Dwivedi and colleagues put up a great report on disclosure of HIV status
to children [1]. A time when hesitation generally takes the upper hand
over need for disclosure, the article deserves appreciation for its bold
effect on the unsung stories of HIV-affected families. However, I would
like to add few more points:
1. The issue has multiple effects on the future
health of the family. Parents need to wait till appearance of
symptoms in child for making the decision [2]. This gives rise to a
double-edged problem. Explaining transmission of disease and its
link to behavior is one of the toughest challenges the parents face.
For fear of disclosing their HIV status to peer group or others,
mothers may withhold children from HIV treatment [3]. The
psychological burden of disclosure on the growing child adds to the
gradual discovery of sexuality, leading to complex and potential
consequences [4].
2. There are possibilities of social isolation,
severe emotional distress and perturbed self-image in children when
disclosure is withheld over prolonged periods [5]. Even, uninfected
infants will continue to be exposed to the risk of long-term adverse
effects of antiretroviral drugs. In addition, AIDS orphans were
found engaged in less positive activities and were more likely to
experience higher rates of depression, crime and difficulties with
friend circle compared to children orphaned by other causes [6].
3. Though the authors did not scale the effect of
disclosure on adherence, I think it is good parameter to measure the
success of the program, and for further advocacy. Even when
confusion prevails among counsellors on this topic, in absence of
proper guidance, the documented figures would help us to keep away
scepticism about additional psychological burden [2].
References
1. Dwidevi P, Patkar P, Beard J. Necessity of
systematic HIV disclosure in HIV-infected families: committed
communities development trusts approach and intervention. Indian
Pediatr. 2015;52:375-8.
2. Rwemisisi J, Wolff B, Coutinho A, Grosskurth
H, Whitworth J. What if they ask how I got it?’ Dilemmas of
disclosing parental HIV status and testing children for HIV in
Uganda. Health Policy Plan. 2008;23:36-42.
3. Thorne C, Igor Semenenko I, Malyuta R.
Prevention of mother-to-child transmission of human immunodeficiency
virus among pregnant women using injecting drugs in Ukraine,
2000–10. Addiction. 2012;107:118-28.
4. UNICEF. Thematic report 2013: HIV/ AIDS and
children. UNICEF. New York. 2014.
5. Instone SL. Perceptions of children with HIV
infection when not told for so long: implications for diagnosis
disclosure. J Pediatr Health Care. 2000;14:235-43.
6. Cluver L, Gardner F, Operario D. Effects of stigma on the mental
health of adolescents orphaned by AIDS. J Adolesc Health. 2008;42:410-7.
