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Caregivers’ Intentions to Disclose HIV Diagnosis to Children Living with HIV in South Africa: A Theory-Based Approach

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Abstract

When children know their HIV serostatus, they are more likely to cooperate with steps to manage their health and the risk of transmitting HIV to others. Mounting evidence indicates that caregivers often do not disclose to HIV-positive children that the children are living with HIV, but little is known about the modifiable determinants of pediatric HIV disclosure. The present study examined theory-of-planned-behavior predictors of the intention to disclose to children their HIV diagnosis. The participants were 100 caregivers of HIV-positive children in Eastern Cape Province, South Africa. Proportional-odds logistic regression analysis revealed that normative support for disclosure and caregiver-child communication predicted the intention to disclose, whereas behavioral beliefs regarding the consequences of disclosing and self-efficacy to disclose did not. The results suggest that interventions to increase pediatric HIV disclosure in South Africa should help caregivers enlist support for disclosure among important referents and improve communication with their HIV-infected children.

Resumen

Cuando los niños seropositivos conocen su estado serológico son más propensos a cooperar con las medidas relacionadas con el control de su salud y el riesgo de transmisión del VIH a otros. La evidencia acumulada indica que los cuidadores a menudo no revelan a los niños VIH positivos su estado serológico, pero poco se sabe sobre los determinantes modificables de la revelación del diagnóstico pediátrico de VIH. El presente estudio examinó los predictores de la Teoría de la Acción Planeada de la intención de revelar el estado serológico a los niños con diagnóstico de VIH. Los participantes fueron 100 cuidadores de niños VIH positivos de la provincia oriental del Cabo, Sudáfrica. Los odds proporcionales de los análisis de regresión logística revelaron que el apoyo normativo para la revelación y la comunicación cuidador-niño fueron predictores de la intención de revelación, mientras que las creencias comportamentales relacionadas con las consecuencias de la revelación y la autoeficacia para la revelación no lo fueron. Los resultados sugieren que las intervenciones para incrementar la revelación del diagnóstico pediátrico de VIH en Sudáfrica deben ayudar a los cuidadores a conseguir apoyo para la revelación entre los referentes importantes y mejorar la comunicación con sus hijos infectados por VIH.

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Acknowledgments

This research was funded in part by NIH research Grant 1 R34 MH078803. We wish to thank the nurses working in the nongovernmental organizations, clinics, and churches for their support in recruitment of the participants. We also wish to thank Mrs. Soleka Bunting for assisting with the recruitment of participants and the data collection. We wish to thank Ms. Janet Hsu and Ms. Pandora Woods for data management and Dr. Ann O’Leary and Jingwen Zhang, MA, for their helpful comments on a draft of this article. We wish to thank the participants for their time and effort.

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Authors and Affiliations

  1. Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA

    John B. Jemmott III & G. Anita Heeren

  2. Annenberg School for Communication, University of Pennsylvania, 3535 Market Street, Suite 520, 19104, Philadelphia, PA, USA

    John B. Jemmott III

  3. Department of Statistics and Biostatistics, University of Fort Hare, Alice, South Africa

    Lulama Sidloyi, C. Show Marange & Joanne C. Tyler

  4. Department of Anthropology, Haverford College, Haverford, PA, USA

    Zolani Ngwane

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  1. John B. Jemmott III
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Correspondence to John B. Jemmott III.

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Jemmott III, J.B., Heeren, G.A., Sidloyi, L. et al. Caregivers’ Intentions to Disclose HIV Diagnosis to Children Living with HIV in South Africa: A Theory-Based Approach. AIDS Behav 18, 1027–1036 (2014). https://doi.org/10.1007/s10461-013-0672-0

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