Despite some advancements in achieving key milestones towards ending AIDS in children and adolescents, progress remains slow and major challenges continue to hinder the attainment of global targets. Disclosure is a continuing challenge for these groups, with limited evidence for effective interventions.
Disclosure refers to the process by which children and adolescents are made aware of their own HIV status, enabling them to share this with others safely and when ready, and empowering them to be engaged in and lead decision-making about their own health. Disclosure, when done the right way, can lead to significant benefits, increased social support, reduced stress and improved mental health. Although they are a driver of improved clinical outcomes, disclosure decisions can be particularly complex, with important considerations to be weighed up concerning potential risks and benefits. To address these gaps, an up-to-date understanding of the evidence on disclosure interventions for this age group is necessary.
WHO has released new guidance to help children and adolescents living with HIV navigate disclosure. Since the guidance released by WHO in 2011, no practical tools have been made available for ministries of health, health-care providers and their teams.
"With this new document, WHO is responding to country requests to support the implementation of evidence-informed activities guiding safe and quality disclosure. This new guidance provides an overview of disclosure interventions that are developmentally appropriate, address layered stigma, promote caregiver-client communication, and facilitate supportive health and community systems both pre- and post-disclosure for policy-makers, health workers, caregivers, children, adolescents and the community at large" says Wole Ameyan, WHO Global HIV, Hepatitis and STIs Programmes.
The updated guidance outlines safe approaches and proven interventions, presented in 2 parts.
The first part presents findings from a scoping review of 25 interventions supporting HIV status disclosure to, and by, children and adolescents aged 6-19. These include disclosure-specific and disclosure-inclusive interventions.
"All children and adolescents have the right to and need for information that helps them make sense of their world," said Nicola Willis, Executive Director, Zvandiri, a community-based organization in Zimbabwe. "Yet many living with HIV have lacked this vital support. This new guidance reminds us that discussing their HIV status with them is an essential component of their treatment and care. Evidence-based approaches exist and it's time to prioritize their implementation to improve mental health and viral suppression."
The second part outlines emerging considerations, gaps and key actions on adolescent development and autonomous decision-making; stigma and rights-based approaches; measurement, monitoring and evaluation; building support systems across families and communities; and the need for innovation in an evolving epidemic. It offers health workers, policy-makers, and other practitioners and researchers working with vulnerable populations, an overview of evidence integrated with rights-based approaches centred on child and adolescent well-being in the process of disclosure.
"This new guidance offers clear, actionable examples and a strong summary of updated, context-specific interventions," said Luann Hatane, Executive Director, Paediatric-Adolescent Treatment Africa (PATA). "We look forward to sharing it across our network and incorporating the case studies into our capacity-building efforts."
Disclosure is both a personal decision and a means to safeguard health outcomes, especially for younger populations. The social, relational, and systemic considerations emerging from the evidence are central to promoting safe disclosure.
