Telling a child about HIV
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"The right time"

Sharing information is a process, not a one-off occasion. Parents vary greatly in their views regarding the age that their child is mature enough to cope with being told.

If a parent becomes progressively ill, they will often deem this the 'right time' and decide to tell their children about their diagnosis, again depending on the child's age. Parents recognise the emotional impact on their children if they are ill. The decision may also be linked to preparing their child for the possibility that they might die. Certainly this is far from optimal, and most multidisciplinary teams encourage discussions that start with simple concepts in primary school age children, and end with full information during secondary school years.

Openness in family communication

Parents usually want to be open and honest with their children and do not like having to hide literature on HIV, or stop telephone conversations when their child comes in to the room.

In order to promote open family communication to resolve problems, some parents may decide to tell their children to actively encourage the expression of their feelings and develop their views and plans for the future.

Another reason parents may wish to be 'open' about their status is to explain changes in the household. The parent may feel it is unfair for their children to be the recipient of all these changes without knowing why it is happening. The children may also react to these changes by questions to the parent, or by exhibiting significant behavioural changes.

Inadvertent disclosure of a person's status

Occasionally, if a parent is recently diagnosed and believes they are going to die, they may share information about their illness.

Parents who have been through the process of disclosing their status to other significant people may find it easier to disclose it to their child. Parents may be pressured by these people into telling the child; they may be worried that the child will be told inadvertently by someone else, or that he or she will ask other people. The parents’ decision may also be influenced by the presence of other adults who are available to provide support to the children.

Parents may not have ultimate control in the decision to disclose their illness to their children due to pressure from professionals. This pressure may be due to professional's view that withholding information is not healthy or because they may have serious concerns about the child's emotional welfare.

Unfortunately in some situations professionals have highlighted their concerns because of changes in the child's behaviour, signifying that the child is aware of something happening in the family. In this case it may only be necessary for the parent to tell the child they have an illness (not specifically HIV) for the child's behaviour to improve.

Research into families affected by life-threatening illnesses often found that children had suspected something and that their fantasies about what was happening were worse than the reality of the situation.

Another area that some child care professionals stress is the rights of the child. This school of thought believes that the child should be told about HIV status, whether it is their own or their parents, as a matter of right.

A balanced approach is desirable: it is crucial that parents are encouraged to think about these issues so that they are prepared to give truthful answers to direct questions from their children.