Table 2 Illustrative quotes for factors influencing parental HIV status disclosure

Parental fear of judgment

Because, you know children, they don’t understand what HIV is, some they don’t know about the confidentiality, so they will think it is just normal, so they will go telling people and they will be discriminated.—mother of four

The child might not keep the secret, they might try to share it with other children, you see, so for me I don’t think it is important to share your status with your children. When they are playing, ‘you know my parents has this and this’, and you know they don’t have secrets at times.—mother of two

It is important [to disclose] but at that age when they can’t understand anything and they might talk…when he/she is with her friends or her teacher, or somebody there will hear you know. It’s good to wait for that age when the child can understand everything about life that[‘s] the time now you should disclose.—mother of one

Maybe, you know according to them HIV is usually brought about at times by other things, they will think otherwise. They might think you might have been going out of your marriage, so you might decide not to tell them.—mother of two

They will feel that their parent[s] did not trust each other, maybe they were promiscuous.—father of three

Parental wishes to protect children from distress & child evolving emotional maturity

Because he has not matured mentally and [doesn’t] understand much, so he will feel sorry for you all the time and whenever you get sick, he/she will feel that you are going to die, and that will create a lot of worries which is not good.—mother of two

It’s 50/50, sometimes it’s important [to disclose] and sometimes it’s not important. The kids will start like, ‘our mother is leaving us very soon’ you know they don’t understand, as you understand it. In my case as for me, I can’t tell them. No I can’t tell them, they will start thinking that I am dying tomorrow.—mother of four

The child could get shocked because he/she might feel that maybe the parent is going to die, maybe you can even fall sick and he/she will be thinking ‘is my mum going to die from that particular disease’, it’s that kind of shock that can scare the child.—mother of three

If the child has not matured, I will not tell him/her but I will counsel him/her and treat him/her in a way to show him/her that I love him so much so that the child doesn’t get stressed but I will not tell him/her about my status.—father of ten

At the age of maybe 12, 13, 14 [years] I would speak to them like in a third person, you know people get sick and this and this…but when I think they get to stage like 17, 18 (years), now I think they can start to understand, say I think at that age.—mother of one

Parental planning for the future & child evolving role as caregiver within family

I think if the parents fall sick the child will know the steps to take and they will know the person to confide in.—mother of three

Now if a child knows that you have the virus, he/she will respect you…if you tell him/her to take you to the hospital you are unwell, the child will do that because he/she respects the parents and is empathizing with the situation.—father of ten

That is when will share my status [child aged 17 or 18], but all through, I will even be bringing them to the clinic, getting them to know, what is this that is going on, you know, but sharing my status, that is when I am saying I will share. But all through from that age, you just share small, small.—mother of one

Child evolving sexuality

When I start seeing him/her with some girlfriend or boyfriend, so maybe he will come with a girl and tell me, ‘Mum, this is my girlfriend’ you see, and the way boys are, maybe she is not the only one. Then he goes and meets another girl and I might secretly hear about it before he tells me about it, so I will tell him, ‘Yesterday you came with a different girl and I have heard there is another girl you are seeing, my son this is how the world goes, you should take care of yourself’ so that is where I will start—mother of one

At least when you know that they are almost starting to be sexually active, then if you are [HIV positive], you can tell him, I have this and it’s not a good thing, it’s not that I am going to die but it’s not something good to have, if you can protect yourself, do it, then they can understand.—mother of two

It is important [for them to know] if the children are grown, so that they can know how to protect themselves. And for them to know that HIV exists because most of them just hear about it, so that they can take it as something real.—mother of one