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Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes

INTRODUCTION: As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. METHODS: In 2...

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Autores principales: Mburu, Gitau, Hodgson, Ian, Kalibala, Sam, Haamujompa, Choolwe, Cataldo, Fabian, Lowenthal, Elizabeth D, Ross, David
Formato: Online Artículo Texto
Lenguaje:English
Publicado: International AIDS Society 2014
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956312/
https://www.ncbi.nlm.nih.gov/pubmed/24629845
http://dx.doi.org/10.7448/IAS.17.1.18866
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author Mburu, Gitau
Hodgson, Ian
Kalibala, Sam
Haamujompa, Choolwe
Cataldo, Fabian
Lowenthal, Elizabeth D
Ross, David
author_facet Mburu, Gitau
Hodgson, Ian
Kalibala, Sam
Haamujompa, Choolwe
Cataldo, Fabian
Lowenthal, Elizabeth D
Ross, David
author_sort Mburu, Gitau
collection PubMed
description INTRODUCTION: As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. METHODS: In 2010, we conducted a qualitative study among adolescents aged 10–19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents’ disclosure of their status to others; and the impact of both forms of disclosure on adolescents. RESULTS: Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents’ disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents’ sexual relationships, although it did not always lead to rejection. CONCLUSIONS: There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process.
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spelling pubmed-39563122014-06-18 Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes Mburu, Gitau Hodgson, Ian Kalibala, Sam Haamujompa, Choolwe Cataldo, Fabian Lowenthal, Elizabeth D Ross, David J Int AIDS Soc Research Article INTRODUCTION: As adolescents living with HIV gain autonomy over their self-care and begin to engage in sexual relationships, their experiences of being informed about their HIV status and of telling others about their HIV status may affect their ability to cope with having the disease. METHODS: In 2010, we conducted a qualitative study among adolescents aged 10–19 living with HIV in Zambia, and with their parents and health care providers. Through interviews and focus group discussions, we explored the disclosure of HIV status to adolescents living with HIV; adolescents’ disclosure of their status to others; and the impact of both forms of disclosure on adolescents. RESULTS: Our study identified three main barriers to disclosure of HIV status: local norms that deter parents from communicating with their children about sexuality; fear of HIV stigma; and an underlying presumption that adolescents would not understand the consequences of a HIV diagnosis on their lives and relationships. With regard to adolescents’ disclosure of their HIV status to their sexual partners, our study identified fear of rejection as a common barrier. In rare cases, open family conversations about HIV helped adolescents come to terms with a HIV diagnosis. Findings indicated that disclosure had various outcomes at the individual and interpersonal levels. At the individual level, some adolescents described being anxious, depressed and blaming themselves after being told they had HIV. At the interpersonal level, disclosure created opportunities for adolescents to access adherence support and other forms of psychosocial support from family members and peers. At the same time, it occasionally strained adolescents’ sexual relationships, although it did not always lead to rejection. CONCLUSIONS: There is a need for public health interventions that guide adolescents living with HIV, their parents and families through the disclosure process. Such interventions should help parents to assess and understand the evolving cognitive capacity and maturity of their adolescents in order to determine the appropriate time to inform them of their HIV-positive status. Such interventions should also mitigate the risk of HIV stigma, as well as local norms that may prevent discussions of sexuality within families. Adolescents who have been informed of their HIV status should be provided with on-going support to prevent disclosure from negatively affecting their psychological and sexual wellbeing. Further research is needed to explore the potential role of trusted family members in contributing to the disclosure process. International AIDS Society 2014-03-10 /pmc/articles/PMC3956312/ /pubmed/24629845 http://dx.doi.org/10.7448/IAS.17.1.18866 Text en © 2014 Mburu G et al; licensee International AIDS Society http://creativecommons.org/licenses/by/3.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Mburu, Gitau
Hodgson, Ian
Kalibala, Sam
Haamujompa, Choolwe
Cataldo, Fabian
Lowenthal, Elizabeth D
Ross, David
Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes
title Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes
title_full Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes
title_fullStr Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes
title_full_unstemmed Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes
title_short Adolescent HIV disclosure in Zambia: barriers, facilitators and outcomes
title_sort adolescent hiv disclosure in zambia: barriers, facilitators and outcomes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3956312/
https://www.ncbi.nlm.nih.gov/pubmed/24629845
http://dx.doi.org/10.7448/IAS.17.1.18866
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