HIV Disclosure: Parental dilemma in informing HIV infected Children about their HIV Status in Malawi.

BACKGROUND: Increasingly many perinatally HIV-infected children are surviving through adolescence and adulthood as a result of improvements in the management of paediatric HIV infection, particularly the increased use of combination therapy. It is usually the parents or guardians of these children who are faced with the task of informing the child living with HIV about his or her positive status. However, many parents-particularly biological parents -find this disclosure process difficult to initiate, and this study explored some of the difficulties that these parents encounter. OBJECTIVE: This study set out to explore potential factors that challenge parents and guardians when informing their perinatally HIV-infected child about the child's HIV status. DESIGN: This was a qualitative narrative study that employed in-depth interviews with parents or guardians of children perinatally infected with HIV. A total of 20 parents and guardians of children who attend the outpatient HIV clinic at the Baylor College of Medicine-Abbott Fund Children's Clinical Centre of Excellence (COE) in Lilongwe, Malawi were interviewed. Of these, 14 were biological parents and six were guardians. RESULTS: Guardians and parents expressed uneasiness and apprehension with the disclosure conversation, whether or not they had already told their child that he or she had HIV. Participants who had not told their children recounted that they had contemplated starting the conversation but could not gather enough courage to follow through with those thoughts. They cited the fear of robbing their child of the happiness of living without the knowledge of being positive, fear of making their own status known to more people, and fear of confrontation or creating enmity with their child as impediments to disclosing their child's positive HIV status to him or her. CONCLUSIONS: It is apparent that guardians-more particularly biological parents-of children perinatally infected by HIV find it difficult to inform their children about their children's HIV status. From this disempowered position, parents dread the disclosure of a positive HIV status to a child as a psychosocial process that has the potential to disturb a family's previously established equilibrium with threats of stigmatization, marginalization, and parent-child conflict. This calls for strategies that could support parents to make disclosure to the child less challenging.

Should female health providers be involved in medical male circumcision? Narratives of newly circumcised men in Malawi.

BACKGROUND: The Malawi government has endorsed voluntary medical male circumcision (VMMC) as a biomedical strategy for HIV prevention after a decade of debating its effectiveness in the local setting. The "policy" recommends that male circumcision (MC) should be clinically based, as opposed to the alternative of traditional male circumcision (TMC). Limited finances, acceptability concerns, and the health system's limited capacity to meet demand are among the challenges threatening the mass rollout of VMMC. In terms of acceptability, the gender of clinicians conducting the operations may particularly influence health facility-based circumcision. This study explored the acceptability, by male clients, of female clinicians taking part in the circumcision procedure. METHODS: Six focus group discussions (FGDs) were conducted, with a total of 47 newly circumcised men from non-circumcising ethnic groups in Malawi participating in this study. The men had been circumcised at three health facilities in Lilongwe District in 2010. Data were audio recorded and transcribed verbatim. Data were analysed using narrative analysis. RESULTS: Participants in the FGDs indicated that they were not comfortable with women clinicians being part of the circumcising team. While few mentioned that they were not entirely opposed to female health providers' participation, arguing that their involvement was similar to male clinicians' involvement in child delivery, most of them opposed to female involvement, arguing that MC was not an illness that necessitates the involvement of clinicians regardless of their gender. Most of the participants said that it was not negotiable for females to be involved, as they could wait until an all-male clinician team could be available. Thematically, the arguments against female clinicians' involvement include sexual undertones and the influences of traditional male circumcision practices, among others. CONCLUSION: Men preferred that VMMC should be conducted by male health providers only. Traditionally, male circumcision has been a male-only affair shrouded in secrecy and rituals. Although being medical, this study strongly suggested that it may be difficult for VMMC to immediately move to a public space where female health providers can participate, even for men coming from traditionally non-circumcising backgrounds.

Street children's vulnerability to HIV and sexually transmitted infections in Malawian cities.

BACKGROUND: Street children have largely been ignored in the fight against HIV and AIDS. While some initiatives exist, the nature of street life, probably has not allowed viable interventions to be implemented. However, this is a group of people that could qualify as a "most at risk" group. This study set out to explore street children's vulnerability to sexual exploitation in the cities of Blantyre and Lilongwe in Malawi. OBJECTIVE: The objective for this study was to explore street children's vulnerability to HIV and STIs infection. DESIGN: This qualitative study employed In-depth interviews with street children in the two main cities of Malawi. A total of 23 street children were interviewed. RESULTS: The study strongly suggests that street children could be vulnerable to HIV and other sexually transmitted infections. This is due to various factors which include low knowledge levels of STI and HIV, high risk sexual practices, lack of safer place to spend their nights for both boys and girls rendering them vulnerable to sexual abuses and the use of sex as a tool to secure protection and to be accepted especially for the newcomers on the street. CONCLUSIONS: This study highlights street children's vulnerability to sexual exploitation which predisposes them to risk of HIV and AIDS as well as Sexually Transmitted infections. Furthermore, the street environment offers no protection against such vulnerability. There is need to explore potential and context sensitive strategies that could be used to protect street children from sexual exploitation and HIV and AIDS infection.