Authors:
Dr. Désiré Dahourou | Centre Muraz | Burkina Faso
Dr. Chloé Gautier-Lafaye | Inserm 1027
Dr. Hortense Aka-Dago-Akribi | Université Houphouët Boigny | Cote D'Ivoire
Dr. David Masson | Programme Grandir | France
Dr. Chantal Cacou | Université Houphouët Boigny | Cote D'Ivoire
PhD Corinne Moh | Université Houphouët Boigny | Cote D'Ivoire
PhD Belinda Bouah | Université Houphouët Boigny | Cote D'Ivoire
Maxime Oga | Programme PACCI | Cote D'Ivoire
Prof. Dr. Jean-Philippe Raynaud | Inserm 1027 | France
PhD Gesine Sturm | Université Toulouse 2 Jean Jaurès | France
Dr. Philippe Msellati | IRD 233 | Cote D'Ivoire
Dr. Valeriane Leroy | Inserm 1027 | France
Background: Adolescents living with HIV (ALH) surviving thanks to antiretroviral therapy must learn to live with this chronic infection. The disclosure of their HIV status is the key for coping with treatments during transition to adulthood. Still, disclosure poses challenges to health care teams and literature suggests relatively late disclosure in sub-Saharan Africa. We report the attitudes and practices of health workers involved in the disclosure process to ALH in a network including West and Central African countries, and confront these to the experiences of youth expert patients.
Methods: We organized a 3-day workshop in Abidjan, Côte d’Ivoire with 40 staff members (doctors, psychologists, counselors) from French speaking African countries. Involved in HIV disclosure in their practice, participants shared their guidelines and practices (moment of disclosure, proceeding, staff involved in the disclosure process). Four adolescents/young adults living with HIV shared their experience with the disclosure process.
Results: overall, 35 participants from eight African countries (Benin, Burkina Faso, Côte d'Ivoire, Cameroon, Mali, Democratic Republic of Congo, Senegal, Togo), representing 17 clinical centers with expertise on pediatric HIV care attended the workshop: 14 physicians, 8 psychologists, 6 counselors, 4 youth, and 3 social workers. Various practices and a relatively late age of disclosure were reported for all centers: 34% of the adolescents aged between 10 and 12 had a full disclosure (N=1296, range: 0%-93%) compared to 76% of the adolescents aged between 13 and 19 years (N=2132, range: 23%-100%). The median age of full disclosure was 13 years ranging from 11 to 15 years. Different practices of disclosure were reported, some of them involving adolescent peers or using group sessions. The four patient-experts attending to the meeting advocated for early disclosure, estimating that the disclosure process should start at the age of 10 years.
Discussion: HIV disclosure to adolescents is challenging for both health care worker and parents, and early disclosure remains infrequent due to multiple obstacles. Still, earlier disclosure processes is expected to smoothen the transition to adulthood and to promote empowerment of adolescents living with HIV. During the meeting, a first step to the elaboration of consensual guidelines for a good practice was realized in order to enhance earlier and better adapted disclosure processes.