Grandir

Telling a child he or she is HIV+: helping parents to overcome their qualms about disclosure

If I tell my child that he/she is HIV+ won't he/she become depressed? Or inadvertently tell others? Will he/she judge me and blame me for the disease? Parents often have many qualms about telling their children they are HIV+ and these qualms are completely natural. What follows are some answers to the most frequently asked questions:

Why tell the child that he/she is living with HIV? To help prevent him from coming up with wrong ideas about his illness, to show trust and to encourage him to share his feelings.
When? In the child's early years, especially if he/she asks questions about his/her disease, parents should begin a dialogue which will be ongoing throughout the years to follow. It is important to clearly state the HIV/AIDS diagnosis at some point but it is better to wait until the child fully understands what this means.
Who? It is crucial that the parents and/or caregivers actively participate in the process of disclosure. Health professionals should also help and counsel parents encouraging them to overcome their hesitation, be present when the words HIV and AIDS are pronounced to help reassure the child that medical support is there. But they cannot take the place of parents.
How to talk about it? Or rather how to help the child to talk about it because it's about first listening to what's going on in the child's mind in relation to the sickness. It is critical to use language that is appropriate to each child's cognitive level. Tools are now available for children of all ages such as comic books or DVDs showing teenagers living with HIV recounting their own experiences. You can also ask younger children to draw pictures of their medicines or visits to the clinic to help start this essential dialogue on HIV.

To find out more
To order the DVD "Now you know, now what?" on US teenagers describing their lives with HIV (in English, French, Spanish and Portuguese): http://bayloraids.org/resources/

ICAP/MTCT+'s lecture on paediatric disclosure www.sidaction.org//pro/
international/grandir/
psychosocial

The "JAWS" comic
strip collection www.aidsteaching.com/

Fifty years of family planning
What kind of contraception methods are there for women living with HIV?

The French Family Planning Movement (MFPF) just celebrated its 50th birthday. For the occasion Growing Up Info asked two experts Dr. Valériane Leroy (ISPED) and Dr. Carine Favier (MFPF), to talk about methods of contraception that are available for women living with HIV. Here are some of the things they said.

VL "During each medical consultation the woman's contraceptive situation should be evaluated, even briefly, in complete confidentiality and without coercion. Male or female condoms should be systematically suggested for their double protection against both unwanted pregnancies and STIs, including HIV. Emergency contraception should be reserved for accidental situations (such as torn or forgotten condoms) but should nonetheless be available. This method presents no medical contra-indication whatsoever: 4 tabs of a combination oral contraceptive (> or = 50µg EE/tab), to be taken no later than 72 hours after the risky sexual intercourse has taken place."

CF "Pills and other hormonal methods of contraception work for HIV + women but there are certain interactions with anti-TB medicines and ARVs that require that dosages be adapted."

VL "Behavioral methods should be avoided. But when the woman doesn't have access to other methods, the LAM method is worth considering. It is based on three simultaneous criteria: 1. exclusive breastfeeding, 2. absence of menstruation, 3. reliable only for 6 months after the birth of the child. This very effective method adapted to the African context is a good way to reinforce the practice of exclusive breastfeeding but there is still the undeniable risk of transmitting HIV to the child."

CF "Healthcare-providers have the tendency to assume that HIV+ people use condoms regularly. The reality is often different and other contraceptive methods should be talked about with women."

To find out more
Other methods of contraception not detailed here are also available (such as IUDs, cervical caps, diaphragms etc).

UNFPA's website linking reproductive
health issues to HIV
www.unfpa.org/hiv/index.htm

Planned Parenthood's website
www.ippf.org/

The point of view of the NGO Population Action International www.populationaction.org/
resources/research
Commentaries/Africa_famPlan_
Feb06.htm

The Lactational Amenorrhea Method (LAM) www.linkagesproject.org/media/
publications/frequently%20asked%20questions/FAQLAM.pdf

Answers to last month's crossword puzzle

Last month, Growing Up Info challenged you to a crossword puzzle. Here is the right answer:

And an MCQ on the indications for ART

Choose the situations from among the following examples that require immediate initiation of ARV therapy and then explain your answers:

A 9 month-old infant, whose mother is HIV+ and is in an advanced stage, who is marasmic despite therapeutic nutritional management and whose virologic status is not confirmed yet (PCR not available)
B 3 year-old girl with hepato-splenomegaly, pruritic papular eruption (itchy), parotitis and a total lymphocyte count of 3200/mm3
C 9 year-old boy who had a case of right intercostal zoster 6 months ago; and now has oral candidiasis; CD4 count: 250/mm3
D 18 month old HIV + (confirmed) infant with chronic otorrhoea and extensive molluscum contagiosum. CD4 count: 23 %
E 8 1/2 month-old breastfeeding infant; unable to sit up on his own, increased tone of upper limbs when flexed, small head circumference for his/her age; HIV+ mother (virologic status unconfirmed - PCR unavailable).

Dr. Pulchérie Siewe, from the SWAA in Douala, Cameroon, was the fastest wordsmith to answer.
Bravo Pulchérie!

ERRATUM
The link to WHO's website towards which we directed you last month does not include the revised recommendations.
Available in April.
www.who.int/hiv/mediacentre/
fs_2006guidelines_paediatric/
en/index.html

Send your answers to: grandir@sidaction.org
Still a book to win!

Liquid formulations: the best ways to dose and administer ARVs to young children

There are several ways for parents to administer ARVs to children in liquid form. With the help of their doctor they should select the method most convenient for their lifestyle and then follow the simplest recommendations. Growing Up Info has evaluated the pros and cons of three of the main methods available.
 
1. Reusable plastic syringe (without the needle!): This makes it possible to measure doses more accurately and toddlers and babies can "drink" from the syringe as if it were a baby-bottle. A good way for parents to use it is to mark the syringe either with a permanent felt-tip marker or with dark-colored nail polish. If possible, replace the syringe every time that the dose changes. Pharmacies should always have a few syringes on-hand in case the first one is lost by parents. CAUTION: the cleanliness of the syringe is critical. Parents should wash the syringe carefully after each use with potable water and soap, let it dry opened and then put it away in a clean place. Each liquid medicine should have its own syringe, and if there are several medicines to give, there should be several syringes, one for each medicine. If the quantity of liquid to be taken is large or if the child prefers to drink from glass, the liquid can be measured with the syringe and then poured into a glass or a spoon for the child to take.

2. Graduated cup : Less accurate but still a good alternative if syringes are unavailable, transparent plastic or glass cups are fairly easy to find. As with the syringe each cup should be reserved for each medicine (several medicines=several cups) and marked with felt-tip permanent marker or nail polish on the outside. Once the cup has been washed and dried, put it away upside down. When measuring the liquid place the cup on an even surface so to avoid losses or mistakes in measurement.

3. Measuring spoon : This is more convenient than the cup for small amounts. On the other hand infants may have trouble holding the spoon by themselves and the liquid could easily spill.

An extra tip!
For newborns position the syringe between cheek and gums to reduce the risk of spitting up or vomiting.

Where to find these things?
The CHMP website (plastic measuring spoon, reusable plastic syringe 5/10/15/20 ml)
www.chmp.org

The IDA website (reusable plastic syringe 5/10/20 ml) www.idafoundation.org

Central medical stores usually sell reusable plastic syringes 5/10/15/20 ml