Abstract:
Knowledge of one’s own HIV status is essential for long-term disease management, but there are few data on how
disclosure of HIV status to infected children and adolescents in sub-Saharan Africa is associated with clinical and
psychosocial health outcomes. We conducted a detailed baseline assessment of the disclosure status, medication
adherence, HIV stigma, depression, emotional and behavioral difficulties, and quality of life among a cohort of Kenyan
children enrolled in an intervention study to promote disclosure of HIV status. Among 285 caregiver–child dyads
enrolled in the study, children’s mean age was 12.3 years. Caregivers were more likely to report that the child knew his/
her diagnosis (41%) compared to self-reported disclosure by children (31%). Caregivers of disclosed children reported
significantly more positive views about disclosure compared to caregivers of non-disclosed children, who expressed
fears of disclosure related to the child being too young to understand (75%), potential psychological trauma for the child
(64%), and stigma and discrimination if the child told others (56%). Overall, the vast majority of children scored within
normal ranges on screenings for behavioral and emotional difficulties, depression, and quality of life, and did not differ
by whether or not the child knew his/her HIV status. A number of factors were associated with a child’s knowledge of
his/her HIV diagnosis in multivariate regression, including older age (OR 1.8, 95% CI 1.5–2.1), better WHO disease
stage (OR 2.5, 95% CI 1.4–4.4), and fewer reported caregiver-level adherence barriers (OR 1.9, 95% CI 1.1–3.4). While
a minority of children in this cohort knew their HIV status and caregivers reported significant barriers to disclosure
including fears about negative emotional impacts, we found that disclosure was not associated with worse psycho-social outcomes.