Sunday Times (Johannesburg) - December 2, 2007
Claire Keeton

Caring for adolescents was high on the agenda of the Third Paediatric Aids Treatment Forum for Africa in Swaziland this week, said Dr Paul Roux, director of paediatric HIV/Aids services at Groote Schuur Hospital in Cape Town.

Children cope better in general if they find out they are HIV-positive before they hit the rollercoaster of adolescence, said Marnie Vujovic, a clinical psychologist at one of the South Africa's biggest paediatric treatment sites.

Eighteen-year-old Sthandiwe said she was glad that she found out her HIV status when she was younger.

A social worker told Sthandiwe when she was 12 that she was HIV-positive, and explained that that was why she would be moving to a home for children and women with HIV.

"At first I didn't understand, until Heather [the psychologist at Nkosi's Haven refuge for children affected by Aids] asked if I knew anything about HIV.

"I was still blank, but she tried to tell me and then I understood it was [a virus] in my blood," she said.

Sthandiwe, who has just won a prize for English and will be a prefect next year in Grade 12, said has been on antiretroviral treatment for three years and is doing well.

But, said Sthandiwe, it was difficult knowing you are HIV- positive when you go to parties and meet boys.

"You start to stress about how you are going to tell him," the shy teenager said.

Vujovic, who works at the Harriet Shezi clinic at Chris Hani Baragwanath Hospital, said: "People think adolescence is a good time, but it is probably the worst time as children are struggling with so many issues."

She said it was often a relief for children to know what was going on after having their status kept a secret.

"The earlier the parent or caregiver begins the continuing conversation about having HIV, the better.

"It is a process of teaching a child about their body, and that should begin as soon as possible.

"Of course, you start simply and, at pre-school level, you would not mention HIV," she said.

She pointed out that a child that age would not understand confidentiality.

Vujovic said: "Caregivers are often so afraid of disclosing, for many reasons."

Among the concerns, often unfounded, are that:

* Children will speak indiscriminately and not maintain confidentiality;

* Children will react negatively and be depressed; and

* Children will reject them for telling them their status.

But she said that, in her experience, most of these concerns did not prove to be true.

"Children often have a sense of relief and both parties feel enormously relieved when their HIV status is in the open.

"It is so important for children on treatment to know what their status is. It is their right to know and to take responsibility for their health."

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