Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa

Rochat, Tamsen; Arteche, Adriane Xavier; Stein, Alan; Mitchell, Joanie; Bland, Ruth

doi:10.1097/qad.0000000000000668

Cited by 35 publications

(47 citation statements)

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“…In the evaluation, we also demonstrated improvements in maternal and child mental health, with the intervention significantly reducing parenting stress, and children showing less emotional and behavioral difficulties post-intervention (25, 26). …”

Section: Resultsmentioning

confidence: 69%

“…Avoidant coping strategies include distraction, denial, escape, distancing, and self-blame, with mothers commonly coping with HIV by distancing themselves from it (32). By not disclosing, which is commonly reported in the HIV literature (18, 33, 34), the mother is practicing a form of avoidant coping, which is often motivated by a desire to safeguard children from psychological distress (26), or concerns about stigma and fear that the child may disclose to others (13, 35). …”

Section: Resultsmentioning

confidence: 99%

“…The study was conducted from the Africa Centre for Population Health in rural KwaZulu-Natal, South Africa. The methodology and results are described in two open access papers in the journal AIDS (25, 26), and a brief summary of the results are given below. Written informed consent was obtained from mothers/caregivers and assent from children, and ethical approval was obtained from the Biomedical Ethics Committee of the University of KwaZulu-Natal (Ref: BF 144/010).…”

Section: Resultsmentioning

confidence: 99%

“…The Amagugu intervention has this aim; it is a family-centered disclosure intervention providing support to HIV-infected mothers to disclose their status to their HIV-uninfected primary school-aged children and to educate them about health and HIV. This paper has two aims: (i) to describe the proposed pathways of risk that Amagugu aims to disrupt through its intervention targets, mechanisms, and activities and (ii) to present a summary of results from the large-scale evaluation study of Amagugu (25, 26). …”

Section: Introductionmentioning

confidence: 99%

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The Amagugu Intervention: A Conceptual Framework for Increasing HIV Disclosure and Parent-Led Communication about Health among HIV-Infected Parents with HIV-Uninfected Primary School-Aged Children

Rochat

Mitchell

Stein

et al. 2016

Front. Public Health

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Advances in access to HIV prevention and treatment have reduced vertical transmission of HIV, with most children born to HIV-infected parents being HIV-uninfected themselves. A major challenge that HIV-infected parents face is disclosure of their HIV status to their predominantly HIV-uninfected children. Their children enter middle childhood and early adolescence facing many challenges associated with parental illness and hospitalization, often exacerbated by stigma and a lack of access to health education and support. Increasingly, evidence suggests that primary school-aged children have the developmental capacity to grasp concepts of health and illness, including HIV, and that in the absence of parent-led communication and education about these issues, HIV-exposed children may be at increased risk of psychological and social problems. The Amagugu intervention is a six-session home-based intervention, delivered by lay counselors, which aims to increase parenting capacity to disclose their HIV status and offer health education to their primary school-aged children. The intervention includes information and activities on disclosure, health care engagement, and custody planning. An uncontrolled pre–post-evaluation study with 281 families showed that the intervention was feasible, acceptable, and effective in increasing maternal disclosure. The aim of this paper is to describe the conceptual model of the Amagugu intervention, as developed post-evaluation, showing the proposed pathways of risk that Amagugu aims to disrupt through its intervention targets, mechanisms, and activities; and to present a summary of results from the large-scale evaluation study of Amagugu to demonstrate the acceptability and feasibility of the intervention model. This relatively low-intensity home-based intervention led to: increased HIV disclosure to children, improvements in mental health for mother and child, and improved health care engagement and custody planning for the child. The intervention model demonstrates the potential for disclosure interventions to include pre-adolescent HIV education and prevention for primary school-aged children.

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Section: Resultsmentioning

confidence: 69%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Amagugu Intervention: A Conceptual Framework for Increasing HIV Disclosure and Parent-Led Communication about Health among HIV-Infected Parents with HIV-Uninfected Primary School-Aged Children

Rochat

Mitchell

Stein

et al. 2016

Front. Public Health

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“…Despite the paucity of literature describing the impact of disclosure of a child's perinatal HIV/ARV exposure, several studies suggest positive effects on family relationships when disclosure of maternal HIV status to children occurs [11,27,28]. The Amagugu study in South Africa reported significant reduction in parental stress and child emotional/behavioural problems after an intervention to aid in disclosure of maternal HIV status [27].…”

Section: Discussionmentioning

confidence: 99%

Disclosing in utero HIV/ARV exposure to the HIV‐exposed uninfected adolescent: is it necessary?

Jao

Hazra

Mellins

et al. 2016

Journal of the International AIDS Society

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IntroductionThe tremendous success of antiretroviral therapy has resulted in a diminishing population of perinatally HIV-infected children on the one hand and a mounting number of HIV-exposed uninfected (HEU) children on the other. As the oldest of these HEU children are reaching adolescence, questions have emerged surrounding the implications of HEU status disclosure to these adolescents. This article outlines the arguments for and against disclosure of a child's HEU status.DiscussionDisclosure of a child's HEU status, by definition, requires disclosure of maternal HIV status. It is necessary to weigh the benefits and harms which could occur with disclosure in each of the following domains: psychosocial impact, long-term physical health of the HEU individual and the public health impact. Does disclosure improve or worsen the psychological health of the HEU individual and extended family unit? Do present data on the long-term safety of in utero HIV/ARV exposure reveal potential health risks which merit disclosure to the HEU adolescent? What research and public health programmes or systems need to be in place to afford monitoring of HEU individuals and which, if any, of these require disclosure?ConclusionsAt present, it is not clear that there is sufficient evidence on whether long-term adverse effects are associated with in utero HIV/ARV exposures, making it difficult to mandate universal disclosure. However, as more countries adopt electronic medical record systems, the HEU status of an individual should be an important piece of the health record which follows the infant not only through childhood and adolescence but also adulthood. Clinicians and researchers should continue to approach the dialogue around mother–child disclosure with sensitivity and a cogent consideration of the evolving risks and benefits as new information becomes available while also working to maintain documentation of an individual's perinatal HIV/ARV exposures as a vital part of his/her medical records. As more long-term adult safety data on in utero HIV/ARV exposures become available these decisions may become clearer, but at this time, they remain complex and multi-faceted.

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Child and Adolescent Development

Shute

Hogan

2017

Handbook of Australian School Psychology

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All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or any information storage or retrieval system, without prior permission in writing from the publisher. Subject to any applicable licensing terms and conditions in the case of electronically supplied publications, a person may engage in fair dealing with a copy of this publication for his or her personal or private use, or his or her research or private study. See Section 12(1)(a) of the Copyright Act 98 of 1978.

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Maternal and child psychological outcomes of HIV disclosure to young children in rural South Africa

Abstract: Amagugu led to improvements in mothers' and children's mental health and parenting stress, irrespective of disclosure level, suggesting general nonspecific positive effects on family relationships. Findings require validation in a randomized control trial.

Cited by 35 publications

References 68 publications

The Amagugu Intervention: A Conceptual Framework for Increasing HIV Disclosure and Parent-Led Communication about Health among HIV-Infected Parents with HIV-Uninfected Primary School-Aged Children

The Amagugu Intervention: A Conceptual Framework for Increasing HIV Disclosure and Parent-Led Communication about Health among HIV-Infected Parents with HIV-Uninfected Primary School-Aged Children

Disclosing in utero HIV/ARV exposure to the HIV‐exposed uninfected adolescent: is it necessary?

Child and Adolescent Development

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