Perceptions and Barriers to Disclosure of HIV Status of Children by Caregivers at Donkerhook Clinic, Windhoek, Khomas Region, Namibia

Background: Disclosure of HIV status in general and to children in particular has remained a challenge along the continuum of HIV prevention, treatment care and support. Failure to disclose often brings several challenges for both the caregiver and the children involved. Method: The study used a qualitative research approach whereby 35 parents and caregivers were interviewed using a semi-structured interview guide at Donkerhoek clinic in Windhoek. Moreover, in-depth interviews were held with the parents and caregivers who volunteered to participate in the study after giving consent to participate in the study. Results: The study found out that caregivers face multiple challenges related to disclosure of HIV status to children. One major barrier is finding an age-appropriate way to explain HIV, fearing children may misunderstand it as a punishment or fail to grasp the need for medication adherence. There is also fear of emotional and psychological reactions, with caregivers worrying that children may become depressed, angry, or isolated, potentially leading to denial or refusal to take medication. Another barrier they face is responding to difficult questions, particularly around how the child contracted HIV, they fear this can trigger guilt and anxiety, especially if the caregiver transmitted the virus. Stigma and discrimination are significant concerns; caregivers fear the child might disclose their status to others, resulting in rejection or bullying. Adherence to medication is another challenge, as some children may resist treatment after disclosure. Conclusions: Caring for children living with HIV poses significant challenges, primarily due to societal stigma, the need for continuous health management, and the emotional toll on both the child and caregiver. Although early disclosure and education about HIV status have shown positive impacts, many caregivers remain uncertain about how to approach disclosure and navigate the related emotional complexities. The findings indicate a need for improved support systems for caregivers and children, aimed at reducing stigma, providing education, and ensuring emotional well-being.