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Dr. Judith Kose

Technical Advisor

Elizabeth Glaser Pediatric AIDS Foundation

HIV Adolescence Workshop, Nairobi, Kenya, 2-4 October, 2019

Disclosing HIV Status: Mission Possible

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Disclosing HIV Status

For perinatally acquired HIV, WHO guidelines recommend

that children of school-going age (6-12 years) be told they

are HIV-positive

Disclosure prevalence in resource limited settings ranges

0-69%

Factors influencing disclosure:

- Child’s age

- Perceived ability to understand HIV infection

- Caregiver education level

- Caregiver openness about their own HIV status

Common barriers:

- Fear that the child would disclose HIV status to

others

- Fear of stigma

- Concerns for children’s emotional or physical health

Adolescent HIV disclosure is more

complex, involves multiple parties

and has limited guidance

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Disclosing HIV Status

• Disclosure needs to be planned ahead! If

accidental disclosure happens, post-disclosure

management is more essential than ever!

• No one time event, the process of

disclosure can take months and years!

• Models of disclosure are diverse:

- Independent disclosure

- Empowered disclosure by caregivers or

adolescents

- Joint disclosure with healthcare worker

- Assisted disclosure with caregiver/

healthcare worker/counsellor/peer support

CountryAge of Partial

Disclosure

Age of Full

Disclosure

Cameroon 7-11 years 12-13 years

Lesotho5-9 years 10 years

Malawi 5-7 years 11-13 years

Rwanda 8-10 years 11-14 years

Tanzania4-6 years 8-10 years

Uganda None 12 years

Zambia 5-7 years 7+ years

Kenya 6-10 years 10- 12 years

Ages of Disclosure of HIV Status

in Selected African Countries.

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Disclosure Toolkit Components

• Evidence-informed with references to

global sources

• Guidance and checklists for disclosure by:

- Healthcare workers

- Caregivers

- Horizontally-infected adolescents

- Disclosure to social networks, community

and partners by adolescents

• Job aids:

- Algorithms

- Readiness assessment checklists

- Role playing scenarios (3) for each module

- Testimonies by adolescents, caregivers and

healthcare workers

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Structure of Modules

Each module includes:

• Benefits and barriers

• Readiness assessment

• Disclosure tips and key talking points

• Post-disclosure evaluation and follow up

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Disclosure Algorithm

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Readiness Assessment Checklist

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Kenya Example

Eliud Kipchoge of Kenya

Gold medal in the men's Marathon race

Rio 2016 Olympic Games Athletics

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Role Playing Scenario

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“When I had to disclose to my boyfriend

because I had to tell him from my

mouth, not him hearing me speak on

different media channels. I only did this

through a message (felt face to face

was hard) then called him later to

confirm what I had written down. It is

then that I discovered that disclosure

is hard, it’s been easy for me on TV

and other platforms to talk about my

status, but it was hard for me to face

my boyfriend and confirm what I

always say on media platforms.”

An open youth advocate disclosing

to a boyfriend

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Disclosure Tool available in English, French and Portugues at:

https://www.pedaids.org/resource/disclosure-of-hiv-status-toolkit-for-pediatric-

and-adolescent-populations/