Conceived Through Rape/Incest? Adoptive Parents' Experiences Managing Uncertainty and Disclosure Surrounding their Children's Origins.

Adoptive parents may be placed with children conceived under difficult circumstances, such as via rape or incest. At the same time, adoptive parents are generally encouraged to communicate openly with their children about their adoption stories and birth families. No research has examined the experiences of parents who adopt children who were conceived through rape or incest. This exploratory study examines how parents discuss their decision-making when adopting children conceived via rape or incest, how they manage varying levels of uncertainty about their children's origins, and whether and how they plan to disclose this information to children. The researchers used thematic analysis to examine the experiences of 11 couples (22 parents) interviewed at four time points after adopting children who were reportedly conceived via rape or incest. Findings revealed that even soon after adopting, parents discussed the need to eventually talk to their children about their conception circumstances. Parents generally struggled to determine how and when to disclose this information, particularly when they felt uncertain about the veracity of the conception stories they had been told. Some hoped to rely on professionals or birth mothers to guide them in these communications. Findings have implications for supporting adoptive families as they navigate the complexity of managing sensitive information and uncertainty when adopting children conceived through rape or incest. Practitioners should provide ongoing guidance to adoptive parents about how and when to disclose developmentally appropriate information to children about difficult conception circumstances.

Los padres adoptivos pueden recibir niños concebidos en circunstancias difíciles, por ejemplo, por violación o incesto. Al mismo tiempo, a los padres adoptivos generalmente se los anima a comunicarse abiertamente con sus hijos acerca de las historias sobre su adopción y sus familias biológicas. Ninguna investigación ha analizado las experiencias de los padres que adoptan a niños que fueron concebidos por violación o incesto. Este estudio exploratorio analiza cómo los padres debaten su toma de decisiones cuando adoptan a niños concebidos mediante violación o incesto, cómo manejan los diversos niveles de incertidumbre acerca de los orígenes de sus hijos, y si planean revelar esta información a los niños y cómo lo harán. Los investigadores utilizaron el análisis temático para analizar las experiencias de 11 parejas (22 padres) entrevistadas en cuatro momentos específicos después de adoptar a niños que supuestamente fueron concebidos por violación o incesto. Los resultados revelaron que incluso poco después de adoptar, los padres analizaron la necesidad de hablar finalmente con sus hijos acerca de las circunstancias de su concepción. A los padres generalmente les costó decidir cómo y cuándo revelar esta información, particularmente cuando se sentían inseguros acerca de la veracidad de las historias sobre la concepción que les habían contado. Algunos esperaban contar con profesionales o con las madres biológicas para que los guíen en estas comunicaciones. Los hallazgos tienen consecuencias para el apoyo a familias adoptivas que sortean la complejidad de manejar información sensible y la incertidumbre cuando adoptan a niños concebidos por violación o incesto. Los profesionales deberían proporcionar orientación constante a los padres adoptivos sobre cómo y cuándo revelar a sus hijos información adecuada para el desarrollo acerca de las circunstancias difíciles de su concepción.

Implementation and Operational Research: Risk Factors of Loss to Follow-up Among HIV-Positive Pediatric Patients in Dar es Salaam, Tanzania.

OBJECTIVE: To identify risk factors for loss to follow-up (LTFU) in an HIV-infected pediatric population in Dar es Salaam, Tanzania, between 2004 and 2011. DESIGN: Longitudinal analysis of 6236 HIV-infected children. METHODS: We conducted a prospective cohort study of 6236 pediatric patients enrolled in care and treatment in Dar es Salaam from October 2004 to September 2011. LTFU was defined as missing a clinic visit for >90 days for patients on ART and for >180 days for patients in care and monitoring. The relationship of baseline and time-varying characteristics to the risk of LTFU was examined using a Cox proportional hazards model. RESULTS: A total of 2130 children (34%) were LTFU over a median follow-up of 16.7 months (interquartile range, 3.4-36.9). Factors independently associated with a higher risk of LTFU were age ≤2 years (relative risk [RR] = 1.59, 95% CI: 1.40 to 1.80), diarrhea at enrollment (RR = 1.20, 95% CI: 1.03 to 1.41), a low mid-upper arm circumference for age (RR = 1.20, CI: 1.05 to 1.37), eating protein-rich foods ≤3 times a week (RR = 1.39, 95% CI: 1.05 to 1.90), taking cotrimoxazole (RR = 1.39, 95% CI: 1.06 to 1.81), initiating onto antiretrovirals (RR = 1.37, 95% CI: 1.17 to 1.61), receiving treatment at a hospital instead of a local facility (RR = 1.39, 95% CI: 1.06 to 1.41), and starting treatment in 2006 or later (RR = 1.10, 95% CI: 1.04 to 1.16). CONCLUSIONS: Health workers should be aware of pediatric patients who are at a greatest risk of LTFU, such as younger and undernourished patients, so that they can proactively counsel families about the importance of visit adherence. Findings support decentralization of HIV care to local facilities as opposed to hospitals.