School of Public Health, City University of New York , New York, NY , USA.
Department of Social Work, York College, City University of New York , New York, NY , USA.
Front Public Health. 2016 Sep 8;4:181. doi: 10.3389/fpubh.2016.00181. eCollection 2016.
While the psychological and health benefits of knowing one's HIV diagnosis have been documented for adults and adolescents, practice is still in development for younger children. Moderating conditions for whether or not to tell a child he/she has HIV vary by region and local context. They include accessibility of treatment, consideration of HIV as a stigmatizing condition, prevalence of HIV, and an accompanying presumption that any illness is HIV-related, parent or caregiver concerns about child reactions, child's worsening health, assumptions about childhood and child readiness to know a diagnosis, and lack of policies such as those that would prevent bullying of affected children in schools. In this systematic review of the global literature, we summarize the reasons caregivers give for telling or not telling children 12 and under their HIV diagnosis. We also include articles in which children reflect on their desires for being told. While a broad number of reasons are given for telling a child - e.g., to aid in prevention, adaptation to illness (e.g., primarily to promote treatment adherence), understanding social reactions, and maintaining the child-adult relationship - a narrower range of reasons, often related to immediate child or caregiver well-being or discomfort, are given for not telling. Recommendations are made to improve the context for disclosure by providing supports before, during, and after disclosure and to advance the research agenda by broadening samples and refining approaches.
虽然已经有文献证明了解 HIV 诊断结果对成年人和青少年的心理和健康有益，但对于年龄较小的儿童，这方面的实践仍在发展中。是否告知儿童 HIV 感染状况的决定因素因地区和当地情况而异。这些因素包括治疗的可及性、对 HIV 的污名化程度、HIV 的流行情况以及随之而来的假设，即任何疾病都与 HIV 有关、父母或照顾者对儿童反应的担忧、儿童健康状况恶化、对儿童的假设以及儿童准备好了解诊断的程度，以及缺乏政策，例如防止学校中受影响儿童受到欺凌的政策。在对全球文献的系统回顾中，我们总结了照顾者告知或不告知 12 岁及以下儿童 HIV 诊断的原因。我们还包括了一些儿童反映自己对被告知的愿望的文章。虽然有很多理由可以说明要告知孩子，例如帮助预防、适应疾病（主要是促进治疗依从性）、理解社会反应以及维持儿童与成人的关系，但不告知孩子的理由往往更窄，通常与儿童或照顾者的即时健康或不适有关。我们建议在告知前、告知中和告知后提供支持，以改善披露的环境，并通过扩大样本和改进方法来推进研究议程。
