AIDSImpact.com:: - Santa Fe, USA 2011

Abstract #259 - A family-based disclosure intervention for HIV-infected mothers with HIV-uninfected school-aged children in rural KwaZulu-Natal, South Africa
Authors: Presenting Author: Dr Tamsen Rochat - University of KwaZulu Natal
Additional Authors: Ms. Ntombizodumo Mkwanazi, Dr. Ruth Bland,
Aim: Issue: Disclosure of HIV status by parent to child is a complex and challenging psychological and social process. Existing research from the United States and Europe shows that decisions to disclose are commonly linked to age and gender of the child and the stage of disease or illness of the mother. Few mothers disclose before age 7, most by age 10. Disclosure results in improvements in the quality of relationship between mother and child, lower anxiety and depression among mothers, higher perceived social support and family cohesion, and better emotional and behavioral functioning and school performance among children. Despite these benefits, disclosure rates remain low, between 30-45% in most studies. Further, in sub-Saharan Africa where HIV prevalence is high it is likely that children will learn about HIV at increasingly younger ages and delaying disclosure in such scenarios could worsen children’s psychological and social outcomes. While disclosure support may be an important family strengthening activity in heavily affected communities, there is a distinct lack of evidence and best practice models to guide disclosure support in poorly-resourced settings.
Method / Issue: Project Description: This purpose of this project is to develop, implement and evaluate a family-based intervention to support age-appropriate HIV disclosure. The intervention aims to benefit the child through improved parenting relationships, less depression, improved custody planning, increase knowledge about HIV, and an increased health care social support network. The project targets HIV-positive mothers with HIV-negative children aged 6 to 10 years and will enroll 300 families. A 6-session structured counseling intervention was designed to be delivered in homes by lay professionals including: creative artwork, family trees and storytelling, a HIV educational board game, health promotion playing cards, a gender sensitive family-centered storybook, and dolls used for play and communication. The intervention is designed to provide the mother with the opportunity to receive information, and to plan and practice a series of intervention activities to be able to facilitate safe developmentally appropriate disclosure with her children. Fathers and other family members are encouraged to participate in activities. Once disclosure is achieved, the intervention encourages families to engage in health promoting activities and behaviors including a clinic visit and custody planning. The project includes pre and post assessment measures including a health survey (SF36) the parent disclosure interview (PDI) maternal depression (GHQ12) social support (SSQ) parenting stress (PSI-36) and children’s emotional and behavioral functioning (CBCL) and qualitative process indicators will be collected during study implementation for evaluation purposes.
Results / Comments: Lessons learnt: A pilot with 24 families showed high levels of acceptability and effectiveness. This presentation includes illustrations and demonstrations of activities and materials used in the intervention and presents training, operational and costing lessons and experiences of families included in the intervention. Material design, illustrations and branding have proved critical to reinforcing parental self efficiency. Investing in high quality, age-appropriate and attractively designed materials communicates value and respect, reinforces positive attributes and inspires confidence in HIV disclosure.
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