Family Processes and Child Outcomes in the Context of HIV Infection: The Role of Maternal Disclosure Self-Efficacy

Introduction: African Americans have increasingly been affected by the HIV/AIDS epidemic, accounting for 47% of all new HIV diagnoses in 2012. An estimated 1 in 32 African American women will be diagnosed with HIV in their lifetime (CDC, 2015), and many of these women are mothers.  A mother’s decision of whether to disclose her HIV status to offspring is a difficult one, and most mothers choose not to disclose (Corona et al., 2006). Nondisclosure may result in disruptions in the mother-child relationship (Brown & Powell-Cope, 1993) and compromised child functioning (Murphy et al., 2008). An important step toward disclosure includes confidence in one’s ability to appropriately disclose the diagnosis, and feeling unprepared for disclosure may also lead to negative outcomes. This investigation explores relations between maternal self-efficacy for HIV disclosure and family, as well as child, functioning. 

Methods: Results presented in this paper draw from a larger randomized controlled trial of an intervention with mothers living with HIV. The ongoing trial is examining the efficacy of an intervention designed to assist maternal disclosure of HIV. Before and after intervention implementation, trained interviewers meet with mothers and their children in the families’ homes to conduct structured interviews in either Spanish or English. Mothers and children are assessed separately, and only baseline data are considered in the current study.

Results: Mother report of disclosure self-efficacy was associated with child report of depressive symptoms (r = -0.25) and worry (r = -0.36), such that lower efficacy correlated with more symptoms. Mothers with low efficacy for disclosure also reported lower family cohesion (r = 0.26). Additional analyses will more thoroughly examine these relations prior to the conference presentation.

Conclusions: Regardless of whether she intends to disclose imminently, a mother who feels unprepared to disclose may avoid engaging in a variety of conversations with her children for fear of being asked about her health. Avoidance, coupled with maternal anxiety around disclosure, may negatively impact family and child functioning. Results suggest that enhancing mothers’ self-efficacy to disclose her HIV status to children may be protective for family and child functioning.