1. Talking with your children and family about living with HIV/AIDS

2. Questions Regarding Disclosure from the parents perspective Should I tell my child(ren)? When should I talk with them? How will my child(ren) take the news? Will my diagnosis stigmatize my child(ren)? How will my relationship with my child(ren) change? Can my kids keep a secret? Will my HIV status be a burden to my children? How should I prepare to tell them? (Perm planning, education, resources)

3. Talking to your children about HIV Status Emotions Overwhelmed Fear Anxiety Guilt Support Doctor Social Worker Family Friends Church

4. Disclosure Decisions to disclose HIV status depend on several factors: How long a person has been positive Access to social and emotional resources The nature of the relationship between the person with HIV/AIDS and the person being disclosed to

5. Telling children they are HIV+ Why do you want you children to know HIV-related questions and answers Resources and Information Age –appropriate Information little by little as they are ready Cognitive age vs. Physical Age Open communication and non judgment Prepare to talk about sexual health Feelings of isolation, anger, depression Ask for help Disclosure is a private/family manner

6. Telling Children you are HIV+ How will your children react? Children will ask about your health What will happen to them if you get sick? How did you get it? Will they get it? Might have no questions at all Your children might already know something May be angry about the secrets Open communication is key Use this as an opportunity to educate Encourage them to talk to you and others if needed

7. Taking care of yourself It is important to keep doctors appointments and take medications You are a better parent if you are healthy Important to deal with feelings and questions Support groups and peer groups can be helpful Talk to your social worker/counselor

8. Preparation for Disclosure Role Play with your Social Worker Rehearse different sceneries Have support systems and resources available Permanency Planning and Legal in Place Standby Guardianships Living Wills Power of Attorney Support Groups and Peer Support Individual, Family, and Children

9. Permanency Planning and Case Management Part of Check list (housing, mental health, etc) Empowerment Permanency Planning for all parents and caregivers Positive decision Normalize the decision

10. Social Worker’s Role Level 1: No involvement Level 2: Working with Family Before and After Disclosure but not present at event Level 3: Present at disclosure for support but not involved with event Level 4:Participates in disclosure event but does not lead Level 5:Leads the disclosure discussion Level 6: Social Worker/Doctor discloses status of child or parent

11. Case Study: Rochelle

12. Case Study: Samantha

13. Tips Deal with your own feelings first Have answers to anticipated questions Build a strong parent-child relationship Seek support for yourself and children Gather HIV-related information and resources Create an appropriate environment for disclosure: No interruptions Relaxed as Possible’ Social Worker involvement (Level) Remember to follow up and that it is a process Give love, reassurance and hugs!!

14. Resources Bauman, L. J. et al, (2007). Children of Mothers With HIV/AIDS: Unmet Needs for Mental Health Services. Pediatrics, 120 (5), pp. 1141- 1146. Cichocki, M. (2009, Jan. 10). How to Tell Your Children You Have HIV or AIDS. (chap. Health’s Disease and Condition) Retrieved Nove. 23, 2011, from http://aids.about.com/od/hivseniors/a/aginghly.htm Cogwill, B. O. et al, (2008). Fears About HIV Transmission in Families With an HIV- Infected Parent: A Qualitative Analysis. Pediatrics, 122 (5), pp. 950-956. Kalichman, S.C. (2007, Nov). HIV/AIDS Case Managers and Client HIV Status Disclosure: Perceived Client Needs, Practices, and Services. Health & Social Work. 33(4), 259-262. Retrieved Nov 2011, from NASW. Kennedy, D. P, B. Cogwill, et al (2010). Parents’ Disclosure of Their HIV Infection to Their Children in the Context of the Family. Springer, 14 pp. 1095-1104. Mahanes, J. (2011, Jun. 16). D.C. HIV/AIDS Rate Still At Epidemic Levels. Washington City Paper. Retrieved May 22, 2012, from www.washingtoncitypaper.com/blogs/citydesk/2011/16/d-chivaids. www.washingtoncitypaper.com/blogs/citydesk/2011/16/d-chivaids World Health Organization (2011). Guideline on HIV Disclosure Counseling For Children Up to 12 Years of Age. [Manual/Programme]. Geneva, Switzerland: WHO Press