McHugh Grace, Simms Victoria, Dziva Chikwari Chido, Mujuru Hilda, Nathoo Kusum, Chonzi Prosper, Munyati Shungu, Dauya Ethel, Bandason Tsitsi, Busza Joanna, Ferrand Rashida A
a Biomedical Research and Training Institute , Harare , Zimbabwe.
b London School of Hygiene and Tropical Medicine , London , UK.
AIDS Care. 2018 Jul;30(7):830-835. doi: 10.1080/09540121.2018.1434118. Epub 2018 Feb 4.
Increasing numbers of children with HIV are surviving to adolescence and beyond, many of whom are orphaned. Disclosure of childrens' and adolescents' HIV status has been shown to improve adherence and retention in HIV treatment programmes. We investigated caregiving arrangements and intra-familial experience of HIV and its relationship to HIV disclosure to older children and adolescents. Children aged 6-15 years, newly diagnosed with HIV infection or previously diagnosed but not engaged in HIV care, were recruited from seven primary care clinics in Harare, Zimbabwe. Their caregivers responded to a nurse-led questionnaire. Family history of HIV, disclosure of HIV status to the child and reasons for non-disclosure were ascertained. The association between sociodemographics, caregiving, family HIV history and other characteristics and non-disclosure of HIV status to the child was determined using univariate and multivariate logistic regression. We recruited 385 participants, median age = 11 years (IQR: 9-13); 52% were female. Disclosure had occurred in 79% of children aged 11-15 years and 19% of children aged 6-10 years. Age under 11 years (adjusted OR [aOR] = 18.89, 95% confidence interval [CI] = 10.64-33.55; p < 0.001), being male [aOR]= 2.56, 95% CI = 1.49-4.54; p = 0.001, being unaware of the parents' HIV status [aOR]= 32.42, 95% CI = 13.19-79.71; p < 0.001, and being newly diagnosed [aOR]= 2.52, 95% CI = 1.29-4.91; p = 0.007, were independently associated with non-disclosure. Disclosure outside of the family occurred infrequently and included friends of family (7%), school teacher (8%), school headmaster (4%) and church pastor (6%). High non-disclosure rates were present as well as a lack of discussion about HIV within the family. Disclosure outside of family was low reflecting difficulty in caregivers' ability to discuss HIV with their child or surrounding community. HIV programmes need to support families in the disclosure process.
越来越多感染艾滋病毒的儿童存活至青春期及以后，其中许多人成为了孤儿。已表明披露儿童和青少年的艾滋病毒感染状况可提高他们对艾滋病毒治疗方案的依从性和留存率。我们调查了艾滋病毒感染者的照料安排、家庭内部经历及其与向大龄儿童和青少年披露艾滋病毒感染状况之间的关系。从津巴布韦哈拉雷的7家初级保健诊所招募了6至15岁新诊断出感染艾滋病毒或之前已诊断但未接受艾滋病毒护理的儿童。他们的照料者回答了一份由护士主导的问卷。确定了艾滋病毒家族史、向儿童披露艾滋病毒感染状况以及未披露的原因。使用单因素和多因素逻辑回归确定社会人口统计学、照料情况、家庭艾滋病毒病史及其他特征与未向儿童披露艾滋病毒感染状况之间的关联。我们招募了385名参与者，年龄中位数为11岁（四分位距：9 - 13岁）；52%为女性。11至15岁儿童中有79%的艾滋病毒感染状况已被披露，6至10岁儿童中这一比例为19%。11岁以下（调整后比值比[aOR]=18.89，95%置信区间[CI]=10.64 - 33.55；p<0.001）、男性[aOR]=2.56，95%CI=1.49 - 4.54；p=0.001、不知道父母的艾滋病毒感染状况[aOR]=32.42，95%CI=13.19 - 79.71；p<0.001以及新诊断感染艾滋病毒[aOR]=2.52，95%CI=1.29 - 4.91；p=0.007与未披露独立相关。在家庭以外披露艾滋病毒感染状况的情况很少见，包括家人的朋友（7%）、学校教师（8%）、学校校长（4%）和教堂牧师（6%）。未披露率很高，而且家庭内部缺乏关于艾滋病毒的讨论。家庭以外的披露率很低，这反映出照料者难以与孩子或周围社区讨论艾滋病毒问题。艾滋病毒防治项目需要在披露过程中为家庭提供支持。
