Objectives: Using the socio-ecological approach, the current study aims to identify facilitators and barriers to decision-making regarding parental HIV disclosure or nondisclosure at intrapersonal, interpersonal, and sociocultural levels; and examine the unique contribution of factors at different level of influences to the decision of disclosure or nondisclosure.
Design: A cross-sectional survey was conducted among people living with HIV in Guangxi, China. A sub-sample of 1254 participants, who had children aged 5-16 years, was included in the data analysis in the current study.
Methods: Multivariate models using hierarchical logistic regression were employed to assess the association of parental decision regarding HIV disclosure to children with various factors at intrapersonal, interpersonal, and sociocultural levels controlling background characteristics, and detect the level-specific influence on disclosure decision.
Results: Positive coping with HIV infection and a good parent-child relationship facilitated parental HIV disclosure; whereas high level of resilience and fears of parental HIV disclosure impeded their decisions to talk about HIV status to their children. In addition, the current study recognized specific contribution of multiple ecological levels to parental decisions regarding disclosure to children.
Conclusion: The socio-ecological model is a promising theoretical framework to guide further studies and interventions related to parental HIV disclosure. Directions for further studies using socio-ecological approach were also discussed.