AIDS and Behavior

, Volume 13, Issue 6, pp 1241–1252 | Cite as

Disclosure of Maternal HIV-Infection in South Africa: Description and Relationship to Child Functioning

  • Frances L. PalinEmail author
  • Lisa Armistead
  • Alana Clayton
  • Bethany Ketchen
  • Gretchen Lindner
  • Penny Kokot-Louw
  • Analie Pauw
Original Paper


South Africa has one of the highest HIV-infection rates in the world, yet few studies have examined disclosure of maternal HIV status and its influence on children. This study provides descriptive information about HIV disclosure among South African mothers and explores whether family context variables interact with maternal HIV disclosure to affect children’s functioning. A total of 103 mothers, who self-identified as living with HIV and who were the primary caregivers of a child between the ages of 11 and 16, were interviewed. A total of 44% of mothers had disclosed, and those who had most typically perceived children’s reactions to disclosure to be sadness and worry. Widows and married mothers were more likely than single mothers to disclose their HIV status. Disclosure to children significantly predicted externalizing, but not internalizing, behaviors. Family variables had direct but not interactive effects on child functioning. This study highlights the complexity of disclosure-related decisions and the importance of addressing the family context.


HIV disclosure South African mothers 



The authors acknowledge the financial support provided by the National Institute of Child Health and Human Development and the National Institute of Mental Health (R03HD046371), as well as the mothers who participated in this research.


  1. Achenbach, T. M., & Edelbrock, C. S. (1991). Manual for the child behavior checklist: 4–18 and 1991 profile. Burlington, VT: University of Vermont.Google Scholar
  2. Ahrons, C. (1979). The binuclear family: Two households, one family. Alternative Lifestyles, 2, 499–515. doi: 10.1007/BF01082682.CrossRefGoogle Scholar
  3. Ahrons, C. R. (1981). The continuing coparental relationship between divorced spouses. The American Journal of Orthopsychiatry, 51(3), 415–428.PubMedGoogle Scholar
  4. Armistead, L., & Forehand, R. (1995). For whom the bell tolls: Parenting decisions and challenges faced by mothers who are HIV seropositive. Clinical Psychology: Science and Practice, 2(3), 239–250.CrossRefGoogle Scholar
  5. Armistead, L., Klein, K., Forehand, R., & Wierson, M. (1997). Disclosure of parental HIV-infection to children in the families of men with hemophilia: Description, outcomes, and the role of family processes. Journal of Abnormal Child Psychology, 25, 201–213.Google Scholar
  6. Armistead, L., Tannenbaum, L., Forehand, R., Morse, E., & Morse, P. (2001). Disclosing HIV status: Are mothers telling their children. Journal of Pediatric Psychology, 26(1), 11–20. doi: 10.1093/jpepsy/26.1.11.CrossRefPubMedGoogle Scholar
  7. Atwine, B., Cantor-Graae, E., & Bajunirwe, F. (2005). Psychological distress among AIDS orphans in rural Uganda. Social Science and Medicine, 61(3), 555–564. doi: 10.1016/j.socscimed.2004.12.018.CrossRefPubMedGoogle Scholar
  8. Barbarin, O. A., & Khomo, N. (1997). Indicators of economic status and social capital in South African townships: What do they reveal about the material and social conditions in families of poor children? Childhood: A Global Journal of Child Research, 4(2), 193–222.Google Scholar
  9. Barbarin, O. A., & Richter, L. M. (2001). Mandela’s children: Growing up in post-apartheid South Africa. New York, NY: Routledge.Google Scholar
  10. Black, L. W. (1993). AIDS and secrets. In E. Imber-Black (Ed.), Secrets in families and family therapy (pp. 355–369). New York: W.W. Nortom and Co.Google Scholar
  11. Brislin, R. W. (1970). Back-translation for cross-cultural research. Journal of Cross-Cultural Psychology, 1(3), 185–216. doi: 10.1177/135910457000100301.CrossRefGoogle Scholar
  12. Cluver, L., Gardner, F., & Operario, D. (2007). Psychological distress amongst AIDS-orphaned children in urban South Africa. Journal of Child Psychiatry and Psychology, 48(8), 755–763. doi: 10.1111/j.1469-7610.2007.01757.x.CrossRefGoogle Scholar
  13. Compas, B., Worsham, N., Epping-Jordan, J., Grant, K., Mireault, G., Howell, D., et al. (1994). When mom or dad has cancer: Markers of psychological distress in cancer patients, spouses, and children. Health Psychology, 13, 507–515. doi: 10.1037/0278-6133.13.6.507.CrossRefPubMedGoogle Scholar
  14. Department of Health. (2005). National HIV and syphilis antenatal sero-prevalence survey in South Africa, 2004 . Google Scholar
  15. Doll, L. S., & Dillon, B. A. (1997). Counseling persons seropositive for Human Immunodeficiency Virus and their families. In V. T. Devita, S. Hellman, & S. A. Rosenberg (Eds.), AIDS: Etiology, diagnosis, treatment, and prevention (pp. 533–540). Philadelphia: Lippincott-Raven.Google Scholar
  16. Dorsey, S., Forehand, R., Armistead, L. P., Morse, E., Morse, P., & Stock, M. (1999a). Mother knows best? Mother and child report of behavioral difficulties of children of HIV-infected mothers. Journal of Psychopathology and Behavioral Assessment, 21(3), 191–206. doi: 10.1023/A:1022821314228.CrossRefGoogle Scholar
  17. Dorsey, S., Watts Chance, M., Forehand, R., Morse, E., & Morse, P. (1999b). Children whose mothers are HIV infected: Who resides in the home and is there a relationship to child psychosocial adjustment? Journal of Family Psychology, 13(1), 103–117. doi: 10.1037/0893-3200.13.1.103.CrossRefGoogle Scholar
  18. Draimin, B., Hudis, J., & Segura, J. (1992). The mental health needs of well adolescents in families with AIDS. Final Report, NIH Grant #279492. New York, NY: Human Resources Administration, Division of Aids Services.Google Scholar
  19. Faithful, J. (1997). HIV-positive and AIDS affected women: Challenges and difficulties of mothering. The American Journal of Orthopsychiatry, 67, 144–151. doi: 10.1037/h0080219.CrossRefGoogle Scholar
  20. Fassin, D., & Schneider, H. (2003). The politics of AIDS in South Africa: Beyond the controversies. British Medical Journal, 326, 495–497. doi: 10.1136/bmj.326.7387.495.CrossRefPubMedGoogle Scholar
  21. Forehand, R., Klein, K., Kotchick, B. A., & Watts Chance, M. (1996). The art of coping: Men with hemophilia and their families. HemAware, 12, 16–19.Google Scholar
  22. Forehand, R., Steele, R., Armistead, L., Morse, E., Simon, P., & Clark, L. (1998). The Family Health Project: Psychosocial adjustment of children whose mothers are HIV infected. Journal of Consulting and Clinical Psychology, 66(3), 513–520. doi: 10.1037/0022-006X.66.3.513.CrossRefPubMedGoogle Scholar
  23. Foster, G. (2000). The capacity of the extended family safety net for orphans in Africa. Psychology Health and Medicine, 5(1), 55–59. doi: 10.1080/135485000106007.CrossRefGoogle Scholar
  24. Foster, G., & Williamson, J. (2000). A review of the current literature on the impact of HIV/AIDS on children in sub-Saharan Africa. AIDS (London, England, 14(3), S275–S284.Google Scholar
  25. Garmezy, N. (1983). Stressors of childhood. In N. Garmezy & M. Ruther (Eds.), Stress, coping, and development in children (pp. 43–84). New York: McGraw Hill.Google Scholar
  26. Hough, E. S., Brumitt, G., Templin, T., Saltz, E., & Mood, D. (2003). A model of mother–child coping and adjustment to HIV. Social Science and Medicine, 56, 643–655. doi: 10.1016/S0277-9536(02)00061-8.CrossRefPubMedGoogle Scholar
  27. Jewkes, R. K., Levin, J. B., & Penn-Kekana, L. A. (2003). Gender inequalities, intimate partner violence and HIV preventive practices: Findings of a South African cross-sectional study. Social Science and Medicine, 56, 125–134. doi: 10.1016/S0277-9536(02)00012-6.CrossRefPubMedGoogle Scholar
  28. Joint Civil Society Monitoring Forum. (n.d.). ARV numbers . Retrieved on July 21, 2008 from
  29. Jones, D. J., Foster, S. E., Zalot, A., Chester, C., & King, A. (2007). Knowledge of maternal HIV/AIDS and child adjustment: The moderating role of children’s relationships with their mothers. AIDS and Behavior, 11, 409–420. doi: 10.1007/s10461-006-9188-1.CrossRefPubMedGoogle Scholar
  30. Kotchick, B. A., Forehand, R., Brody, G., Armistead, L., Simon, P., Morse, E., et al. (1997). The impact of maternal HIV-infection on parenting in inner-city African American families. Journal of Family Psychology, 11(4), 447–461. doi: 10.1037/0893-3200.11.4.447.CrossRefGoogle Scholar
  31. Lawson, A. L.-G. (1999). Women and AIDS in Africa: Sociocultural dimensions of the HIV/AIDS epidemic. International Social Science Journal, 51(161), 391–400. doi: 10.1111/1468-2451.00207.CrossRefGoogle Scholar
  32. Lee, M. B., & Rotheram-Borus, M. J. (2002). Parents’ disclosure of HIV to their children. AIDS (London, England), 16(16), 2201–2207. doi: 10.1097/00002030-200211080-00013.Google Scholar
  33. Letteney, S., & LaPorte, H. H. (2004). Deconstructing stigma: Perceptions of HIV-Seropositive mothers and their disclosure to children. Social Work in Health Care, 38(3), 105–123. doi: 10.1300/J010v38n03_06.CrossRefPubMedGoogle Scholar
  34. Loeber, R., Green, S. M., & Lahey, B. B. (1990). Mental health professionals’ perception of the utility of children, mothers, and teachers as informants on childhood psychopathology. Journal of Clinical Child Psychology, 19, 136–143. doi: 10.1207/s15374424jccp1902_5.CrossRefGoogle Scholar
  35. McBride, C. K., Paikoff, R. L., & Holmbeck, G. N. (2003). Individual and familial influences on the onset of sexual intercourse among urban African American adolescents. Journal of Consulting and Clinical Psychology, 71(1), 159–167. doi: 10.1037/0022-006X.71.1.159.CrossRefPubMedGoogle Scholar
  36. Murphy, D. A., Johnston Roberts, K., & Hoffman, D. (2003). Regrets and advice from mothers who have disclosed their HIV+ serostatus to their young children. Journal of Child and Family Studies, 12(3), 307–318. doi: 10.1023/A:1023939827449.CrossRefGoogle Scholar
  37. Murphy, D. A., Marelich, W. D., & Hoffman, D. (2002). A longitudinal study of the impact on young children of maternal HIV serostatus disclosure. Clinical Child Psychology and Psychiatry, 7(1), 55–70. doi: 10.1177/1359104502007001005.CrossRefGoogle Scholar
  38. Murphy, D. A., Roberts, K. J., & Hoffman, D. (2006). Young children’s reactions to mothers’ disclosure of maternal HIV+ serostatus. Journal of Child and Family Studies, 15(1), 39–56. doi: 10.1007/s10826-005-9007-8.CrossRefGoogle Scholar
  39. Murphy, D. A., Steers, W. N., & Dello Stritto, M. E. (2001). Maternal disclosure of mother’s HIV serostatus to their children. Journal of Family Psychology, 15, 441–450. doi: 10.1037/0893-3200.15.3.441.CrossRefPubMedGoogle Scholar
  40. Norman, A., Chopra, M., & Kadiyala, S. (2007). Factors related to HIV disclosure in two South African communities. American Journal of Public Health, 97, 1775–1781. doi: 10.2105/AJPH.2005.082511.CrossRefPubMedGoogle Scholar
  41. Pequegnat, W., & Bray, J. H. (1997). Families and HIV/AIDS: Introduction to the special section. Journal of Family Psychology, 11(1), 3–10. doi: 10.1037/0893-3200.11.1.3.CrossRefGoogle Scholar
  42. Petros, G., Airhihenbuwa, C. O., Simbayi, L., Ramlagan, S., & Brown, B. (2006). HIV/AIDS and ‘othering’ in South Africa: The blame goes on. Culture, Health & Sexuality, 8(1), 67–77. doi: 10.1080/13691050500391489.CrossRefGoogle Scholar
  43. Prinz, R. J., Foster, S. L., Kent, R. N., & O’Leary, K. D. (1979). Multivariate assessment of conflict in distressed and nondistressed mother-adolescent dyads. Journal of Applied Behavior Analysis, 12(4), 691–700. doi: 10.1901/jaba.1979.12-691.CrossRefPubMedGoogle Scholar
  44. Robin, A. L., & Weiss, J. G. (1980). Criterion-related validity of behavioral and self-report measures of problem solving communication skills in distressed and non-distressed parent-adolescent dyads. Behavioral Assessment, 2, 339–352.Google Scholar
  45. Rotheram-Borus, M. J., Draimin, B., Reid, H., & Murphy, D. (1997). The impact of illness disclosure and custody plans on adolescents whose parents live with AIDS. AIDS (London, England), 11(9), 1159–1164. doi: 10.1097/00002030-199709000-00012.Google Scholar
  46. S.A.B.C. News. (June 7th, 2005). TAC campaigns for 200 000 people on ARVs by 2006. Retrieved on June 23rd, 2005 from,2160,106019,00.html.
  47. Schrimshaw, E. W., & Siegel, K. (2002). HIV-infected mothers’ disclosure to their uninfected children: Rates, reasons, and reactions. Journal of Social and Personal Relationships, 19(1), 19–43. doi: 10.1177/0265407502191002.CrossRefGoogle Scholar
  48. Shaffer, A., Jones, D., Kotchick, B. A., Forehand, R., & The Family Health Project Research Group. (2001). Telling the children: Disclosure of maternal HIV-infection and its effects on child psychosocial adjustment. Journal of Child and Family Studies, 10(3), 301–313.CrossRefGoogle Scholar
  49. Singh, J. A. (2004). Standards of care in the antiretroviral rollout world. Lancet, 364, 920–922. doi: 10.1016/S0140-6736(04)17040-2.CrossRefPubMedGoogle Scholar
  50. Skinner, D., & Davids, A. (Eds.). (2006). Multiple vulnerabilities: Qualitative data for the study of orphans vulnerable children in South Africa. Cape Town: HSRC Press.Google Scholar
  51. South African National Council for Child and Family Welfare (SANCCFW). (1999). HIV/AIDS and the care of children. South Africa.Google Scholar
  52. UNAIDS.WHO. (2005). AIDS epidemic update December 2005. Special report on HIV prevention. Retrieved on November 21st, 2005 from
  53. Vallerand, A., Hough, E., Pittiglio, L., & Marvicsin, D. (2005). The process of disclosing HIV serostatus between HIV-positive mothers and their HIV-negative children. AIDS Patient Care, 19(2), 100–109. doi: 10.1089/apc.2005.19.100.CrossRefGoogle Scholar
  54. Wahler, H. J. (1973). Wahler physical symptoms inventory manual. Los Angeles: Western Psychological Services.Google Scholar
  55. Wiener, L. S., Battles, H. B., & Heilman, N. (1998). Factors associated with parents’ decision to disclose to their HIV diagnosis to their children. Child Welfare League of America, LXXVII(2), 115–135.Google Scholar
  56. Wierson, M., & Forehand, R. (1992). Family stressors and adolescent functioning: A consideration of models for early and middle adolescents. Behavior Therapy, 23, 671–688. doi: 10.1016/S0005-7894(05)80228-X.CrossRefGoogle Scholar
  57. Wild, L. (2001). The psychosocial adjustment of children orphaned by AIDS. Southern African Journal of Child and Adolescent Mental Health, 13(1), 3–22.Google Scholar
  58. Zay, L. S., & Roma, K. (1994). Adolescents and parental deaths from AIDS. In C. Levine (Ed.), AIDS and the new orphans (pp. 59–76). Westport, CT: Auburn House.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  • Frances L. Palin
    • 1
    Email author
  • Lisa Armistead
    • 2
  • Alana Clayton
    • 2
  • Bethany Ketchen
    • 3
  • Gretchen Lindner
    • 4
  • Penny Kokot-Louw
    • 5
  • Analie Pauw
    • 5
  1. 1.Cherokee Health SystemsKnoxvilleUSA
  2. 2.Psychology DepartmentGeorgia State UniversityAtlantaUSA
  3. 3.San Francisco VA Medical CenterSan FranciscoUSA
  4. 4.Veterans Affairs Palo Alto Health Care SystemPalo AltoUSA
  5. 5.Psychology DepartmentUniversity of PretoriaPretoriaSouth Africa

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