HIV This Week

Corona R, Beckett MK, et al. Do Children Know Their Parent's HIV Status? Parental Reports of Child Awareness in a Nationally Representative Sample. Ambul Pediatr 2006;6:138-44. http://www.sciencedirect.com/science/journal/15301567

Corona and colleagues aimed to determine the rates and predictors of child awareness of parental HIV status and the effect of that knowledge on children. The authors conducted interviews with 274 parents from a nationally representative sample of HIV-infected adults receiving health care for HIV in the United States. HIV-infected parents reported that 44% of their children (5-17 years old) were aware of their parent's HIV status, and parents had discussed with 90% of those children the possibility that HIV or AIDS might lead to their parent's death. Multivariate analyses revealed that parents with higher income, with an HIV risk group of heterosexual intercourse, with higher CD4 counts, with greater social isolation, and with younger children were less likely to report that their child knew the parent was HIV positive. Parents reported that 11% of children worried they could catch HIV from their parent. Reasons children did not know their parent's HIV status included that the parent was worried about the emotional consequences of disclosure (67%), was worried the child would tell other people (36%), and did not know how to tell their child (28%). The authors conclude that clinicians may be able to support and guide HIV-infected parents in deciding whether, when, and how to disclose their infection to their children.

The concepts of health and self have become intimately entangled in contemporary western society. Health is figured as a marker of identity, as a vehicle of self-production and self-actualisation, while the individual is also made increasingly responsible for his or her health. Persson and Newman explore how "self" is constituted in discourses that shape the ways in which people understand and do health and medicine, particularly discourses of neo-liberalism and of the immune system. They situate the discussion in the context the antiretroviral drug efavirenz. This drug, commonly described as "potent", can have a number of troubling effects on a person's everyday sense of self, including insomnia, confusion, cognitive disorders, depression, de-personalisation, psychosis, and suicidal ideation. While efavirenz may be clinically effective in its capacity to suppress the virus, these effects are at odds with the implicit aim of HIV medicine to restore and secure the self by way of immunological integrity and strength. These effects also bring into focus the predicament of choice under the contemporary political conditions of neo-liberalism with its emphasis on health as an enterprise of the autonomous, rational self. In exploring first-person accounts, the paper unpacks a number of the binary concepts on which contemporary discourses of health and medicine rely, such as immunity and vulnerability, potency and fragility, rationality and madness, self and non-self, and asks whether the individual under neo-liberalism is being asked the impossible.