“It’s a secret between us”: a qualitative study on children and care-giver experiences of HIV disclosure in Kinshasa, Democratic Republic of Congo

BMC Public Health

Jean Lambert Chalachala¹  Elysée Manziasi Sumbi²  Rebecca Harrison²  Kleio Iakovidi³  Mariana Garcia³  Gilles van Cutsem³  Emilie Venables⁴ 

[1] Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA;Médecins Sans Frontières, Kinshasa, Democratic Republic of Congo;Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa;Southern Africa Medical Unit, Médecins Sans Frontières, Main Road, Observatory, Cape Town, South Africa;Division of Social and Behavioural Sciences, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa;

关键词: Children;    Democratic Republic of Congo;    HIV care continuum;    Disclosure;    Qualitative research;   

DOI  :  10.1186/s12889-021-10327-5

来源: Springer

【 摘 要 】

BackgroundIt is estimated that 64,000 children under 15 years of age are living with HIV in the Democratic Republic of Congo (DRC). Non-disclosure – in which the child is not informed about their HIV status - is likely to be associated with poor outcomes during adolescence including increased risk of poor adherence and retention, and treatment failure. Disclosing a child’s HIV status to them can be a difficult process for care-givers and children, and in this qualitative study we explored child and care-giver experiences of the process of disclosing, including reasons for delay.MethodsA total of 22 in-depth interviews with care-givers and 11 in-depth interviews with HIV positive children whom they were caring for were conducted in one health-care facility in the capital city of Kinshasa. Care-givers were purposively sampled to include those who had disclosed to their children and those who had not. Care-givers included biological parents, grandmothers, siblings and community members and 86% of them were female. Interviews were conducted in French and Lingala. All interviews were translated and/or transcribed into French before being manually coded. Thematic analysis was conducted. Verbal informed consent/assent was taken from all interviewees.ResultsAt the time of interview, the mean age of children and care-givers was 17 (15–19) and 47 (21–70) years old, respectively. Many care-givers had lost family members due to HIV and several were HIV positive themselves. Reasons for non-disclosure included fear of stigmatisation; wanting to protect the child and not having enough knowledge about HIV or the status of the child to disclose. Several children had multiple care-givers, which also delayed disclosure, as responsibility for the child was shared. In addition, some care-givers were struggling to accept their own HIV status and did not want their child to blame them for their own positive status by disclosing to them.ConclusionsChild disclosure is a complex process for care-givers, health-care workers and the children themselves. Care-givers may require additional psycho-social support to manage disclosure. Involving multiple care-givers in the care of HIV positive children could offer additional support for disclosure.

【 授权许可】

CC BY