Maternal HIV disclosure to young HIV-uninfected children: An evaluation of a family-centred intervention in South Africa
Africa Centre for Health and Population Studies, University of KwaZulu-Natal, R618 towards Hlabisa, P O Box 198, Somkele, Mtubatuba, 3935, South Africa; Department of Psychology, Stellenbosch University, South Africa; Department of Psychology, Pontifical Catholic University of Rio Grande Do sul (PUCRS), Porto Alegre, Brazil; Section of Child and Adolescent Psychiatry, Department of Psychiatry, Oxford University, Oxford, United Kingdom; School of Public Health, University of Witwatersrand, Johannesburg, South Africa; Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa; Royal Hospital for Sick Children, University of Glasgow, Glasgow, United Kingdom
OBJECTIVES:: Sub-Saharan Africa has large populations of HIV-infected parents who need support to raise their HIV-uninfected children. This research evaluates the 'Amagugu Intervention' aimed at supporting mothers to disclose their own HIV diagnosis to their HIV-uninfected children. DESIGN:: Uncontrolled pre and post-intervention evaluation. SETTING:: Africa Centre for Health and Population Studies, South Africa. PARTICIPANTS:: Two hundred and eighty-one HIV-infected women and their HIV-uninfected children aged 6-10 years. INTERVENTION:: This lay counsellor-led intervention included six sessions conducted with mothers at home, providing printed materials and child-friendly activities to support disclosure of their diagnosis. MAIN OUTCOME MEASURE:: The primary outcome was disclosure to the child (full, partial, none). The secondary outcomes included maternal mental health (General Health Questionnaire) and child mental health (Child Behaviour Checklist). RESULTS:: One hundred and seventy-one (60%) women 'fully' disclosed and 110 (40%) women 'partially' disclosed their HIV status to their child. Women who perceived their health to be excellent were less likely to 'fully' disclose compared to those considering their health to be poorer [adjusted odds ratio 0.48 (0.28-0.95), P = 0.11]. Compared to those not in a current partnership, those with a current partner were almost three times more likely to 'fully' disclose [adjusted odds ratio 2.92 (1.33-6.40), P = 0.008]. Mothers reported that most children reacted calmly to 'full' (79%) or 'partial' disclosure (83%). Compared to 'partial' disclosure, 'full' disclosure was associated with more children asking questions about maternal death (18 versus 8%). CONCLUSIONS:: This intervention is acceptable in resource-limited settings and shows promise. Further research using a controlled design is needed to test this intervention. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.
adult; article; child; child welfare; comparative study; family centered care; female; human; Human immunodeficiency virus infected patient; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; human immunodeficiency virus uninfected children; interpersonal communication; major clinical study; male; maternal disease; maternal mortality; maternal welfare; mental health; outcome assessment; population research; priority journal; randomized controlled trial (topic); South Africa; HIV Infections; middle aged; mother child relation; pregnancy; psychology; young adult; Adult; Child; Disclosure; Female; HIV Infections; Humans; Male; Middle Aged; Mother-Child Relations; Pregnancy; South Africa; Young Adult
097410/Z/11/Z, Wellcome Trust