Characteristics associated with HIV status disclosure to HIV-infected youth receiving antiretroviral therapy (ARV) in the Dominican Republic (DR)

Background: Given ARV's increasing worldwide availability, many HIV-infected youth are reaching adulthood. Disclosure of serostatus to youth is critical for greater ARV adherence and prevention of HIV transmission in sexually-active adolescents. Methods: To identify characteristics associated with serostatus knowledge, medical records of patients aged 5-18 years receiving ARV in the two leading pediatric HIV clinics were reviewed. These clinics served 559 (40%) of 1,386 HIV-infected infants, children and adolescents receiving care in the DR in 2011. Results: Of 326 HIV-infected youth, 182 (55.8%) were female. Mean age was 11.1 years; 118 (36.1%) were older than 12 years (adolescents). Most (321 [98.5%]) lived with community-based caregivers; 5 lived in orphanages. Only 74 (22.8%) knew their HIV serostatus. Likelihood of knowing did not differ significantly by sex (24.0% of females, 21.4% of males; p=.57). Adolescents were more likely to know their serostatus (49.6%) than younger patients (7.7%; p<.001); 104 (31.8%) had participated in an activity for HIV-infected youth, including sleepover camps (81.4%), support groups (12.7%) or meetings and retreats (6.7%). Participation in such activities was associated with a greater likelihood of knowing serostatus (46.1%) than non-participation (12.1%; p<.001). When restricted to adolescents, camp and support group participants were more likely than non-participants to know their status (72.4% versus 42.0%; p=.008 and 100% versus 44.9%; p<.001, respectively). Conclusions: As reported in many developing countries, most DR HIV-infected youth receiving ARV do not know their status. Safe, effective procedures to inform them are needed, which may be facilitated by recreational activities, such as camps.