Abstract
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.
Highlights
It is estimated that 64,000 children under 15 years of age are living with Human Immunodeficiency Virus (HIV) in the Democratic Republic of Congo (DRC)
Child disclosure is a complex process for care-givers, health-care workers and the children themselves
We explored why some care-givers had disclosed to their children and why others had not, as well as how children experienced the disclosure process
Summary
It is estimated that 64,000 children under 15 years of age are living with HIV in the Democratic Republic of Congo (DRC). HIV prevalence in the Democratic Republic of Congo (DRC) is estimated to be 0.8% amongst adults aged 15–49. 450,000 people in DRC are living with HIV, with 57% of them receiving antiretroviral (ARV) treatment [1]. In 2015 approximately 1.8 million children globally were living with HIV and 400 children were newly infected each day. Of these children living with HIV, an estimated 49% have access to the ARV treatment they require [2]. It is estimated that there are 64,000 children under the age of 15 living with HIV in DRC [1]
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