We don't dare to tell her we don't know where to begin: Disclosure experiences and challenges among adolescents living with HIV and their caregivers in China.

BACKGROUND AND OBJECTIVES: With increasing access to antiretroviral therapy, HIV-infected youth are living longer, but are vulnerable as they navigate the transition to adulthood while managing a highly stigmatized condition. Knowing one's HIV status is critical to assuming responsibility for one's health. The process of disclosure to adolescents living with HIV is not well understood globally, even less so in China. To help address this gap, we explored practices for disclosure to adolescents living with HIV (ALHIV) among Chinese caregivers and clinicians, and the disclosure experiences of the adolescents themselves using qualitative methods. DESIGN AND SETTING: The study was conducted in 2014 at the Guangxi Center for Disease Control and Prevention ART (CDC-ART) clinic in Nanning, China. We used a qualitative design, incorporating in-depth interviews (IDIs) and focus group discussions (FGDs). PATIENTS AND METHODS: We conducted IDIs with 19 adolescent/caregiver dyads and five FGDs with adolescents and clinicians. Adolescent participants were aged 10-15 years, and had contracted HIV perinatally. Using NVivoTM software, we summarized major themes. RESULTS: Only 6/19 caregivers reported disclosing to their child; matched adolescents' statements indicate that 9/19 children knew their HIV status. Caregivers planned to disclose when children were 14 years or older. Concerns about stigma toward children and families were associated with reluctance to disclose. CONCLUSION: Disclosure to adolescents living with HIV in China was delayed compared with recommended guidelines. Culturally appropriate disclosure strategies should be developed, focused on supporting caregivers and de-stigmatizing HIV.

The prediction of maternal HBV transmission by breast milk of postpartum women with chronic HBV infection / 中华临床感染病杂志

Objective To investigate the prediction of maternal HBV transmission by breast milk of postpartum women with chronic HBV infection.Methods HBV DNA levels in serum and breast milk weredetected by fluorescent quantitative polymerase chain reaction in 64 postpartum women with chronic HBV infection.HBV DNA≥1.0×103copies/ml was defined as positive,and correlation analysis was conducted.Results HBV DNA positive rate was 78.1%and 62.5%in serum and breast milk respectively,with a HBV DNA range of 1.05×103～3.87 ×104copies/ml in breast milk.When HBV DNA in serum was 1.0×105～1.0×107copies/ml,the HBV DNA positive rate in breast milk reached to 94.9%;however,when HBV DNA in serum was 1.0×103～1.0×104copies/ml,the positive rate in breast milk was only 18.2%.Conclusion The HBV DNA positive rate of breast milk in postpartum women with chronic HBV infection is correlated with the HBV DNA levels in serum;and breast-feeding should be avoided for postpartum women with HBV DNA≥1.0×105copies/ml in the serum.So serum HBV DNA detection is necessary in antenatal care for women with chronic HBV infection.