Factors Influencing Parents’ Decision to Disclose Their HIV Status to Their Children in Makete District, Tanzania

HIV remains a major public health challenge in sub-Saharan Africa, and Tanzania is among the most affected countries. Beyond medical treatment, families living with HIV face complex social realities, one of which is whether parents should disclose their HIV status to their children. Disclosure can reduce stigma, improve family communication, and strengthen adherence to treatment, yet little is known about how Tanzanian parents make these decisions. This qualitative ethnographic study was conducted in Makete District, which has the highest HIV prevalence rate in Tanzania. Seventy participants, including HIV-positive parents, children, healthcare workers, family members, and community-based service providers, were engaged through in-depth interviews, focus group discussions, and participant observation. Data were analysed thematically using NVivo8 software. Findings revealed that disclosure decisions were shaped more by children’s maturity than age, alongside factors such as the need for treatment supporters (as recommended in national HIV guidelines), children’s suspicions, parents’ illness experiences, and HIV education programmes. Parents disclosed seeking emotional and practical support and to normalise HIV discussions within families. These findings suggest that HIV policies should strengthen family-centred counselling, expand HIV education, and provide parents with culturally appropriate communication strategies. Tailored disclosure guidelines can empower families, improve treatment adherence, and reduce stigma in Tanzanian communities.