Adolescents In Rural Communities Research Articles

Inflammation biomarkers and neurobehavioral performance in rural adolescents.

Systemic inflammation has been associated with lower neurobehavioral performance in diverse populations, yet the evidence in adolescents remains lacking. Cytokines can alter neural network activity to induce neurocognitive changes. This work seeks to investigate the association between inflammation and neurobehavior in adolescents living in a rural region of Ecuador. We examined 535 adolescents in rural communities of Ecuador (ESPINA study), 508 of which had neurobehavioral assessments (NEPSY-II) and circulating plasma levels of inflammatory markers (CRP, IL-6, TNF-⍺, sICAM-1, sVCAM-1, SAA, and sCD14). Associations between inflammatory biomarker concentrations and neurobehavioral scores were examined using adjusted bivariate semi-parametric models with generalized estimating equations. A partial least square regression approach was used to create composite variables from multiple inflammation biomarkers and model their association with cognitive outcomes. Higher sCD14 and TNF-α concentrations were significantly associated with lower social perception scores, by -0.47 units (95% CI: -0.80, -0.13) and -0.42 (-0.72, -0.12) for every 50% increase in inflammatory marker concentration, respectively. Similarly, every 50% increase in the inflammation summary score was associated with a significantly lower Social Perception score by -0.11 units (-0.19, -0.03). A unit increase in inflammatory composites of seven markers were associated with lower scores in language (-0.11 units, p=0.04), visuospatial processing (-0.15, p= 0.09), and social perception (-0.22, p=0.005) domains. Higher levels of inflammation were associated with lower neurobehavioral performance in adolescents, especially with social perception. In addition, using a robust analytic method to examine an association between a composite inflammatory variable integrating seven markers led to additional findings, including the domains of language and visuospatial processing. A longitudinal follow-up of such investigations could unveil potential changes in inflammation-neurobehavior performance links through developmental stages and intervention opportunities.

Conceptualization of Firearm-Related Terms Among Rural Adolescents: Definitions Matter.

Rural adolescents are at risk for firearm-related injury and death. In response, professional organizations have called for communication between adolescents, parents, and providers about firearms. A shared understanding of firearms between providers and families can facilitate effectiveness of health interventions. However, few studies engage adolescents in identifying their perception of common firearm terminology. The current study aimed to understand how adolescents in rural communities defined firearm-related terms including firearm, carrying, and handling, and differences in terms based on prior firearm training. Data were from a mixed methods community-based participatory study of 93 adolescents from rural Washington state. Thematic qualitative coding identified themes for firearm (gun, weapon, projectile, and tool), carrying (on you/your person, transportation, and holding), and handling (actively using, safe use, and holding) and differences between those with prior firearms training. Findings provide insight into perceptions of firearm-related terms for adolescents, an often-neglected voice, and inform rural policy and prevention efforts.

School-based health centers as an approach to address health disparities among rural youth: A study protocol for a multilevel research framework.

School-Based Health Centers (SBHCs) are important healthcare providers for children in medically underserved communities. While most existing research on SBHCs has focused on urban environments, this study protocol proposes a mixed-methods, multi-level research framework to evaluate the role of SBHCs in addressing health disparities among underserved children and adolescents in rural communities. The study area includes four high-poverty rural counties in New York State served by Bassett Healthcare Network that permits a comparison of school districts with SBHCs to those without SBHCs, all served by providers within the Bassett Healthcare Network. We employ a human ecological framework that integrates the micro layer of individuals and families, the meso layer of school districts and community institutions, and the macro layer of local and state policies. Our research framework first identifies the socioecological health risk factors, and then proposes innovative strategies to investigate how SBHCs impact them. We propose evaluating the impact of SBHCs on the individual (micro) level of child healthcare utilization using patient records data. At the meso level, we propose to investigate how School-SBHCs partnership may facilitate greater cross-agency collaboration and broader structural and social determinist of health to address health disparities. At the macro level, we propose to assess the impact of SBHCs and cross-agency collaboration on outcomes associated with a culture of community health. This study protocol will enable researchers to assess how SBHCs reduce rural health disparities, and provide evidence for organizational and public policy change.

Implementation of a Booster Sexual Health Education Curriculum for Older Adolescents in Rural Communities.

Ongoing education on sexual health and other health promotion topics is critical as young people transition into adulthood. A "booster" round of education may be an effective strategy to reinforce information previously taught and expand to additional topics relevant later in adolescence. In partnership with a Youth Advisory Council, we co-designed READY, Set, Go!, a booster curriculum for older adolescents with modules covering adult preparation skills, sexual identity, relationships, reproductive health, and mental health. From November 2021 to January 2023, we provided the curriculum to 21 cohorts of 12th grade students (N = 433) in rural communities of Fresno County, CA, and conducted an implementation evaluation to assess its feasibility in school settings, acceptability by participants, and changes in short-term outcomes. Health educators completed implementation logs to track program adaptations. Youth completed pretest/posttest surveys to assess changes in outcomes and participant satisfaction. We used descriptive statistics to examine program adaptations and satisfaction. We used multivariable regression models to examine changes in outcomes, adjusted for sociodemographic characteristics. Health educators completed most activities as planned, with adaptations occurring in response to youth needs and scheduling limitations. Sexual health knowledge, confidence in adult preparation skills, awareness of local sexual and mental health services, and willingness to seek health services all increased significantly from pretest to posttest. Youth feedback was strongly positive. We conclude that booster sexual health education is a promising strategy to address critical knowledge gaps and support health promotion, especially in rural and other under-resourced communities.

Patterns of alcohol use among middle school students in rural communities: Associations with community violence exposure.

Stress-coping theory posits that exposure to stressors, such as community violence, increases risk for early alcohol initiation. The current study identified patterns of alcohol use in an ethnically diverse sample of early adolescents in rural communities, and examined relations between different forms of exposure to community violence and severity of adolescents' alcohol use patterns. Participants were 5011 middle school students (46.4% non-Hispanic White, 25.5% Latinx, and 13.4% Black; 50% female) living in rural communities in the southeastern United States. Latent class analysis identified subgroups that differed in their patterns of lifetime and past 30-day alcohol use, and subgroup differences in exposure to community violence. Five subgroups were identified: abstainers (56.5%), initiators of wine and beer (12.5%); moderately frequent wine and beer users (10.3%); moderately frequent wine, beer, and liquor users who got drunk (12.0%); and highly frequent wine, beer, and liquor users who got drunk (8.6%). Subgroups differed across sex, grade, and racial-ethnic background. Subgroups characterized by severe alcohol use reported more frequent exposure to community violence and physical victimization, while controlling for nonviolent stressors. Consistent with stress-coping theory, the results indicate that experiencing physical victimization and witnessing community violence robustly relate to adolescents' high-risk alcohol use.

Amount of Fibre in the Diet with Regard to Excessive Weight and Obesity among Children and Adolescents in Rural Communities.

One component of a correctly balanced diet is dietary fibre. Fibre acts protectively-it improves the functioning of the intestines, regulates the rhythm of bowel movements, inhibits the absorption of sugar and also lowers the level of cholesterol. The aim of the research was to determine the intake of fibre in relation to the occurrence of excessive weight and obesity among children and adolescents living in rural areas. The research was conducted using an authored questionnaire. The study questionnaire was completed by the study participants and their parents over 7 d. The anthropometric measurements were carried out on pupils in their underwear in conditions of privacy. Based on the results obtained, the BMI index was calculated for each pupil and then ranked according to WHO reference values. Among the pupils in the study group, the intake of fibre was at a very low level. The lowest amount of fibre in the diet was found among those with excessive weight and with obesity. Over 39% pupils never consumed wholegrain bread. Fruit and vegetables were consumed most seldom by pupils with excessive body weight. Knowledge about the lifestyles of children and adolescents is of crucial importance in taking multidirectional preventative actions to make changes to such lifestyles.

Environmental Factors Predicting Unintended Pregnancies Among In-School Female Adolescents in Rural Communities in South-South Nigeria

Unintended Pregnancy is generally considered to be a high-risk event amongst adolescents due to various factors. Understanding factors predicting unintended pregnancies among in-school female adolescents can provide mechanisms for preventing unintended pregnancies and also providing youth friendly centers. In Nigeria, as a whole, unintended pregnancy among adolescents is a daunting problem. Studies have shown the prevalence of unintended pregnancy among adolescents to be 23% in the west, 36% in the southwest and 26% in the North central part of the country. It also ranges from 17% in Edo state and 6.2% in the other Niger Delta states to 49% in Abia State. The main Objective of this study is to investigate the Environmental factors predicting unintended pregnancies among in-school female adolescents in South-South Nigeria. A cross-sectional study which employed the use of quantitative methods of data collection was conducted among 239 in-school female adolescents who were selected through simple random sampling. Data was collected using a semi-structured validated questionnaire with Cronbach’s Alpha that ranged from 0.705 to 0.811. Data were analysed using descriptive and inferential statistics (logistic regression, correlation and chi-square). The result showed that those with low peer influence as compared with high peer influence were 0.92 times less likely to have unintended pregnancy (Odds ratio; 0.92; CI: 0.78-1.08; p=0.27). Low media influence as compared with those with high media influence had an odds of 1.01 likelihood of unintended pregnancy (Odds ratio=1.01; CI: 0.87-1.17;p=0.007), those with low parent support as compared with those with high parent support were 0.96 times less likely to have unintended pregnancy (Odds ratio=0.96; CI: 0.81-1.14, p=0.66). The environmental factor predictor was media influence while peer influence and parents’ support were not good environmental predictors of unintended pregnancy. Re-engineering media sources are needed to produce more positive and protective behaviours towards adolescent sexuality.

Self-Stigma Is Associated with Depression and Anxiety in a Collectivistic Context: The Adaptive Cultural Function of Self-Criticism

Literature on the cultural psychological aspect of mental health suggests that antecedents of mental health in individualistic cultures, or societies that prioritize independence, autonomy, and personal uniqueness do not always apply in collectivistic cultures, or societies that prioritize interdependence, social connection, interpersonal harmony, and norms. The aim of the present study was to determine the mechanisms underlying the impact of self-stigma on depression and anxiety in a collectivistic culture such as the Philippines. Specifically, this study sought to examine: (1) the mediating role of self-criticism on the impact of self-stigma on depression and anxiety, and (2) the moderating role of interdependent self-construal on the impact of self-criticism on depression and anxiety in Filipinos. Surveys measuring self-stigma, self-criticism, interdependent self-construal, depression, and anxiety symptoms were administered to 312 adolescents in rural communities in the Philippines. Using structural equation modeling, findings revealed indirect effects of self-stigma on both depression and anxiety via self-criticism. Findings confirmed that interdependent self-construal attenuate the detrimental impact of self-criticism on depression and anxiety in collectivistic contexts. This study offers novel insights about the underlying mechanisms that operate in the impact of self-stigma on depression and anxiety symptoms among individuals in collectivist contexts. We highlight that self-criticism may have both adaptive and maladaptive functions in collectivist cultures. The study provides implications on the importance of culturally sensitive clinical interventions in preventing depression and anxiety by combating self-stigma and the negative aspect of self-criticism in collectivist cultures. Limitations and future directions are discussed.

Considerations for conducting global health research with adolescents in rural communities

Considerations for conducting global health research with adolescents in rural communities

“I’ve been through a lot”: Perspectives on growing up in rural poverty

Abstract Research suggests that poverty and rural contexts can create specific risk and/or protective factors in the developmental trajectories of adolescents. This study examined the experiences and perspectives of low-income, rural adolescents, as well as of the non-parental adults who supported them and community leaders. Data were collected via key informant interviews and participant observation in a rural community in Oregon. Researchers utilized a symbolic interactionist lens in study design and data analysis to understand constructed meanings, shared interpretations, and disparate understandings held by youth and adults in the community. Some of the challenges that these youth faced included mental health issues, homelessness, and school disruption. Sources of strength and support are also reported, including youth agency, family, non-parental adults, and community. The results have implications for educators and community service providers working with low-income adolescents in rural communities.

Inconsistent Reports of Sexual Intercourse by Adolescents in Edo State, Nigeria

Previous research acknowledges the limitations of self-report data on adolescent sexual behaviors. Specifically, the reliability of data on sexual activity collected through survey techniques has been questioned. This paper begins to fill both gaps by analyzing inconsistencies in reporting sexual experience among adolescents in rural communities in Edo State, Nigeria. Longitudinal (panel) data were collected at three annual time points (2009, 2010, and 2011) from adolescents aged 12–17 attending Junior Secondary Schools. Multinomial logistic regression was used to analyze inconsistencies in the reporting of sexual activity between the first two waves. About 26% of the respondents indicated they had not had sex at wave 2 after reporting sexual experience at wave 1 (recanting). Compared with males, females were significantly more likely to recant. Older adolescents were less likely to recant their sexual experiences than younger ones. The study’s findings corroborate previous research questioning the validity of self-report data on adolescent sexual activity and add to calls to find ways to improve data collected from young people on their sexual behaviors, especially for adolescents in rural settings where admitting sexual experience may be highly stigmatized.

STEREOTIP MAKNA KEPERAWANAN (VIRGINITY) REMAJA PEREMPUAN DALAM MASYARAKAT PEDESAAN

ABSTRACT . Virginity in the context of Indonesia still has high sacrality and is considered very important in society. It is different in the Western World which considers virginity not to be debated, even free sex has become a normal activity. In Indonesia, there are two sides to different cultures, namely the culture of urban communities and rural communities. Rural communities hold fast to traditions, morals and customs and uphold values ​​and norms. Young women who lose their virginity with various factors will be considered as a violation and disgrace which is very embarrassing even to the point of being discarded by their family to be exiled by the community. In contrast to urban communities, although only some people consider loss of virginity to be an impact of association that can happen to anyone. On this basis researchers are interested in looking at the stereotypes of rural communities in the sense of virginity of female adolescents in Karanganyar Village, South Lampung Regency, to find the other side of discrimination is virgin girls. This research uses qualitative method with a population of 200 people in Karanganyar village, but the samples studied were 20 randomly selected people through observation and interview techniques. The results of this research are to find out the stereotypes of meaning that are built up about the virginity of female adolescents in rural communities to maintain culture and customs according to prevailing values ​​and norms.

Only Yes Means Yes: Sexual Coercion in Rural Adolescent Relationships

PurposeSexual consent is important to healthy relationships; however, sexual coercion is common. We examine modifiable risk and protective factors for sexual coercion among high school students in a rural community. MethodsWe surveyed 10th graders (N = 442) in a rural, Midwestern, low-to-middle income county before receiving an evidence-based sex education program. Sexual coercion was a single item, “has anyone you were dating or going out with forced you to do sexual things that you did not want to do?” We examined associations between sexual coercion and demographics, risk behaviors, sexual self-efficacy, controlling relationship behaviors, parent communication, and adverse childhood experiences. ResultsApproximately 22% of females and 8% of males reported experiencing sexual coercion at least once in their lifetime. Gender differences emerged in associated risk and protective factors, including sexual sex efficacy, controlling relationship behaviors, parent–adolescent communication about sex, and adverse childhood experiences. ConclusionsSexual coercion is common among adolescents in rural communities. Prevention interventions should target modifiable risk and protective factors.

Identifying Nutrition and Health-Relevant Behaviors, Beliefs, and Values of School-Going Adolescent Girls in Rural Bangladesh: Context for Interventions

BackgroundFocusing on adolescent schoolgirls in rural Bangladesh, this study aimed to describe the nutrition-relevant context required for effective intervention planning. It included attention to dietary behaviors, daily schedules and activities, and girls’ beliefs and values. We placed a special emphasis on iron because anemia has been identified as a significant problem in adolescent girls in Bangladesh. ObjectivesThe study was undertaken to inform a larger project to develop a replicable model for integrating nutrition activities into the multiple social programs in BRAC, a large nongovernmental service delivery organization in Bangladesh. MethodsFollowing an initial phase of exploratory key informant interviewing, data collection was conducted through the use of focused ethnographic methods in 2 additional phases. Phase II consisted of in-depth interviews with school-going adolescents in rural communities in Rangpur District (n = 23). Interview modules included sociodemographic information; a qualitative 24-h dietary recall; respondents’ concepts of “health,” “healthy foods,” and “anemia”; exposure to nutrition messages and ratings of their importance and feasibility; and actions to maintain health. In phase III, ratings and other data were collected systematically from a separate sample of 20 adolescent girls. Analyses included thematic analysis of transcribed and translated text and quantitative analysis of numeric data. ResultsKey findings include evidence that school-going girls consume a variety of foods and have substantial knowledge about good health and nutrition practices. However, we also found beliefs and practices that challenge the development of nutritionally sound food practices, including iron nutrition. The study revealed the importance of teachers and mothers as information sources, and the dietary and cultural roles of purchased snacks, which occur in connection with school attendance. ConclusionsThese findings, together with insights about girls’ values, particularly conceptions related to “a healthy life,” have implications for expanding BRAC activities to support the nutrition of adolescent school girls.

Awareness and perception regarding female foeticide among adolescents in rural community of Nalgonda district, Telangana

Background: Female foeticide is perhaps one of the worst forms of violence against women where a woman is denied her most basic and fundamental right i.e. “the right to life”. Exorbitant dowry demand is one of the main reasons for female infanticide and other reasons include belief that it is only the son who can perform the last rites, that lineage and inheritance runs through the male line, sons will look after parents in old age, men are bread winners etc. The present study was aimed to assess the awareness & perception regarding female foeticide among adolescents in rural community.Methods: A cross-sectional study was conducted among 200 school students with a pre-tested, semi structured questionnaire in order to assess the awareness & perception regarding female foeticide among adolescents. Data collected was analysed using SPSS software.Results: Majority (52.5%) of the study subjects were males. Majority (70%) of the subjects could define foeticide. Boys have better knowledge than girls regarding current sex ratio (21%), state position(20%) and district position(33.3%).The most common reasons for not preferring girl child were not carrying family name and burden to the family. Major source of information was social media.Conclusions: This study reveals that there is considerable scope for spreading awareness to youth about this social malady with medical implications. This will not only change the perception and behaviour of future generation, but motivated adolescents can also influence the families and communityation.

Mobile Phone Intervention to Reduce Youth Suicide in Rural Communities: Field Test.

BackgroundSuicide is a leading cause of death among 10- to 19-year-olds in the United States, with 5% to 8% attempting suicide each year. Suicide risk rises significantly during early adolescence and is higher in rural and underserved communities. School-based universal prevention programs offer a promising way of reducing suicide by providing strategies for emotion regulation and encouraging help-seeking behaviors and youth-adult connectedness. However, such programs frequently run into difficulties in trying to engage a broad range of students. Text messaging is a dominant medium of communication among youths, and studies show both efficacy and uptake in text messaging interventions aimed at adolescents. Text-based interventions may, thus, offer a means for school-based universal prevention programs to engage adolescents who would otherwise be difficult to reach.ObjectiveWe field tested Text4Strength, an automated, interactive text messaging intervention that seeks to reach a broad range of early adolescents in rural communities. Text4Strength extends Sources of Strength, a peer-led school suicide prevention program, by encouraging emotion regulation, help-seeking behaviors, and youth-adult connectedness in adolescents. The study tested the appeal and feasibility of Text4Strength and its potential to extend universal school-based suicide prevention.MethodsWe field tested Text4Strength with 42 ninth-grade students. Over 9 weeks, students received 28 interactive message sequences across 9 categories (Sources of Strength introduction, positive friend, mentors, family support, healthy activities, generosity, spirituality, medical access, and emotion regulation strategies). The message sequences included games, requests for advice, questions about students’ own experiences, and peer testimonial videos. We measured baseline mental health characteristics, frequency of replies, completion of sequences and video viewing, appeal to students, and their perception of having benefited from the program.ResultsOf the 42 participating students, 38 (91%) responded to at least one sequence and 22 (52%) responded to more than a third of the sequences. The proportion of students who completed multistep sequences they had started ranged from 35% (6/17) to 100% (3/3 to 28/28), with responses dropping off when more than 4 replies were needed. With the exception of spirituality and generosity, each of the content areas generated at least a moderate number of student replies from both boys and girls. Students with higher and lower levels of risk and distress interacted with the sequences at similar rates. Contrary to expectations, few students watched videos. Students viewed the intervention as useful—even those who rarely responded to messages. More than 70% found the texts useful (3 items, n range 29-34) and 90% (36) agreed the program should be repeated.ConclusionsText4Strength offers a potentially engaging way to extend school-based interventions that promote protective factors for suicide. Text4Strength is ready to be revised, based on findings and student feedback from this field test, and rigorously tested for efficacy.

Fear of stigma, beliefs, and knowledge about HIV are barriers to early access to HIV testing and disclosure for perinatally infected children and adolescents in rural communities in South Africa

Background: The majority of HIV-infected children in resource-limited countries are not aware of their HIV status because of the various reasons responsible for the delay in seeking HIV testing for children. The aim of the study was to determine the prevalence and barriers to testing and disclosing the HIV status of children aged between 5 and 18 years.
 
 Methods: This was a cross-sectional survey involving 405 caregivers of HIV perinatally infected children receiving anti-retroviral treatment (ART) in primary health care facilities in a rural district of Mpumalanga province in South Africa.
 
 Results: The prevalence of disclosure was 27%, and disclosure was done to promote adherence (26%) or because it was the child’s right to know his/her status (43%). Children’s age was significantly associated with disclosure (AOR = 2.81, p < 0.000, CI 1.64–4.81). Concerns that children were too young and would not understand the implications of HIV diagnosis (74.5%) or would not keep the diagnosis secret (7%) were reasons for non-disclosure. Over half of the caregivers intended to disclose status when the child was aged between 12 and 15 years. In response to children’s questions about medication, caregivers substituted HIV with other less stigmatising conditions (32%).
 
 Conclusion: The prevalence of disclosure was low and delayed till the child was above 10 years of age. The main barrier to disclosure was fear of stigma, or fears of the child telling others about their HIV status with consequences of stigma. The need for guidelines to provide caregivers with disclosure skills, to overcome the barriers that prevent disclosure, is crucial.
 
 (Full text of the research articles are available online at www.medpharm.tandfonline.com/ojfp)
 
 S Afr Fam Pract 2017; DOI: 10.1080/20786190.2017.1329489

Adolescents' Experiences and Coping Strategies with Parental Substance Addiction Within a Rural Farming

South African legislation and policy documents provide a framework that emphasises the need to protect and care for children of addicted parents. However, the literature and recent studies do not focus on how adolescents in rural communities experience dealing with an addicted parent or the type of services they need. This article is based on a qualitative research study that explored and described the experiences and coping strategies of adolescents in rural communities who are faced with their parents’ addiction. The findings describe their perceptions of the nature of parental substance addiction, how it affects them, how they deal with it and their requests for support.

Implementation of a School-Based Educational Program to Increase Breast Cancer Awareness and Promote Intergenerational Transmission of Knowledge in a Rural Mexican Community.

Rural women have limited access to breast cancer education, which partially contributes to late diagnosis and treatment. In this pilot study, we tested the feasibility of implementing a school-based breast cancer educational program for adolescents in a rural Mexican community. We hypothesized that the adolescents' knowledge on breast cancer would increase as a result of the program, and that there would be intergenerational transmission of that knowledge to their older female relatives. Female adolescents from a rural middle school received the educational program. The program would be considered feasible and acceptable if more than 75% reported being satisfied with its contents. Changes in knowledge in the students and their relatives were evaluated using baseline and 4 months follow-up questionnaires. One hundred twenty-six students were enrolled. The program was considered acceptable by 96% of the participants. The students' knowledge regarding breast cancer increased significantly from baseline to 4 months follow-up (63% to 82%). One hundred ninety-four female relatives completed the initial knowledge questionnaires. The relatives' knowledge regarding breast cancer showed a significant increase from baseline to 4 months follow-up (55% to 61%). Implementing breast cancer educational programs for adolescents in rural communities is feasible and acceptable. The program increased the adolescents' knowledge on breast cancer, and promoted the intergenerational transmission of that knowledge to their female relatives. Intergenerational transmission of knowledge represents a potential method for providing population-based health awareness education globally. In limited-resource settings, education is a valuable tool for achieving early detection and downstaging of breast cancer. Unfortunately, rural women lack access to educational opportunities and information about breast cancer, which is a factor contributing to late diagnosis and treatment. In this study, we demonstrated that implementing a school-based breast cancer educational program for female adolescents in a rural Mexican community was feasible, acceptable, and increased their knowledge about breast cancer. Furthermore, the program encouraged the transmission of information to the students' older relatives. Intergenerational transmission of knowledge represents a novel and potentially effective tool in cancer education and promotion.

Fear of stigma, beliefs, and knowledge about HIV are barriers to early access to HIV testing and disclosure for perinatally infected children and adolescents in rural communities in South Africa

Background: The majority of HIV-infected children in resource-limited countries are not aware of their HIV status because of the various reasons responsible for the delay in seeking HIV testing for children. The aim of the study was to determine the prevalence and barriers to testing and disclosing the HIV status of children aged between 5 and 18 years.Methods: This was a cross-sectional survey involving 405 caregivers of HIV perinatally infected children receiving anti-retroviral treatment (ART) in primary health care facilities in a rural district of Mpumalanga province in South Africa.Results: The prevalence of disclosure was 27%, and disclosure was done to promote adherence (26%) or because it was the child’s right to know his/her status (43%). Children’s age was significantly associated with disclosure (AOR = 2.81, p < 0.000, CI 1.64–4.81). Concerns that children were too young and would not understand the implications of HIV diagnosis (74.5%) or would not keep the diagnosis secret (7%) were reasons ...