Prevalence of, and barriers to the disclosure of HIV status to infected children and adolescents in a district of Ghana

Abstract

BackgroundGlobally there are about 3.3million children under the age of 15 years living with HIV. Of this number, 88% live in sub-Saharan Africa. In Ghana, an estimated 33,000 children were said to be living with the HIV infection in 2012. Lack of disclosure adversely affects the well-being of the child, including access to paediatric HIV treatment and care and adherence to treatment. However, the greatest psychosocial challenges that parents and caregivers of HIV-infected children face is disclosure of HIV status to their infected children. This study sought to determine the prevalence of and the barriers to the disclosure of HIV status to infected children and adolescents in Lower Manya-Krobo District in Ghana.MethodsA cross sectional study with a sample of 118 caregivers of HIV infected children and adolescents aged 4–19 years attending three HIV clinics in the Lower Manya Krobo District, and 10 key informants comprising of healthcare workers and HIV volunteer workers involved in the provision of care to infected children and their families.ResultsThe prevalence of disclosure was higher. Main barriers to disclosure identified in this study included age of child, perceived cause of HIV, stigma attached to HIV, child’s inability to keep diagnosis to self and fear of psychological harm to child.ConclusionThere is the need for the Ghana Health Service in conjunction with the Ghana Aids Commission and the National Aids Control Programme to develop comprehensive context-based disclosure guidelines.

Results from a difference‐in‐differences evaluation of health facility HIV and key population stigma‐reduction interventions in Ghana

“…Evidence continues to grow of the negative relationship of stigma to pre‐exposure prophylaxis [1], HIV testing [2‐4], linkage and retention in care [5‐7], medication adherence [8‐13] and viral load suppression [2,14,15]. More visible global recognition of stigma in fuelling the HIV epidemic and in undermining the HIV response has been forthcoming through recent global declarations [29,35,71].…”

“…Mounting evidence documents that stigma undermines HIV prevention strategies such as pre‐exposure prophylaxis [1], HIV testing [2‐4], linkage to and retention in care [5‐7], medication adherence [8‐13] and ultimately viral load suppression [2,14,15]. Increasingly recognized as a key determinant of health and health inequity [16], stigma is a powerful social process characterized by labelling (distinguishing differences), stereotyping (attributing negative characteristics to the distinguished differences), separation (through physical and social isolation), leading to status loss (social and economic) and discrimination, all occurring in the context of power [17].…”

“…A health facility stigma assessment in Ghana [58] identified the physical layout of healthcare services; lack of in‐depth knowledge about HIV; fear of contracting the disease; and low levels of respect and dignity based on cultural and moral grounds as contributing factors for stigma and discrimination experienced by PLHIV in health facilities. HIV stigma in Ghana has been documented as a barrier to antiretroviral therapy (ART) services [60]; voluntary testing and counselling (VCT) uptake [61,62]; and to parents informing children living with HIV of their seropositive status [5,63].…”

24-month clinical, immuno-virological outcomes and HIV status disclosure in adolescents living with perinatally-acquired HIV in the COHADO cohort, in Togo and Côte d’Ivoire, 2015-2017

“…In our study, we found that only 46.1% knew their HIV status at baseline, and 74.1% by 24 months of follow-up. Although this should be closer to 100% according to the WHO recommendations, this is higher than reported in previous studies, particularly for West Africa [25,31,42]. In Ghana, two separate studies reported the proportion of HIV disclosure to be 11.2% among children and adolescents aged 8-14 years in 2009 and 44% among ALHIV aged 12 -19 years in 2015 [25,43].…”

“…In many African pediatric sites, even if children or adolescents on ART, healthcare providers and caregivers delayed their HIV-disclosure because of cultural factors, the lack of national guidance [21]. Caregivers are also not ready, and fear their adolescent will disclose the family secret with subsequent stigma [25][26][27][28]. According to a previous review, 1.7% to 41% of children and ALHIV in low and middle-income countries are fully disclosed of their HIV-positive status [29].…”