Variations in pediatric HIV status disclosure between the orphanage and the community in Ethiopia

ABSTRACT

Past studies on pediatric HIV disclosure have not investigated the variations across childcare settings. This study explored pediatric HIV disclosure for children living in the community with their birthparents or relatives and those living in orphanages in Addis Ababa, Ethiopia, to highlight the variations in reasons, processes and outcomes of disclosure across childcare settings. Semi-structured interviews were conducted with children and their caregivers attending an HIV clinic in Addis Ababa, Ethiopia. Among children living in orphanages, the proportion with disclosure was significantly higher (p < 0.001) and age at disclosure was younger (p = 0.09). Although the proportions of children with unplanned disclosure were similar in orphanages and the community, there were notable differences between children’s experiences. Children living in the community often found out their status alone through exposure to antiretroviral therapy advertisements in the media, unbeknownst to their caregivers and healthcare providers and suffered silently without any support. Orphans, on the other hand, experienced unplanned disclosure after the death of their birthparents and subsequently received significant emotional support. Healthcare professionals need to consider these variations with childcare settings in disclosure processes. Practices in orphanages may be important models for developing adequate support system for caregivers and children in the community.

KEYWORDS:

• HIV disclosure
• children
• childcare settings
• psychosocial stressors
• Ethiopia

Acknowledgments

We would like to share our sincere gratitude for the participating children and their caregivers, the administrative staff and the clinic staff of the Worldwide Orphans Foundation Family Health Clinic for their support and participation in this research project. This research project was supported by the generous internship grants of the Princeton University Global Health Program and was made possible by the Princeton University International Internship Program. We would also like to thank Professor Sarah S. McLanahan for her support during the project inception and participation in the IRB approval process.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work was supported by Princeton University Global Health Program Summer Research Internship Award.