Disclosure of human immunodeficiency virus status to children in South Africa : a comprehensive analysis

CITATION: Van Elsland, S. L., et. al. 2019. Disclosure of human immunodeficiency virus status to children in South Africa : a comprehensive analysis. Southern African Journal of HIV Medicine, (20(1):a884, doi:10.4102/sajhivmed.v20i1.884.The original publication is available at http://www.sajhivmed.org.za/Background: The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives: To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a South African semi-urban clinic. Methods: This cross-sectional study used structured interview administered questionnaires which were supplemented with medical record data. Predictors included child, caregiver, clinical and socio-economic characteristics, viral suppression, immune response, adherence, health-related quality of life and family functioning. Results: We included 190 children of whom 45 (23.7%) received disclosure about their HIV status, of whom 28 (14.7%) were partially disclosed and 17 (8.9%) were fully disclosed. Older age of the child and higher education of the caregiver were strongly associated with disclosure. Female caregivers, detectable viral load, syrup formulation, protease inhibitor (PI) regimens with stavudine and didanosine, and self-reported non-adherence were strongly associated with non-disclosure. Conclusion: When children do well on treatment, caregivers feel less stringent need to disclose. Well-functioning families, higher educated caregivers and better socio-economic status enabled and promoted disclosure. Non-disclosure can indicate a sub-optimal social structure which could negatively affect adherence and viral suppression. There is an urgent need to address disclosure thoughtfully and proactively in the long-term disease management. For the disclosure process to be beneficial, an enabling supportive context is important, which will provide a great opportunity for future interventions.https://sajhivmed.org.za/index.php/hivmed/article/view/884Publisher's versio

Disclosure of human immunodeficiency virus status to children in South Africa: A comprehensive analysis

Background: The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives: To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a South African semi-urban clinic. Methods: This cross-sectional study used structured interview administered questionnaires which were supplemented with medical record data. Predictors included child, caregiver, clinical and socio-economic characteristics, viral suppression, immune response, adherence, health-related quality of life and family functioning. Results: We included 190 children of whom 45 (23.7%) received disclosure about their HIV status, of whom 28 (14.7%) were partially disclosed and 17

Breaking Down Barriers to Tell: A Mixed Methods Study of Health Worker Involvement in Disclosing to Children That They Are Living with HIV in Rural South Africa

Disclosing to a child that s/he is living with HIV is necessary to promote adherence to treatment and improve health outcomes. Facilitating disclosure between caregivers and children remains a challenge for health workers. Understanding how health workers are involved in and perceive the disclosure process is integral to engaging with such challenges. We held group discussions with and surveyed 73 physicians, nurses, and counselors across 16 randomly selected facilities in two rural South African health districts, exploring their experiences of supporting disclosure between caregivers and children. Ninety percent of those surveyed agreed that children should be informed of their HIV status. Differences between categories of health workers regarding training, involvement in the disclosure process, and perceived responsibility for disclosure support led to inconsistent disclosure practices within facilities. Disclosure-strengthening interventions must consider the composition of the health worker team and the role that each category of health worker performs in their local settings

Disclosure of human immunodeficiency virus status to children in South Africa : a comprehensive analysis

CITATION: Van Elsland, S. L., et. al. 2019. Disclosure of human immunodeficiency virus status to children in South Africa : a comprehensive analysis. Southern African Journal of HIV Medicine, (20(1):a884, doi:10.4102/sajhivmed.v20i1.884.The original publication is available at http://www.sajhivmed.org.za/Background: The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives: To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a South African semi-urban clinic. Methods: This cross-sectional study used structured interview administered questionnaires which were supplemented with medical record data. Predictors included child, caregiver, clinical and socio-economic characteristics, viral suppression, immune response, adherence, health-related quality of life and family functioning. Results: We included 190 children of whom 45 (23.7%) received disclosure about their HIV status, of whom 28 (14.7%) were partially disclosed and 17 (8.9%) were fully disclosed. Older age of the child and higher education of the caregiver were strongly associated with disclosure. Female caregivers, detectable viral load, syrup formulation, protease inhibitor (PI) regimens with stavudine and didanosine, and self-reported non-adherence were strongly associated with non-disclosure. Conclusion: When children do well on treatment, caregivers feel less stringent need to disclose. Well-functioning families, higher educated caregivers and better socio-economic status enabled and promoted disclosure. Non-disclosure can indicate a sub-optimal social structure which could negatively affect adherence and viral suppression. There is an urgent need to address disclosure thoughtfully and proactively in the long-term disease management. For the disclosure process to be beneficial, an enabling supportive context is important, which will provide a great opportunity for future interventions.https://sajhivmed.org.za/index.php/hivmed/article/view/884Publisher's versio

Disclosure of human immunodeficiency virus status to children in South Africa: A comprehensive analysis

Background: The extent of disclosure of HIV status to children and adolescents and the context facilitating their disclosure process have received little attention. Objectives: To assess disclosure and provide a comprehensive analysis of characteristics associated with disclosure to children (3–14 years) receiving antiretroviral treatment in a South African semi-urban clinic. Methods: This cross-sectional study used structured interview administered questionnaires which were supplemented with medical record data. Predictors included child, caregiver, clinical and socio-economic characteristics, viral suppression, immune response, adherence, health-related quality of life and family functioning. Results: We included 190 children of whom 45 (23.7%) received disclosure about their HIV status, of whom 28 (14.7%) were partially disclosed and 17 (8.9%) were fully disclosed. Older age of the child and higher education of the caregiver were strongly associated with disclosure. Female caregivers, detectable viral load, syrup formulation, protease inhibitor (PI) regimens with stavudine and didanosine, and self-reported non-adherence were strongly associated with non-disclosure. Conclusion: When children do well on treatment, caregivers feel less stringent need to disclose. Well-functioning families, higher educated caregivers and better socio-economic status enabled and promoted disclosure. Non-disclosure can indicate a sub-optimal social structure which could negatively affect adherence and viral suppression. There is an urgent need to address disclosure thoughtfully and proactively in the long-term disease management. For the disclosure process to be beneficial, an enabling supportive context is important, which will provide a great opportunity for future interventions

National Wetland Map 5: An improved spatial extent and representation of inland aquatic and estuarine ecosystems in South Africa

The improved representation of freshwater and estuarine ecosystems and associated data was a key component of the 2018 National Biodiversity Assessment, and is an essential step in enhancing defensible land use planning and decision making. This paper reports on the enhancement of the National Wetland Map (NWM) version 5 for South Africa and other data layers associated with the South African Inventory of Inland Aquatic Ecosystems. Detail is provided on (i) the extent of wetlands mapped in NWM5, compared to previous versions of the NWMs; (ii) the improved extent of inland wetlands mapped in focus areas in NWM5 relative to NWM4; (iii) the type of cover associated with the wetlands (inundated, vegetated or arid); (iv) the ecotone between rivers and estuaries; and (v) level of confidence for the inland wetlands in terms of how well the extent and hydrogeomorphic units were captured for each sub-quaternary catchment of South Africa. A total of 4 596 509 ha (3.8% of South Africa) of inland aquatic ecosystems and artificial wetlands have now been mapped, with NWM5 delineating 23% more inland wetlands (2 650 509 ha or 2.2% of SA) compared with NWM4. The estuarine functional zone, which encapsulates all estuarine processes, and associated habitats and biota, was refined for 290 systems totalling 200 739 ha, with the addition of 42 micro-estuaries totalling 340 ha. Nearly 600 000 ha (0.5% of SA) of artificial wetlands were mapped in SA. Inland wetlands are predominantly palustrine (55%), with some arid (34%) and a few inundated systems (11%). Ecotones between rivers and estuaries, ecotones where biota and processes continuously vary from freshwater to estuarine, formed a small fraction (<1.5%) of river total extent (164 018 km). Most inland wetlands (~70%) had a low confidence ranking for designation of extent and typing, because they were not mapped by a wetland specialist and not verified in the field. Future improvements of the map should be focused on catchment-based improvements, particularly in strategic water-source areas, areas of high development pressure and those with low confidence designation