HIV status disclosure to children by health care practitioners against parental consent in South Africa

Abstract

Based on a report published by the UNAIDS, close to 2 million young people who have not reached age 14 are HIV positive (UNAIDS, 2015). With the development in antiretroviral therapy (ART), parents of these children and the professionals taking care of the children ought to grapple with the daunting burden of communicating their seropositive status to their children as they grow and become more curious. Revealing an HIV diagnosis requires talking to children and their parents about a potentially fatal, highly stigmatized, and highly contagious disease, and many parents and caregivers find this upsetting to their children. It has been found through research with young people who have gone through the disclosure process that they get to experience benefits which other children may not receive because of lack of knowledge (Gyamfi et al., 2015). Furthermore, some parents found it difficult to initiate disclosure because they felt that their children were not old enough to understand the information about health and illness (Gyamfi et al., 2017). I argue that disclosure to children between the ages of 6 and 8 is ethically justified if the child has matured enough and their best interests have been considered. I argue that rule utilitarianism is suitable for HIV partial disclosure because it requires that the rule of partial disclosure to children in the age group of 6 to 8 years to be followed when initiating disclosure, when they intend to maximize utility and benefit the child and as far as the child is of sufficient maturity. I further argue that even though the health care practitioner has dual loyalty to the child and their parent, the benefits of disclosure outweigh any harms that can happen because of disclosure. Finally, in my final chapter I argue for conditions under which it would be ethically justified to initiate disclosure with a child even against parental consent.