Parental Disclosure of Own HIV Status to Children in Two Ghanaian Regions; Examining the Determinants within a Child Vulnerability Context

Abstract

Purpose: Parent informing children and adolescents about their own HIV infection status is crucial for harmonious and interfamilial relationship despite the associated dilemma. This study assessed the factors associated with parental disclosure of own HIV status to their biological children. Methods: The facility based cross-sectional design approach informed the recruitment of 192 HIV positive parents. This was done through a two-stage stratified (rural/urban) and random sampling technique across 7 ART clinics and hospitals in the Ashanti and Brong Ahafo regions in Ghana between June 2018 and June 2019. Data was collected through interviewer-administered structured questionnaires. Parental disclosure to children was defined as parent own verbal statement of having mentioned HIV or AIDS as the name of his/her illness to at least one of his or her biological children. The study compared weighted proportions for variables measured categorically by the use of chi-square (X2) significant at P<0.05 and binary logistic regression to find out the predictors of parental HIV status disclosure to children. Results: Of the 192 HIV positive parents aged 20 to 64 years (M, SD=38.56, 8.34), 89.1% were females, averagely having 3 children with 89.5% having only one child being HIV positive, out of which one in every four parent was without formal education. Parental disclosure to biological children was 11% while parental own status disclosure to any child under the parent's care was 14.6%. Parental disclosure was associated with being married or living with a sexual partner (OR=3.4; 95% CI: 1.08-10.66, P<0.036), disclosing to HIV positive child (OR=169.9, 95% CI: 34.16-845.32, P<0.000), parental perception of disclosure improving child wellbeing (OR=10.6, 95% CI: 1.48-76.08, P<0.019) and parental knowledge of someone else having disclosed status to children (OR=5.9, 95% CI: 2.13-16.42, P<0.001). None of the variables showed a significant independent association with parental disclosure when adjusted in the multivariate logistic regression. The dominant barrier to disclosure concerned parental view that children may not understand the disclosure and the parents' discomfort on finding answers to child potentially questioning parent on how the parent got infected with HIV. Conclusions: Only a tenth of all HIV positive parents had told their children about their own (parents) HIV status. Parental disclosure should be encouraged and interventions designed to improve it particularly as they contribute to shaping the vulnerability context of HIV and AIDS positive children.