Disclosure of Diagnosis in Children with HIV: A Mixed Methods Study

countries, remains a one-time event owing to limited healthcare engagement.10 IntroductIonHistorically, limited awareness and poor access to antiretroviral therapy (ART) led to high childhood mortality among children with HIV; however, expanded ART availability has enabled more children to survive into adolescence.1 As with other chronic illnesses, adolescents living with HIV must manage psychosocial challenges, treatment adherence, and emerging sexual relationships during rapid physical and psychological development.2 Existing evidence suggests improved coping among children with chronic illnesses when they are adequately informed about their condition.3 Multiple professional organizations, including the World Health Organization 4 and the American Academy of Pediatrics, 5 have recommended disclosing the diagnosis to children living with HIV (CLH) in an incremental fashion tailored to suit their cognitive needs.Due to its association with high-risk behaviors, HIV carries substantial stigma, and parental disclosure decisions are shaped by fears of adverse emotional reactions and social repercussions if the child reveals the diagnosis to others.6 Thus, social forces of stigma and discrimination associated with HIV infection often play a major role in hindering the disclosure of the diagnosis.7 Nondisclosure poses public health risks, including poor adherence leading to drug resistance and increased transmission through risky sexual behavior, underscoring the urgency of HIV disclosure to children.6 While evidence on disclosure in low-and middle-income countries largely comes from Africa, Indian data remain limited, with disclosure rates ranging from 9.7% 8 to 43.1%.9 Despite broad recognition of its importance, disclosure lacks a standardized process and, in many low-and middle-income