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					                                                                                STEP BY STEP GUIDE
                                                                   FOR CONVERSATIONS WITH CHILDREN
                                                                        (TOWARDS DISCLOSURE)
     Can be a difficult process for all concerned                                                          The first step is to find out what the child already
     Effective conversations are dependent on the                                                           knows (often more than adults think)
      age and understanding (developmental level)                                                           Failure of full disclosure by early teenage
      of the child                                                                                           years can lead to:
                                                                                                                   Poor adherence
     Aim to build up a body of knowledge in the                                                                   Emotional difficulties
      child that leads to the point of disclosure of                                                               Poor school performance
      HIV diagnosis                                                                                                HIV transmission if sexually active

              VERY YOUNG                                                  YOUNG CHILD                               SCHOOL CHILD                          SCHOOL CHILD
                 0 - 4 Years                                       (Pre-school) 5 – 7 Years                          8 – 11 Years                           11 – 14 Years

          NO DISCLOSURE YET                                               EARLY DISCLOSURE                       PARTIAL DISCLOSURE                         FULL DISCLOSURE
  DEVELOPMENTAL LEVEL                                              DEVELOPMENTAL LEVEL                    DEVELOPMENTAL LEVEL                     DEVELOPMENTAL LEVEL
 Depends on adult for all needs                                    Can understand concrete             Able to hold onto ideas and              More abstract thinking
  and information                                                    based ideas e.g. real events in      apply them to new situations              (understands future
 Child needs comfort, support                                       the present and past                Can understand past, present              consequences of actions)
  and most of all security                                          Thinking is based in the             and future                               Increasingly making decisions
                                                                     present                             Has social and moral awareness            on their own regarding identity,
                                                                    Take the lead from confidence        about right & wrong behaviour             independence, school, career
  WHAT DO YOU EXPLAIN:                                               of caregiver interactions with      Beginning to be more curious and         Puberty/sexual development
 Carry on consultation with child                                   health workers
                                                                                                          take some control over their lives       Dependence on caregivers
  present                                                           Beginning to link medicines
 Child too young for direct                                         and health
  information about HIV but                                                                                                                        Importance of relationships
                                                                                                          WHAT DO YOU EXPLAIN:                      with friends increases
  explanations to caregiver about
                                                                   WHAT DO YOU EXPLAIN:                  Explain that the germ concerned
  how HIV can affect the child
                                                                   Child needs to learn about illness     is a virus
  remain important
                                                                   but not HIV by name yet               Viruses are ‘clever germs’ which can    WHAT DO YOU EXPLAIN:
 Provide ideas to help caregiver
                                                                                                          damage white blood cells                 Check understanding of health,
  support child taking medicine
                                                                    Introduce ideas of good and         If medicines are not taken                medicines, sexual development
 Congratulate child on taking
                                                                     bad health by eating healthy         correctly, the virus can get stronger     and HIV infection
  medicines well
                                                                                                          and stop the medicines working           Directly address young person
 Address caregiver anxieties                                        food, keeping clean, exercising,
                                                                                                          (resistance)                              during clinic consultations
 Build relationship with the                                        looking after teeth etc.
                                                                                                         Naming of virus as HIV may               Need         to       understand
  child through play/singing                                        Medicines help to keep a body
                                                                                                          occur but not essential                   responsibility      for      not
 Provide a safe and                                                 healthy and strong
                                                                                                         Need to explain that information is       transmitting HIV i.e. safer sex,
  welcoming clinic                                                  Introduce infections as ‘germs’      private and should only be                and their rights i.e. family
                                                                     that can hurt or damage the          shared with those agreed with the         planning, confidentiality
  AIM                                                                body/make you sick or hurt           caregiver(s)                             Preparation       for     future,
  BUILD UP CONFIDENCE of CHILD in                                   Introduce (white) blood cells as    Help the child identify who they          encourage direct involvement in
  HEALTH WORKERS and MEDICINE TAKING                                 the part of the body that look       can to talk with about their              discussions and decisions
                                                                     for and kill infections or germs     health or HIV with                       Promote the benefits of
                                                                    Some germs hide and you need        Disclosure to symptomatic school          attendance at adolescent
                                                                     to take medicines to help fight      age children is strongly                  support group
                                                                     the germs                            encouraged
Compiled by Kimesh Naidoo (Department of Paediatrics -
University of KwaZulu Natal), Diane Melvin (Department of                                                                                         AIM
Psychology - Great Ormand Street Hospital for Sick Children) and
Juliet Houghton (Programme Director CHIVA South Africa)            AIM                                    AIM                                     FULL UNDERSTANDING and RIGHTS and
Contact Telephone: 031 260 4111/031 309 2217
                                                                   UNDERSTANDING that MEDICINES           NAMING of INFECTION as HIV VIRUS        RESPONSIBILITIES
                                                                   SUPPORT the BODY to KEEP WELL                                                  ABILITY to NEGOTIATE own HEALTH CARE

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