Disclosure of HIV status to HIV-infected children in a large African treatment center: Lessons learned in Botswana

HIV-infected children in areas of the world with high HIV prevalence have increasing access to highly active antiretroviral therapy and are aging into adolescence in large numbers. These children need to develop an understanding of their illness that minimizes negative self-image and supports adherence to life-saving treatment. The disclosure of HIV status to an HIV-infected child is a process that is often anxiety-provoking for parents and caregivers. We describe a comprehensive clinic-based disclosure-support process, implemented in a large outpatient pediatric HIV care and treatment center in Botswana. The goals of this process are to allow the child to learn about the illness in an incremental and supported fashion, allowing for healthy psychosocial maturation. Successful development and implementation of this process at a single treatment center led to a revision of national guidelines and training programs to promote clinic-based disclosure support for children country-wide.