看護とケアのジャーナル

Benefits and Risks of Disclosing Human Immunodeficiency Virus Diagnosis to Perinatally Infected Children: A Critical Review of the Literature

Abstract

Chrissie Phiri and Evelyn Chilemba

Disclosure of HIV infection to perinatally infected children is a contemporary issue that demands conscientiousness among health workers in dealing with those affected. This is because of the complicated treatment regimen that prompts questions from the affected children, their parents and of course the caregivers. The aim of the review was to seek evidence from literature regarding the benefits and risks of disclosing HIV status to perinatally infected children in order to influence practice in educating, informing and supporting parents/caregivers in Malawi. The review sought for evidence in order to appreciate the benefits and risks through a critical appraisal of literature and synthesis of the findings of the existing studies. The search strategy was achieved through an electronic data base search of research articles from Medline, Embase and CINAHL. The search strategy was limited to articles published between 1996 to June 2011. These were qualitative studies conducted in Southern Africa and were in English language with relevance as the guiding principle in the search. The review results exposes that parents of HIV infected children experience barriers to disclosure and that stigma is such a major and one of barriers to disclosure and that stigma particularly brings fear among the parents of the children. The fears came about because the children would request to know how they got infected and these type of questions would make parents upset. Therefore, it is postulated that adequate preparation and specific plans of disclosure should be designed before disclosure is implemented. The plan considers issues of age, intellectual abilities and developmental milestones. The ethical issues in giving wrong information, thus the inaccurate diagnosis when the child asked questions regarding their status are dangerous to the child’s compliance to treatment regimen. Despite the secrecy surrounding the affected children’s status, these children ultimately become aware of their problems. In conclusion, some parents of the HIV affected children prefer disclosure of HIV/AIDS status to their children based on age, while others prefer giving them inaccurate diagnosis. It is envisaged that these parents need support to this dilemma from health workers. Support and discussions at convenient times with parents should be considered a major need in the management of HIV/AIDS.