Pediatric HIV, How early is too early to disclose?

Statistics from the WHO show that across the world there are approximately 1.3 million children under the age of 15 living with HIV. These children will need anti-retro viral therapy and medical care for their entire lives to stay healthy. However, many of these kids don’t even know they have HIV.

Early disclosure of HIV to children has various benefits including increased medication adherence, psychosocial development, decrease anxiety and depression and generally reduce mortality rate. Its better to disclose to children their HIV positive status before they become teens to avoid the complexities of adolescence. From the communities i work with those that disclosed to their children earlier do not experience as many challenges with their children as compared to those that disclose during adolescence. Its advisable to disclose to the child as early as possible because as you buy time,the child might just get the information from another source which will complicate issues.

Take for example Sam from the Mathare slums in Nairobi. He is 13 years old and in class seven. Since class four, he has been learning in school about the dreaded killer disease AIDS. The teacher has been emphasizing that they should be careful and not have sex because they would be in danger of contracting HIV that leads to having AIDS then death. Sam was born with HIV but did not know about it till last month. He has been taking his medication religiously till he got to know why he had been on medication all this while. The most unfortunate thing was that Sam got the news from friends and confronted the mother about it. The mother took him to the comprehensive care center and with the help of a pediatric nurse, they confirmed that it was indeed true that he had the virus.  

Sam's mother felt that Sam was still young and therefore was buying time but had plans to disclose to Sam once he finished primary school. She did not want to interfere with his studies. But that was never to be and now Sam is blaming her for sleeping around and then transmitting the virus to him. Since Sam knew about it last month, he has refused to take his ARVs and accuses his parents of infecting him. His mother has been crying through out this one month that Sam has changed into a hard nut. She has invited counselors, other children living with HIV and older ones too but Sam is still quiet. He does not talk to anyone nor does he want to take the meds. He listens to those who talk to him and you can clearly tell that he is not listening or he just don't care. 

Know of anyone who is buying time to disclose to their children of their status? Run and advise them to do it before adolescence hits. Its complicated!