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BACKGROUND Disclosure of donor conception has been advocated in several jurisdictions in recent years, especially in those that practice identity-release donation. However, research on disclosure decisions has not been consolidated systematically in the last 10 years to review if parents are telling and what factors may be impacting their decisions. OBJECTIVE AND RATIONALE Are parents disclosing to their donor-conceived children, and what factors have influenced their disclosure decisions across different contexts and family forms in the last 10 years? SEARCH METHODS A bibliographic search of English-language, peer-reviewed journal articles published between 2012 and 2022 from seven databases was undertaken. References cited in included articles were manually scrutinized to identify additional references and references that cited the included articles were also manually searched. Inclusion criteria were articles focused on parents (including heterosexual, single mothers by choice, same-sex couples, and transsexual) of donor-conceived persons in both jurisdictions with or without identity-release provisions. Studies focused solely on surrogacy, donors, donor-conceived persons, or medical/fertility staff were excluded as were studies where it was not possible to extract donor-recipient parents' data separately. Both quantitative and qualitative studies were included. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed and Joanna Briggs Institute Critical Appraisal Tools for Systematic Reviews were used to assess article quality and bias. OUTCOMES Thirty-seven articles met the inclusion criteria representing 34 studies and 4248 parents (including heterosexual, single, same-sex, and transsexual parents although the majority were heterosexual) from countries with anonymous donation and those with identity-release provisions or who had subsequently enacted these provisions (Australia, Belgium, Finland, France, Hong Kong, Middle East, Spain, Sweden, the UK, and the USA) A general trend towards disclosure was noted across these groups of parents with most disclosing to their donor-conceived children before the age of 10 years. Further, the majority of those who had not yet told, reported planning to disclose, although delayed decisions were also associated with lower disclosure overall. Same-sex and single parents were more likely to disclose than heterosexual parents. There was recognition of disclosure as a process involving ongoing conversations and that decisions were impacted by multiple interacting intrapersonal, interpersonal, and external contextual and social factors. Methodological limitations, such as the different population groups and contexts from which participants were drawn (including that those parents who choose not to disclose may be less likely to participate in research), are acknowledged in integrating findings. WIDER IMPLICATIONS This review has reinforced the need for a theoretical model to explain parents' disclosure decisions and research exploring the role of legislative provisions, culture, and donor/family type in decision-making. Greater ongoing access to psychological support around disclosure may be important to promote parent and family well-being. [ABSTRACT FROM AUTHOR]

Abstract Background There is mixed evidence on the influence of self-disclosure of one’s HIV status on mental health, health behaviours and clinical outcomes. We studied the patterns of self-disclosure among parents living with HIV, and factors that influence parental disclosure. Methods This mixed-methods study was among adults in HIV care participating in a study assessing the uptake of pediatric index-case testing. They completed a survey to provide demographic and HIV-related health information, and assess self-disclosure to partners, children and others. We ran generalized linear models to determine factors associated with disclosure and reported prevalence ratios (PR). Eighteen participants also participated in in-depth interviews to explore perceived barriers and facilitators of self-disclosure to one’s child. A content analysis approach was used to analyze interview transcripts. Results Of 493 caregivers, 238 (48%) had a child ≥ 6 years old who could potentially be disclosed to about their parent's HIV status. Of 238 participants, 205 (86%) were female, median age was 35 years, and 132 (55%) were in a stable relationship. Among those in a stable relationship, 96 (73%) knew their partner’s HIV status, with 79 (60%) reporting that their partner was living with HIV. Caregivers had known their HIV status for a median 2 years, and the median age of their oldest child was 11 years old. Older caregiver age and older first born child’s age were each associated with 10% higher likelihood of having disclosed to a child (PR: 1.10 [1.06–1.13] and PR: 1.10 [1.06–1.15], per year of age, respectively). The child’s age or perceived maturity and fear of causing anxiety to the child inhibited disclosure. Child’s sexual activity was a motivator for disclosure, as well as the belief that disclosing was the “right thing to do”. Caregivers advocated for peer and counseling support to gain insight on appropriate ways to disclose their status. Conclusions Child’s age is a key consideration for parents to disclose their own HIV status to their children. While parents were open to disclosing their HIV status to their children, there is a need to address barriers including anticipated stigma, and fear that disclosure will cause distress to their children.

Background: There is mixed evidence on the influence of self-disclosure of one's HIV status on mental health, health behaviours and clinical outcomes. We studied the patterns of self-disclosure among parents living with HIV, and factors that influence parental disclosure. Methods: This mixed-methods study was among adults in HIV care participating in a study assessing the uptake of pediatric index-case testing. They completed a survey to provide demographic and HIV-related health information, and assess self-disclosure to partners, children and others. We ran generalized linear models to determine factors associated with disclosure and reported prevalence ratios (PR). Eighteen participants also participated in in-depth interviews to explore perceived barriers and facilitators of self-disclosure to one's child. A content analysis approach was used to analyze interview transcripts. Results: Of 493 caregivers, 238 (48%) had a child ≥ 6 years old who could potentially be disclosed to about their parent's HIV status. Of 238 participants, 205 (86%) were female, median age was 35 years, and 132 (55%) were in a stable relationship. Among those in a stable relationship, 96 (73%) knew their partner's HIV status, with 79 (60%) reporting that their partner was living with HIV. Caregivers had known their HIV status for a median 2 years, and the median age of their oldest child was 11 years old. Older caregiver age and older first born child's age were each associated with 10% higher likelihood of having disclosed to a child (PR: 1.10 [1.06–1.13] and PR: 1.10 [1.06–1.15], per year of age, respectively). The child's age or perceived maturity and fear of causing anxiety to the child inhibited disclosure. Child's sexual activity was a motivator for disclosure, as well as the belief that disclosing was the "right thing to do". Caregivers advocated for peer and counseling support to gain insight on appropriate ways to disclose their status. Conclusions: Child's age is a key consideration for parents to disclose their own HIV status to their children. While parents were open to disclosing their HIV status to their children, there is a need to address barriers including anticipated stigma, and fear that disclosure will cause distress to their children. [ABSTRACT FROM AUTHOR]

The Amsterdam Sexual Abuse Case (ASAC) presented parents with a dilemma about disclosing preverbal sexual abuse to their child. Advising parents was challenging due to limited knowledge about the consequences of preverbal child sexual abuse (CSA) and the rarity of children having no conscious awareness of their experience. To enhance recommendations and knowledge, we explored parents' experiences over the years. This unique qualitative study introduced "parental disclosure", where non-offending parents disclose CSA to their child, and investigated the decision-making process spanning a decade after the ASAC discovery. Longitudinal qualitative data were collected through yearly interviews. In total, 41 parents participated for 47 children. An additional in-depth interview was conducted with 20 parents in 2015. Quantitative data highlighted that over 10 years, parents of more than half of the children disclosed the preverbal CSA. Our analyses revealed that parental disclosure decisions entail dilemmas and unfold as a gradual process. Factors influencing decision-making included fear of stigma, child's emotional readiness, perceived benefits and risks, parental beliefs, values, and CSA circumstances. This study underscores the complex nature of parental disclosure and shows that it is an ongoing process rather than a singular event. Parents' choices evolved based on changing circumstances and new information. Outcomes enrich the understanding of parental disclosure decision-making, highlighting the need for tailored support services to aid parents navigating the aftermath of preverbal CSA. Parental disclosure is highly individualized and calls for evidence-based interventions and policies. [ABSTRACT FROM AUTHOR]

The largest populations of HIV-infected patients live in Africa and care for many un-infected children, this has heightened the need for disclosure of parental HIV status to un-infected children. However, existing literature in sub-Saharan shows low parental disclosure rates. The study sought to determine reasons for parental disclosure and non-disclosure of HIV status to uninfected children and examine the reactions of children to disclosure. A cross sectional survey was conducted among HIV-infected parents of children aged 6-18 years attending a primary health care clinic at Ekurhuleni district, Gauteng province. The sample consisted of 340 HIVinfected adult patients. There were more females 235 (69%) than males 105 (31%). Over half (n=197, 57.9%) had known about their HIV status for 1-5 years, 210 (63%) tested because they were sick, 215 (72.9%) were receiving ART for 1-5 years, 105 (31%) disclosed to children and 26 (26.4%) disclosed immediately after testing. Based on parents reports, the majority (n=74, 68%) of children were sad, worried, angry, confused, shocked, tearful, scared, and distressed after parental disclosure. Non-disclosed parents believed that the child was too young to understand, 217 (94.8%) planned to disclose in the future, and 129 (57.1%) said 21-25 years was the ideal age for disclosure. Non-disclosed parents were not totally against disclosure but were fearful of the perceived negative consequences of disclosure. Health care-workers can play a crucial role in supporting parents to disclose but also offer specific counselling and support to children before and after parental disclosure. [ABSTRACT FROM AUTHOR]

Abstract Introduction This is a case scenario simulating a physician encounter with a parent who has concerns about the sexual abuse of her child. The case scenario was developed to enhance competencies around the initial steps in management of child sexual abuse. Methods In the initials stages of a case like this, the establishment of rapport despite the emotionally charged nature of the issue is paramount. This resource is most applicable for addressing communication skills of trainees interacting with the caregiver of a possible child victim. In addition, the scenario impresses the need for trainees to acknowledge their role as a mandated reporter of all forms of family violence. Other competencies relevant to this case include being familiar with sexual behaviors that are considered developmentally appropriate in a prepubertal child while acknowledging the implications when there are variations from the norm. Results Prior to this experience, many trainees assumed that they knew how to manage a case of child abuse. After the training, trainees appeared less confident about the initial stages of managing a case of sexual abuse. On the other hand, they could easily identify the competencies they found the most challenging after the experience. The identification of these management challenges will inform curricular efforts on this topic at individual institutions based on available resources. Discussion Lessons learned from implementing this case in a resource-deficient environment can highlight the need for existing resources and bolster the argument for additional ones. This exercise can also serve as a needs assessment tool to inform the processes required for addressing the identified management challenges for similar cases.

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