Adolescents' Experiences of HIV and Pregnancy Disclosure to Family Caregivers

INTRODUCTION: HIV and pregnancy rates among Kenyan adolescents are among the highest globally. For both conditions, timely disclosure to family caregivers is critical for engagement in antenatal and prevention of HIV mother-to-child transmission care. Unfortunately, adolescents often delay disclosure due to fear of caregivers' responses. We examined disclosure experiences among Kenyan pregnant adolescents living with HIV in 2022 using a qualitative cross-sectional design. METHODS: We conducted individual interviews with 22 adolescents (15-19 years) and 24 "dyadic" interviews with adolescents and adult caregiver (20 years and older) pairs. Interviews were recorded, transcribed, and verified. Our US/Kenyan team then conducted a deductive-inductive thematic analysis. RESULTS: Interviewees included 46 adolescents and 24 caregivers. Caregivers of 43 adolescents knew about their HIV status and pregnancies; one adolescent disclosed only HIV; one only pregnancy; one disclosed neither. We identified five disclosure patterns: direct, indirect, mediated, accidental, and caregiver initiated. Pregnancy disclosure was most often caregiver-initiated, followed by mediated, whereas HIV disclosure was primarily mediated, followed by direct and accidental. Caregivers' disclosure responses were generally more supportive than adolescents anticipated. Interviewees suggested that others in similar situations should disclose directly to their caregiver, especially a mother, or with support from a trusted person or healthcare provider. CONCLUSIONS: Disclosure experiences varied. Some disclosures involved strategies to mitigate perceived risks; others occurred without adolescents' consent. Direct and mediated approaches may be preferrable options for adolescent disclosure. These findings may inform the development of interventions to enhance disclosure communication skills in this underserved population. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT05383755.