were analysed using thematic analysis.
Overall, 17 out of 30 (56.7 %) caregivers had informed the adolescents about their HIV status. Reasons for disclosing of the HIV status included inquiries by adolescents as to why they were taking medication, threats by adolescents not to take HIV medication, desire to promote treatment self-efficacy amongst adolescents as well as facilitating adoption of safe sexual behaviour among adolescents. The disclosure processes were conducted either at the home or at the clinic. Enabling factors for HIV disclosure were adolescents' knowledge of HIV and caregivers' knowledge of and experience with HIV programs. Barriers to disclosure of HIV status included fear of psychological trauma for the adolescents, perceived inability of adolescents to keep their HIV status confidential which could attract HIV stigmatisation for the family, and caregivers', fear of being blamed by the adolescents for the infection, limited disclosure skills by caregivers as well as negative attitude by some HIV counsellors.
Despite challenges associated with disclosure of adolescents' own HIV status by caregivers, environments that facilitate this process exist and can be strengthened. Promoting HIV disclosure requires in-depth and context-specific understanding of the factors that enable and undermine this process. Limitations in this understanding may have played critical roles in past strategic implementation of locally driven and relevant interventions to improve disclosure of HIV status by caregivers to adolescents in Zambia.
照顾者向青少年披露其自身的艾滋病毒感染状况不仅具有挑战性，而且披露率很低。尽管人们努力研究并试图了解披露模式或可能促进或抑制这种披露的因素，但其中的原因仍不明确。本研究探讨了赞比亚卡富埃区照顾者向青少年披露艾滋病毒感染状况的促进因素、障碍及过程。
采用案例研究方法来了解促进或抑制照顾者向10至15岁青少年披露艾滋病毒感染状况能力的因素。通过对30名照顾者以及6名关键信息提供者进行深入访谈收集的数据，采用主题分析法进行分析。
总体而言，30名照顾者中有17名（56.7%）已告知青少年其艾滋病毒感染状况。披露艾滋病毒感染状况的原因包括青少年询问为何服药、青少年威胁不服艾滋病毒治疗药物、希望提高青少年的治疗自我效能以及促使青少年采取安全性行为。披露过程在家庭或诊所进行。艾滋病毒披露的促成因素包括青少年对艾滋病毒的了解以及照顾者对艾滋病毒项目的了解和经验。艾滋病毒感染状况披露的障碍包括担心给青少年造成心理创伤、认为青少年无法对其艾滋病毒感染状况保密从而可能给家庭带来艾滋病毒污名化、照顾者担心被青少年指责感染、照顾者披露技巧有限以及一些艾滋病毒咨询员的消极态度。
尽管照顾者向青少年披露其自身艾滋病毒感染状况存在挑战，但存在促进这一过程的环境且可加以强化。促进艾滋病毒感染状况披露需要深入且针对具体情况了解促成和破坏这一过程的因素。在过去战略实施中，对这种理解的局限性可能在当地推动的相关干预措施改善赞比亚照顾者向青少年披露艾滋病毒感染状况方面起到了关键作用。
