Implementation guidance for health providers and planners

Adolescent knowing their status

Disclosure to an adolescent about their own HIV status should happen during school age (i.e. 6–12 years old). Ideally, this will occur before sexual exploration and the complexities of adolescent development. However, in many settings disclosure happens late, and is often unplanned, creating confusion and leaving adolescents to discover their HIV status without appropriate information and support.

Delayed or unintended disclosure to adolescents can contribute to them living with an increased sense of stigma, shame and fear. Earlier disclosure has health benefits such as improved adherence to medicines, reduced psychological distress, increased likelihood of appropriate disclosure to others, and better engagement in HIV-related care. Disclosure helps adolescents to develop a better understanding of HIV and related conditions, and enables them to access essential services that help protect their own health as well as avoid infecting others.

Considerable effort needs to be undertaken to ensure that adolescents living with HIV become aware of their status as soon as possible. Guidance on HIV disclosure counselling for children up to 12 years of age offers recommendations to health workers about how to help start this process.

Ideally, disclosure to the adolescent should include one of the parents or a caregiver. Due to the fear of stigma for themselves and their adolescent, parents and caregivers may be cautious in informing the adolescent of their status, which can potentially delay the disclosure process. By working with and supporting parents and caregivers to explore their concerns and fears, and by providing them with information, health workers can assist in overcoming such barriers. Consideration needs to be given to circumstances in which adolescents have frequently changing, disengaged or absent caregivers.