HARARE SCHOOL OF RADIOGRAPHY

COMMUNICATION SKILLS ASSIGNMENT

Diploma in Radiography (Diagnostic)

WELLINGTON BWANALI Group 2012

As an HIV positive parent who has an HIV positive teenager (MTC Transmission), it is less traumatic to tell the teenager about his/her HIV status than to leave him/her to discover for him/her-self. Discuss.

Abbreviations: AIDS: ARV: HIV: Acquired Immunodeficiency Syndrome Anti-Retroviral Human Immunodeficiency Virus

Backed by the evolving epidemiology of AIDS and the unprecedented research into new treatment approaches, government-funded paediatric HIV Anti-retroviral therapy was introduced in Zimbabwe about a decade ago - amidst deliberations on policy concerning the various perinatal-infection scenarios that required such intervention and on-going support. As the program gained momentum, many infants who would have failed to make it to the age of five were given hope for a healthier life, with prospects to live longer. This was made possible through statutory bodies and non-governmental organizations like National Aids Council, Global Fund, Population Services International, Zimbabwe Aids Network, DFID (UK), UNAIDS, The Elizabeth Glazer Paediatric Aids Foundation, and many others. Their various initiatives enabled accessible testing, treatment, counselling and mass education about the pandemic. There has been a significant decline in the number of new cases of perinatally infected children due to the aforesaid developments. Though there has been a notable improvement in HIV/AIDS morbidity and a corresponding decline in mortality rate, the parents of the growing children (who have been infected with HIV) are faced with many a dilemma, especially on how to deal with inherent issues and challenges like: Should the child be told the truth about their condition? When and how should he/she be informed about this? Will the child be able to come to terms with the potentially devastating disclosure? Against this background, Mutenga (2011) reported that there is an emerging generation of HIV positive adolescents and teens in Zimbabwe, who are entering adulthood with the infection; thus, raising a topical national debate on how the questions above, and many others, should be addressed. The complex issue of HIV disclosure to children has drawn the attention of many: For instance, the government of Uganda has recently amended their policy on paediatric HIV and recommended that perinatally infected children should be informed of their status by the age of 10 (Anon. 2010). Consequently, worldwide research on paediatric HIV/AIDS has further revealed various important facts and viewpoints on this controversial and sensitive issue: There are many factors and considerations that lead many parents to keep their infected childs status secret. Eneh, Ugwu & Tabansi (2011) and Sidibe (2008) have revealed that the main reason for non-disclosure (or delayed disclosure) is the fear that the infected child may no keep the family secret and society will judge them morally. They harbour concerns that their children may suffer discrimination, isolation and prejudice when they interact with their peers and the society at large. Needless to highlight that many parents and mature adults have not been able to fully deal with the psychosocial challenges that come with HIV diagnosis and illness; hence, parents feel that they may need to protect the infected child from this psychological, emotional and social dilemma. Given that there is no cure for the infection at present, it is also perceived that disclosure may destroy the childs hope and will to live; especially in societies where HIV/AIDS is generally regarded as a hopeless terminal condition. Many parents blame themselves for the unfortunate perinatal infection and, with this sense of guilt and shame, they try to avoid possible painstaking emotionally-charged questions and reaction from the child.

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The disadvantages of disclosing the HIV status to a perinatally infected child is that it is unlike the usual self-disclosure; where one has a right either to keep their diagnosis secret or to disclose to family and friends. In the case of a minor or a perinatally infected child, it is some form of an involuntary disclosure of the childs HIV status. This can weigh too heavily on a child, given that many adults face a lot of considerable difficulty in understanding and accepting a diagnosis of HIV. If it is not handled carefully, such knowledge may predispose or lead the child towards highrisk behaviours like premature/unprotected sex, alcohol and drug abuse. Further to this, Kelly (2004:514) wrote that the Im-going-to-die-anyway attitude is prevalent in many South African teenagers and youths who are infected with HIV. In view of this, there is likelihood of drastic character and behavioural change as the child battles with stress, anger, sorrow, anxiety and depression, amongst other things. However, according to Sidibe (2008) and further research by Donahue (2011), there are great benefits to be realized by methodically divulging the HIV diagnosis to perinatally infected children and many fears can be allayed by their findings. A number of affected children were informed of their condition and significant progress was realized on their lives. With expert support from care-givers, councillors and support groups, the children managed to cope well with their situation and they generally began to cultivate self-control, a positive attitude and good hygiene. It is important to highlight that both the parent and the child will need to deal with the trauma; with the parent expected to play both the victim and care-giver role. Therefore the readiness of the parent to open dialogue and commence disclosure can be assisted by counselling professionals. Marie Donahue has done a lot of extensive field research on paediatric HIV/AIDS in many sub-Saharan African countries including Zimbabwe. In her report, she emphasized that many children felt relieved to be informed of their status and they wished they had been told earlier. With the help of various support groups and community initiatives, many infected young people are getting assistance and are being encouraged to adhere to treatment regimes, educational and career guidance and support, and empowerment of the care-giving parents so that they are able to provide the much needed continuous support. The American Association of Paediatrics have revealed that a child disclosed to at an early age adapts better to the new lifestyle and they are better able to stick to ARV treatment regimes; as compared to leaving the child until they start questioning a certain symptomatic condition or the reason for continued intake of Anti-retroviral (ARV) drugs (ICAP, 2008). Delaying disclosure or leaving the child to discover their HIV status on their own can pose dire consequences. There is a risk of accidental disclosure through various unforeseen ways. The child may overhear a conversation by the parent and care-givers concerning his/her condition. The child may also accidentally come across medical records. Worse still, the affected child may begin to be inquisitive about the ARV treatment and other symptomatic illnesses that may begin to arise. Eventual discovery of the truth in such ways is more psychologically devastating and traumatic. HIV/AIDS voluntary counselling and testing has been made available and accessible at grassroots level in Zimbabwe and the infected child may still get to learn of their status, yet in an unsupportive environment. Thus, the child will develop considerable emotional damage. The trauma can lead the child to make wrong conclusions, and there is an obvious sense of betrayal.

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Such a situation will make it difficult for the child to trust the parents or any other adult who are supposed to be there in his/her life as pillars of support, reliability and strength. Nowadays, teens are getting sexually active as early as 14 years old. Mutenga (2011) disclosed reliable statistics depicting that the average age of commencement of sexual activity in Zimbabwe is now 14 and 15 years for boys and girls respectively. Given this information, we realize that it becomes less distressing when you empower the child with information that will help him/her to make sound and moral decisions involving his/her health and future sexual activity. The counselling and support will boost the childs self-esteem, morale and confidence and nature self-control and a sense of responsibility. The child is therefore allowed to participate in decisions concerning his/her care. Eneh et al reiterated that disclosure will actually remove an emotional burden from both the parent and the child, because it allows a healing process to commence: Anxieties are dispelled and there is a platform for clarification of any wrong conclusions or misconceptions that the child might have. These findings corroborate with the fundamental principles of paediatric HIV/AIDS disclosure. The objective is to protect the interests of the child and emphasis should be placed on what is best for the child. According to the Kbler-Ross Model of the grieving process (Granich & Mermin, 2002:117), different individuals cope and react differently to diagnosis of terminal illness and they go through various stages of the grieving process; characterized by different behaviours, responses and attitudes. Thus, the child may go through stages of denial, anger, bargaining, depression and eventual acceptance: Therefore, the fact that disclosure and acceptance is not an event but a process should be underscored. The process is determined by many factors based on unique individual circumstances, the childs cognitive strength, mental stability, development stage and age. Hence, the childs ability to understand and deal with his/her condition should be assessed, engaging the relevant professional counselling and family support. The child has the right to maintain their individuality, and they should not be judged for any decisions and reactions ensuing from the disclosure. Decisions on whether to disclose or not should also be based on facts, not fears; and it should cultivate, and be founded upon, a culture of honesty. Developmentally appropriate explanations, instead of lies and misrepresentations, are of paramount importance. With proper home based care and professional counselling and support on handling societal stigma, discrimination and on-going psychosocial and health challenges, we can conclude and recommend that parents should disclose the HIV status to their perinatally infected children since the benefits of such a noble move greatly outweigh the disadvantages.
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REFERENCES: Anon. 2010

UGANDA: When do we tell children they are HIV positive? Plus News Kampala, 03/06/2010. Available at www.irinnews.org. Accessed 28/02/12

Eneh A, Ugwu R, Tabansi P. 2011 HIV disclosure in children in Port Harcourt: Mothers perceptions. Department of Paediatrics and Child Health. University of Port Harcourt. Port Harcourt. Nigeria. Available at www.interesjournals.org/JMMS. Accessed 29/02/12 Granich R, Mermin J. 2002 HIV; Health and Your Community: A Guide for Action. California. Hesperian Foundation. (International Centre for Aids Care and Treatment). Pediatric Disclosure: Talking to Children about HIV. International Centre for AIDS Care and Treatment Programs. Columbia University. Mailman School of Public Health. Sexuality Today: The Human Perspective. Boston. McGrawHill. Integrated Patient Care for Imaging Professionals, London. Mosby National Report: Zims HIV Positive Young Generation Poser. Financial Gazette, 10/06/2011. Available at eu.financialgazette.co.zw. Accessed 27/02/2011 Evaluation of the benefits of disclosing HIV status to children: Kndougou Solidarit's experience. A Newsletter on Pediatric HIV in Africa. Available on http://www.grandir.sidaction.org/mails/grandir-2-43.html. Accessed 28/02/12 Disclosure of an HIV diagnosis to children: History, Current Research, and Future Directions. NIHPA Author Manuscripts. Available at www.ncbi.nlm.nih.gov/pmc/articles. Accessed 28/02/2012

ICAP 2008:

Kelly G F, 2004

Kowalyczk N, 2002

Mutenga T. 2011

Sidibe Y. 2008

Weiner L et al, 2008

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