Barriers and impact of disclosure of HIV status to children at the National Hospital, Abuja Nigeria

Background: HIV infected children survive to adolescence because of anti retroviral therapy, however, only a small proportion know their diagnosis.Disclosure is critical to long-term disease management, yet little is known about if, how, and when disclosure takes place and the barriers associated with it, and its impact on children in resource limited settings. Objective: This study set out to determine the process of and barriers to HIV disclosure in children as well as the immediate impact of this on children and their caregivers. Methods: A cross-sectional study was done June-July 2016 using a structured questionnaire, convenience sampling and quantitative methods at the infectious disease clinics of National Hospital Abuja. A sample of 164 caregivers of HIV positive children aged 5 to 16 years receiving antiretroviral therapy for at least one year were enrolled. Results: Prevalence of full disclosure was 24.5%, partial 22.7% with overall prevalence of 47.2%. Main barrier to disclosure was child's age and fear of informing others. The impact of disclosure on caregivers was relief in 45.5% but emotional and difficult for others. Immediate reactions by children were sadness; tearfulness and worry in 28.6%, some showed no reaction while others even expressed relief. On a longer term, disclosure had several effects. Main predictors of disclosure on regression were the child's age and caregiver's opinion on disclosure. Conclusion: The prevalence of full disclosure is low and several barriers affect disclosure. Caregiver's and HCWs need empowerment and support with culturally appropriate skills and platforms to deal with the barriers, process and impact of disclosure

Common dermatological conditions in the HIV patient

The introduction of antiretroviral medication has changed the epidemiology, morbidity and mortality of HIV disease. Nevertheless,cutaneous disorders due to HIV infection remain a major problem in HIV-infected patients. These disorders are mainly infections,inflammatory and neoplastic in origin. Some of these disorders occur at normal CD4 cell counts, while others occur typically at low CD4 cell counts. Clinicians should be aware of various presentations of these disorders and their treatment as they can impact negatively on patient's quality of life

HIV and haematopoiesis

Human immunodeficiency virus (HIV) infection not only leads to a compromised immune system, but also disrupts normal haematopoiesis, resulting in the frequent manifestation of cytopenias (anaemia, thrombocytopenia and neutropenia). Although there is a definite association between the severity of cytopenia and HIV disease stage, this relationship is not always linear. For example, cytopenias such as thrombocytopenia may occur during early stages of infection. The aetiology of these haematological abnormalities is complex and multifactorial, including drug-induced impaired haematopoiesis, bone marrow suppression due to infiltration of infectious agents or malignant cells, HIV-induced impaired haematopoiesis, and several other factors. In this review, we describe the frequencies of anaemia, thrombocytopenia and neutropenia reported for HIV-infected, treatment-naïve cohorts studied in eastern and southern sub-Saharan African countries. We present a rational approach for the use of diagnostic tests during the workup of HIV-infected patients presenting with cytopenia, and discuss how HIV impacts on haematopoietic stem/progenitor cells (HSPCs) resulting in impaired haematopoiesis. Finally, we describe the direct and indirect effects of HIV on HSPCs which result in defective haematopoiesis leading to cytopenias

Involuntary sterilisation of HIV-positive women in South Africa: a current legal perspective

This article examines the reality of HIV-positive women being subjected to perpetual stigmatisation as a result of involuntary sterilisation practices. The reproductive autonomy and dignity of HIV-positive persons is protected by various constitutional provisions, and a legal framework providing for the requirement of informed consent, as well as the prohibition of discrimination on the grounds of HIV status. This article considers the issues of both informed consent and discrimination in the context of the practice of involuntary sterilisation of HIVpositive women. The article considers the legal framework in light of the physical, emotional, social and cultural implications for HIV-positive women who are subjected to involuntary sterilisation