1. Drivers, Barriers And Consequences of HIV Disclosure to HIV-infected Children Age 9-14 Years: A Qualitative Study Among Children and their Caregivers in Thika, Kenya
Njambi Njuguna1, 2, Kenneth Ngure 1, 3, 4, David Bukusi2, Dalton Wamalwa3, 5, Nelly Mugo1, 3, 6
1Partners in Health Research and Development; 2Kenyatta National Hospital;
3University of Washington; 4Jomo Kenyatta University of Agriculture and Technology;
5University of Nairobi; 6Kenya Medical Research Institute
Poster number: THPDB0104

2. Background and Methodology
HIV disclosure to children is beneficial
Disclosure in SSA not well documented: 6 studies estimate 3-37%1-6
Overall aim: describe patterns of disclosure and it’s consequences
Methodology:
Study population: 9-14 year old HIV infected children
Qualitative interviews: 9 FGDs and 20 child-caregiver dyad IDIs
Data collection: May – December 2014
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1Vreeman(2015), 2Vaz(2011), 3Santamaria(2011), 4Bikaako-Kajura (2006), 5Menon(2007), 6Vreeman(2014)
Children and caregivers were interviewed separately. For the Indepth interviews, the median age was 12 years and we interviewed 11 girls and 9 boys. All 20 caregivers were female with a median age of 42 years. Median age of caregivers in IDIs – 42 years – all females
Focus group discussions were stratified by age and sex.

3. Results Disclosure was a discrete event
“…when I was going to hospital. Mmmh. Then she (mother) told me…..I was shocked” (Male,13 years, IDI)
Consequences – emotional distress
“I had gone (to hospital) and my mother was asked how many years I have reached. Then she said I have reached 11 years, (pausing almost tearing up) she was called by the people who know it, we went to another room and I was told and I was not happy that day” (Female, 11 years, IDI)
Though the WHO recommends that disclosure occur as an ongoing process, most of the participants described their own disclosure as a discrete event
Some of the children also described emotional distress immediately following the event

4. Results Drivers: Barriers Continued questioning by children
Age (perceived maturity)
Barriers
Stigma and negative community perceptions
Feeling of inadequacy by caregivers
“I had wanted to tell him, but I wondered how I would start…where I was going to start” (Mother, 42 years, IDI)
Children’s continued questioning about their frequent hospital visits and chronic use of drugs as well as concerns by caregivers that their children would stop taking their antiretroviral drugs spurred them to disclose their children’s HIV status
Age – caregivers disclosed when they thought the child was old enough to understand their diagnosis and not inadvertently disclose their status to others. However, children’s and caregivers differed on age with children describing a younger age as ideal when compared to the caregivers

5. Conclusions Disclosure is a challenge to caregivers
Healthcare workers play a key role in HIV disclosure
More structured interventions for HIV disclosure are needed to assist caregivers and healthcare workers
“They (doctors) first talk(ed) with my father, so I stepped out. Then my father came and told me that he was told to tell me that this (HIV) was passed on to me by my mother.” (Female, 13 years, IDI)

6. Acknowledgements Study participants
Partners in Health Research and Development: Qualitative team
Merck Investigator Studies Program for funding the parent study