ASSESSMENT OF PRACTICES AND CHALLENGES RELATED TO HIV STATUS DISCLOSURE TO MINORS ATTENDING CLINIC AT LONGISA COUNTY REFERRAL HOSPITAL, BOMET COUNTY
IJIRIS:: International Journal of Innovative Research in Information Security, Volume VI (Issue IV):
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Abstract
This study assessed the practices and challenges of the health care professionals (HCPs) and care givers in relation to HIV status disclosure to minors attending clinic at Longisa County Referral Hospital (LCRH) in Bomet County, Kenya. It was conducted between April 2017 and October 2017. A cross-sectional descriptive research design was employed with census sampling method used for the HCPs and purposive sampling for care givers. A total of 18 HCPs and 140 care givers participated in the study. The study revealed that most of the minors (62.35%) at LCRH had been informed of their HIV status. Some of the factors identified to facilitate disclosure included minor inquisitiveness, child being sickly, child nearing puberty, suspicion that the child was sexually active. While those hindering included: fear of child’s reaction, stigma, and lack of knowledge by care givers, culture, and child being young among others. The HCPs reported facing challenges of: lack of cooperation from care givers, stigma associated with HIV, cultural beliefs that hinder disclosure, lack of clear guidelines on disclosure and lack of formal training on disclosure. While care givers reported: fears of how the child will react, not knowing how to disclose, not knowing the exact words to use, minimal support from HCPs and discouragement from family members and friends. The study recommended sensitization of the community and enhanced educational programs to address stigma, and enhanced support group activities to facilitate disclosure, as well as the institution to organize for formal training for staff on disclosure counseling.
Description
This chapter covered the background of the study, the statement of the problem, research objectives, study assumptions, significance of the study, justification of the study, theoretical framework, and the scope of the study and definition of terms.
Background of the Study
In 2014, 36.9 Million adults and 2.6 Million children (< 15years) were living with HIV/AIDS in the world. Approximately 220,000 new infections occurred in 2014 for children less than 15 years. Out of the total infected persons living with HIV, 25.8 Million adults and 2.3 Million children are living in Sub-Saharan Africa. There were 1.4 Million new infections in adult and 190,000 new infections in children in 2014 in Sub-Saharan Africa, (UNAIDS fact sheet 2014). Over 1.6 Million Kenyans were living with HIV in 2013 and 93.7 % of all the new cases were due to sexual intercourse with infected persons (NACC/NASCOP, 2013). UNAIDS (2013) projection report indicated that 13,000 new infections among children occur every year. About 90% of children living with HIV got infection from their mothers during pregnancy, labour and breastfeeding. The overall HIV prevalence was 5.6% and incidence was 0.5% in Kenya in 2012. While prevalence among children aged 18 months to 14 years was 0.9% (KAIS, 2012). With improved access to antiretroviral therapy (ART) life of the children infected at birth is prolonged and these pose a challenge to care givers and health care professionals (HCPs) on: how to disclose the HIV status to the child, at what age should disclosure start, what information to be given to the child and who should disclose to the child.
Disclosure of HIV status is generally thought to be an affirmative and empowering action that assists people in receiving support and understanding, and one that minimizes psychological distress (Rispel, Cloete & Metcalf, 2015). According to KAIS (2012), 53.1% of persons found to be HIV-infected did not know that they were infected and only 23.5% of respondents aged between 15 and 19 years were aware they were infected. While previous studies carried out in some parts of Kenya gave overall prevalence of disclosure to infected children / adolescents at 26% (Vreeman et. al., 2014) and 19% (John-Stewart et. al., 2012) respectively. The government of Kenya has been implementing the prevention with positives (PwP) strategies in which the target is on those who are infected with HIV (NASCOP, 2011). This requires that the infected person should know and accept their status then decide to protect others from getting the infection. For this strategy to be successful, disclosure is vital.
Disclosing of HIV status is important for HIV prevention and maintenance of health for people living with HIV, their partner(s) and the community. It plays a role in the social relation which is critical in reducing HIV transmission (Mburuet.al., 2014). This will be very useful when it is done to the HIV infected children before their sexual debut which is 10.7 years in Kenya. Adolescents engage in high risk sexual behavior with 77.2 % of those aged 12-14 years engaging in unprotected sex in their first sexual encounter (KAIS, 2012). The involvement in unprotected sex increases risk of unknowingly spreading the virus in case the HIV status is not disclosed to the infected teenagers.
Care givers are advised by the Health Care Professionals (HCPs) to use their personal judgment in determining when and how to disclose to the HIV infected children considering the incremental development of the child. Studies have shown that HIV-positive people and their families’ need professional counseling to assist them work through the emotional challenges encountered and identify mechanisms of support and coping in relation to disclosure (Kyaddondo, Wanyenze, Kinsman & Hardon, 2013). This professional counseling ought to be provided by HCPs who sometimes are faced with challenges such as lack of definitive, evidence-based policies and guidelines on when, how, and under what conditions children should be informed about their own HIV-positive status (WHO, 2011). Also, Gachanja, Burkholder, & Ferraro, (2014) in their study on ‘HIV-Positive Parents’ Accounts on Disclosure Preparation Activities in Kenya’ noted that HCPs require HIV disclosure training so that they can be well equipped to facilitate the disclosure process from care givers to child.