Disclosure of HIV status to Adolescents aged 10-15 years living with HIV in Kafue District of Lusaka Province in Zambia

Abstract

Background: Disclosure of HIV status by caregivers to adolescents is low. This affects access to HIV care and treatment by adolescents living with HIV. While studies have been done to understand disclosure patterns, limited knowledge exists on factors that facilitate and inhibit disclosure by caregivers to adolescents aged between 10 to 15 years in Kafue district. This study explored factors related to caregiver disclosure of HIV-positive status to adolescents under their care.Methods: This was an exploratory health facility-based qualitative study. Data was collected through in-depth interviews with 30 caregivers of adolescents living with HIV and health care providers. Data was coded using NVIVO and analysed using latent content analysis approach.Results: 17 out of 30 caregivers had informed the adolescents about their HIV status. Reasons for disclosing the HIV status included inquiries by adolescents about reasons for taking of medication, threats by adolescents not to take HIV medication, desire to promote treatment self-efficacy amongst adolescents,maintaining/sustaining future cordial relationships as well as facilitating adoption of safe sexual behaviour. Direct conversations between caregivers and adolescents as well as assisted disclosure at the health facility were the two strategies used. Factors that facilitated HIV disclosure were adolescents ‘knowledge of HIV and caregiver’s knowledge of and experience with HIV programs. Factors that inhibited disclosure of HIV status included fear of psychological trauma by adolescents, perceived inability of adolescents to keep their HIV status confidential which could attract HIV stigmatisation for the family, and caregivers’ fear of being blamed by the adolescents for the infection. Conclusions: There is a need to improve disclosure skills of caregivers, promote assisted disclosure and establish adolescent-specific clinic days. Caregiver disclosure of their own HIV status is also crucial to ensure acceptance of HIV status by adolescents while efforts to address HIV stigma are still warranted.