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Disclosure of HIV status to HIV-positive children 12 and under: A systematic cross-national review of implications for health and well-being

WHO estimates that 3.4 million children were living with HIV at the end of 2011, 91% of them in sub-Saharan Africa. Until recently, a largely descriptive literature documented wide variability in the practice of disclosure to children and youth, describing both positive and negative effects of disclosure on children, inconsistency in the mean age of first disclosure, and indicating a variety of health- and non-health-related rationales for disclosure or non-disclosure. While several reviews have described disclosure practices, to our knowledge, none has systematically examined the outcomes of disclosure, pre- to post-disclosure, or comparing outcomes for children disclosed to with those for children unaware of their HIV status. Such a review may identify variability or consistency in outcomes across cultures and identify gaps in the literature to date. A systematic review of cross-national, peer-reviewed literature was undertaken to clarify effects on children's health and well-being of disclosure of their HIV status to them. Summarizing 14 studies representing over 3300 HIV-positive children from 10 countries or commonwealths, there is evidence of health benefit and little, if any, evidence of psychological or emotional harm for disclosure of HIV status to HIV-positive children. In at least one longitudinal study, the age at which disclosure occurred dropped as treatments advanced, to age 6–7, with age 7 as the universal age for informed assent and the cognitive and emotional school age recommended for disclosure of many serious illnesses. Despite significant gaps in the review that limited the extent to which comparisons across studies could be made, our findings show that there is evidence of health benefit and little, if any, evidence of harm for disclosure of HIV status to HIV-positive children.