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How to start a conversation with a child about HIV. Councils of doctors

October 30, 2017

Awareness is the guarantee of children’s health.

The health of the child and, especially, their HIV status, directly depend on the decisions made by their parents. Avoiding PMTCT medications during pregnancy or excessive despotism, as well as silencing important matters in a dialogue with a teenager, can lead to equally adverse consequences. RIA “Vostok-Media” offers an overview of the dedicated roundtable in Ussuriysk, where experts discussed how to talk with children about HIV.  

The roundtable location was not random: Ussuriysk urban area has been competing with Nakhodka city in the infamous HIV prevalence leadership. This year it is on the third place, with an indicator of 734.7 cases per 100,000 of population.

“It is scientifically proven that if as much as 1% of the local population is infected, the territory incurs economic, labor, strategic losses comparable to the losses caused by war. And there are more than 10 such territories in Russia. There are locations with 1.5% or 2% rate, and this is a generalized infection. In Ussuriysk, the official figure is 0.7%, while we know that the real figure is more than three times higher”, Yelena Voitovskaya, psychologist of the regional AIDS center, commented. “Therefore, it is good that the state has realized the need and does allocate funds not only for medical research and treatment, but also for awareness campaigns. 20 years ago we either did not receive any information whatsoever, or it was just something like “horror stories”. We can use these campaigns to provide people with correct, scientifically-grounded competent information, to some extent try to calm them and make them more mindful of their own health”.

Theoretically, modern diagnostic methods enable screening the entire population of Ussuriysk city for IV just in a day. But even on such a scale the screening will not provide an exact prevalence rate. The virus may “stay hidden” for up to 3 months from the time of infection when it is not detected by tests. All this time an infected person can transmit HIV others without knowing it themselves.

“Sometimes a woman is HIV negative during the pregnancy, she gives birth to a perfectly healthy child, but after the delivery she contracts HIV from her husband, who did not know or did not say about his status. Mother is breastfeeding for up to two years, and the baby gets an infection with the milk”, says Svetlana Yermolitskaya, head of the prevention and treatment department of the AIDS center. “They may learn about the diagnosis when the child is already about 10 years old. Usually, they seek medical care for some kind of concomitant disease and get included into the statistics of HIV-infected people”.

The doctors believe mandatory HIV testing for the fathers-to-be is a crucial state level change. Until 2013, only a pregnant woman had to pass HIV test twice. Since 2013 in Primorye, and since 2015 in the entire of Russia, out future dads are obligated to take HIV tests, and pregnant women need to be tested for HIV three times.

“Twenty years ago, when we consulted pregnant women with HIV, we honestly told them that it’s almost impossible to have a healthy baby. Today we advise them to become mothers. If they do everything properly, then they are 99% sure to give birth to a healthy child”, says Elena Voitovskaya. “Of course, we face misunderstanding in our work very often. Sometimes pregnant women deny their diagnosis and refuse to give medications to children. Actually, 10 years ago I used to organize trainings for young people join the matters of HIV prevention. Naturally, the municipal money was allocated for it, but I heard that it would be better to buy an extra bowl of soup for an orphanage than to stuff the children’s brains with some useless information. And when the children as young as 18 die because of severe drug addiction, we start crying alarm. It’s a shame, of course, that people prefer to shun the problem rather than be aware of it, understand it and know how to protect themselves and their relatives”.

The algorithm of actions on the topic “how to tell a child about HIV” has not yet been developed. But everyone can follow simple rules in dialogue with your kid.

  • Psychologists recommend to discuss difficult topics several times. Children quickly forget the information.
  • Do not hesitate to ask the child what they think about it, if they ask you a question about sex or drugs. You can determine the level of their knowledge and choose the right answer.
  • Strengthen the child’s self-esteem. Studies show that this is one of the main risk factors for HIV infection. Lack of self-respect can cause a teenager to be unable to refuse from drugs or unprotected sex when spending time in a group of acquaintances. And the level of knowledge will have absolutely nothing to do with it.

“Teach them to say no”. Simulate such situations, explain that their friends are not always able to evaluate the consequences of their actions. This is how real friends actually differ from those who just pretend to be friends. Talk more often about your negative attitude towards any drugs. But be sure to always provide arguments: tyrannical “no” without explanation can only stir up the teenager’s curiosity.

“If a child has HIV, and they start asking questions, explain that there is such a disease, it is for life, but it is not dangerous if they take pills and follow a number of rules. It is not necessary to tell all their friends that the child has HIV. Any illness in general is an intimate thing”, Voitovskaya says. – “When I go on field visits to the districts, I always insist on meetings with the principals of schools, informing them beforehand, and tell them about prevention. Of course, in recent years the information policy emphasizes on the promotion of chastity, and it is not recommended to talk about teenage sex. But how can we talk about HIV and not talk about sex? Of course, no one will have such classes with small kids, but it is well appropriate for the school graduates”.

In 2017 in Primorye 94 children were born from HIV-infected mothers. 78% of mothers received a full three-stage prophylaxis. Why the 100% rate was not achieved? It might be intentional refusal from treatment or late visit to the doctor, but do the reasons matter if the baby gets infected in the end? Before 1.5 years of age such children stay registered with the AIDS Center, until the diagnosis is lifted or confirmed. For almost 2 years even the most competent and conscientious mother lives in fear and tension, waiting for the verdict of doctors. Is it worth one’s stubbornness or negligence during pregnancy? Despite all the efforts of physicians, consultants, volunteers and just people who care, the percentage of those who treat people living with HIV as those with leper is still considerable. This attitude occurs among employees of educational institutions, ordinary passers-by and even physicians. Their opinion cannot be changed in one, two, or even a hundred days. However, each of us can contribute to up a physically and psychologically healthy generation which will be free from stupid prejudices.

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