Stigma and Ostracism Associated with HIV/AIDS: Children Carrying the Secret of Their Mothers' HIV+ Serostatus

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Journal of Child and Family Studies [jcfs] ph117-jcfs-371766 April 1, 2002 10:57 Style file version Nov. 19th, 1999

Journal of Child and Family Studies, Vol. 11, No. 2, June 2002 (C© 2002), pp. 191–202

Stigma and Ostracism Associated With HIV/AIDS:Children Carrying the Secret of Their Mothers’HIV+ Serostatus

Debra A. Murphy, Ph.D.,1,4 Kathleen J. Roberts, Ph.D.,2

and Dannie Hoffman, M.A.3

Qualitative interviews were conducted with mothers(N = 47)who had disclosedtheir HIV status to their children. The majority of mothers explicitly told theirchild not to disclose to other people that she was HIV-positive because they fearedrepercussions in the way of stigma and ostracism for both themselves and theirchild. Approximately one-fourth of the mothers identified “safe people,” to whomtheir child could discuss her serostatus, such as family members, health careproviders, or therapists. The majority of the children respected their mothers’wishes; only four children disclosed to someone after being explicitly told not todo so. A significant number of children expressed concerns about their friendsfinding out, fearing that they would be ostracized or that it would be assumed theywere also infected. In addition, the children did not want others to find out becausethey wanted to protect their mothers. The burden of keeping the secret of theirmothers’ serostatus does seem to be a stressor for some of the children.

KEY WORDS: HIV; maternal disclosure; children; qualitative study; stigmatization.

Due to the stigma associated with some of the better-known means of trans-mission of HIV/AIDS, HIV-infected individuals often choose not to disclose theirstatus or at least to limit the sharing of the diagnosis to selected confidants. A

1Research Psychologist, Health Risk Reduction Projects, Integrated Substance Abuse Programs, De-partment of Psychiatry, University of California, Los Angeles, CA.

2Postdoctoral Fellow, Health Risk Reduction Projects, Integrated Substance Abuse Programs, Depart-ment of Psychiatry & Department of Sociology, University of California, Los Angeles, CA.

3Project Director, Health Risk Reduction Projects, Integrated Substance Abuse Programs, Departmentof Psychiatry, University of California, Los Angeles, CA.

4Correspondence should be directed to Debra A. Murphy, Health Risk Reduction Projects, UCLA,11075 Santa Monica Blvd., Suite 200, Los Angeles, CA 90025-3556; e-mail: [email protected].

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1062-1024/02/0600-0191/0C© 2002 Human Sciences Press, Inc.

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192 Murphy, Roberts, and Hoffman

decision-making process typically occurs in which HIV-infected persons examinewhether the possible gains of sharing this information—such as obtaining ser-vices, support or understanding—outweigh possible negative outcomes, such asdiscrimination and rejection (Draimin, 1993). Fears of negative consequences arewell-founded, as revelation of HIV/AIDS status can result in material losses suchas loss of employment or insurance, as well as loss of support from family andfriends (Black, 1993).

The decision about disclosure is particularly challenging for mothers withHIV/AIDS. In studies exploring the impact of HIV/AIDS on the ability of moth-ers to raise their children, disclosure of serostatus emerged as one of their mainconcerns, ranking with fear of infecting their children through casual contact andthe impact of grief (Faithful, 1997; Moneyham et al., 1996). For parents, decision-making about disclosure may cause high levels of tension and stress (Marks et al.,1992). Many parents choose to keep information about their HIV+ status fromtheir children because they don’t think the children can handle the news (Black,1993). However, there is also some evidence that maintaining such a secret withina family can lead to divisiveness within the family, and confusion and anxietyin children who may be aware that something is wrong (Black, 1993; Murphy,Steers, & Dello Stritto, 2001; Weiner & Septimus, 1990). Parents who keep theirHIV status a secret from their children also run the risk that the children may guesstheir secret, that it might be revealed by someone else, or even by themselves in amoment of stress (Black, 1993).

When a mother decides whether or not to disclose to her child, she mustconsider the impact of the disclosure on the child and the risk that sharing theinformation might make the family vulnerable through the child’s disclosure toothers (Murphy et al., 2001). These concerns are exacerbated among parents whohave young children, who face additional worries such as whether the child isold enough to understand, or if he or she will be able to keep the informationconfidential.

We are aware of no studies that have explored how mothers communicatewith their children about the need for confidentiality when disclosing impor-tant information about highly stigmatized health conditions such as HIV/AIDS,nor how children react to any such requests for confidentiality. Our study helpsfill these gaps in knowledge. Participants in our study were mothers who wereHIV+ symptomatic or AIDS-diagnosed who had disclosed their HIV serosta-tus to their young child. In-depth, qualitative interviews were conducted withmothers who had disclosed their HIV status to their young, well child, and withthe child. The purpose of our study was to explore, from the perspective of themother and of the child, how the mothers communicated with their children aboutthe disclosure. We also wanted to determine the restrictions, if any, that wereplaced upon the child about sharing the disclosed information, and the reasonsthe mothers gave for restrictions. In addition, we explored the extent to which

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Maternal HIV Disclosure 193

children complied with their mothers’ restrictions, and their feelings and aboutthe restrictions.

METHOD

Participants

Participants were recruited from a cohort of 135 mother/child dyads alreadyparticipating in a longitudinal descriptive study, “Parents and children CopingTogether” (PACT). PACT was designed to assess the impact of maternal chronicillness (HIV/AIDS) on young well children over time. PACT mothers were eitherHIV-symptomatic or had an AIDS diagnosis at enrollment, were English or Spanishspeaking, and had a well child 7–14 years of age. Eligibility criteria to participatein this study included: (1) participation in PACT; (2) mother report that she haddisclosed her HIV status to the child (reported in mothers’ PACT interviews);(3) reconfirmation of maternal disclosure of serostatus during recruitment for thisstudy; and (4) informed consent for mother’s participation, parental permissionfor child participation, and child assent.

Of the 135 mothers in PACT, 73 reported that they had disclosed their HIV+serostatus to the participating child. Research staff was able to contact and invite57 of these women to participate in a one-time, in-depth qualitative interview.Nine women could not be reached at the time this study was being conducted;two were deceased; five were either incarcerated or out of state. Three womenrefused participation, and two women said that their children had not understoodthe disclosure, so they did not want to participate. In summary, interviews werecompleted with 52 mothers and their children. Due to technical difficulties withfive of the tapes, 47 interviews with mothers were transcribed for analysis.

At the interview, the mother was given the opportunity to review the protocolfor the child’s interview before making a final decision about the participation of thechild; all mothers agreed to their child’s participation. The child interview beganwith a screening to ensure that the children were aware of their mothers’ HIV+status, due to concerns that some of the children might not have comprehendedor remembered their mother’s disclosure. To ensure mothers’ confidentiality andto avoid inadvertent disclosure if a child had not comprehended the maternaldisclosure, the screening began with general health questions. Only children whovolunteered knowledge of their mother’s illness, and specifically stated that theillness was HIV/AIDS, went on to complete the interview. Nine of the 52 childrendid not acknowledge maternal HIV/AIDS status, and two tapes were unable tobe utilized. Complete interview data was obtained on the remaining 41 children.The average length of time since the disclosure of the mother’s HIV+ serostatusto the child was 27 months (SD= 27.95, range= <1 month to 145 months).

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Sample Description

Mean age of the mothers was 36 years (SD= 5.26; range 24–52). Theracial/ethnic composition of the sample of mothers was: 50% African American;21% mixed or other race, 13% Latina; 8% White; 4% Native American/AlaskanNative; and 4% Asian American. Marital status was as follows: 30% never married;25% widowed; 19% separated; 15% married, and 11% divorced. Almost half of thesample (47%) had not completed high school; approximately 23% had completedhigh school, and the remainder had completed some college, technical school, orhad an undergraduate degree. The average monthly income per household was ap-proximately $1,650.00, with a median income of $1,050.00 (based on all employedpersons in the household). The majority of the women (81%) were unemployed;among those who were employed, the median income was $700.00 per month. Themajority (87%) reported living in their own house or apartment, 7% were livingwith parents, other relatives, or friends, and 2% were in some type of shelter. Themean number of children living in the home was 2 (SD= 1.41, range 1–8).

Medical chart abstraction was completed for 45% of the sample. Most of thewomen (66%) had viral loads under 10,000 cells/mm3, with 19% having viral loadsin the 10,001–50,000 cells/mm3 range, and 14% having viral loads over 50,000cells/mm3. Mean CD4 count was 444.9; the median was 377 (SD= 313.4; range64–1320 copies/mL).

Mean age of the children was 10.47 years (SD= 1.97; range 7 to 14 years);53% were male. All children were living with their mothers at the time of theinterviews.

Procedures

Mothers were invited, either by phone or during their regular PACT interview,to participate with their child in this study if they had previously responded affir-matively in a PACT interview to a question asking if they had disclosed their HIVstatus to their child. Interviewers reconfirmed the mother’s disclosure during thisinvitation. Mothers were advised that the participation should not be the occasionfor disclosure to their children. If a mother confirmed that disclosure had alreadytaken place, she was invited to participate.

All interviews were conducted in participants’ homes. The mother and childwere interviewed at the same time in separate rooms. Spanish-speaking interview-ers were available for women and children who were more comfortable in thatlanguage; 12 of the mother interviews and two of the children’s interviews wereconducted in Spanish. The mother and the child interviews were semistructured,consisting of leading questions and probes. Mothers’ interviews averaged 1 hourin duration; children’s averaged 30 minutes. All interviews were audio taped forlater transcription and analysis.

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Interviews

Mother Interview

The mothers’ were asked to describe exactly what she said to the child whenshe disclosed her HIV-positive serostatus. She was also asked to describe exactlywhat she said to the child about the child telling other people.

Child Interview

Two questions in the child’s interview elicited information about the issue ofwhether or not the child was permitted to tell other people about her/his mother’sHIV+ serostatus. The first question addressed this topic directly, asking whetherthe child had told anyone else about her/his mother’s HIV+ serostatus. If the re-sponse was positive, the child was asked about the age and relationship of theperson/people told and whether the mother knew the child had made the disclo-sure(s). The second interview question asked the child whether s/he was afraidother people might find out about her/his mom having HIV. If the child respondedaffirmatively, s/he was asked about who the child feared might find out, and whatthe child thought would happen if the people identified did found out about themother’s serostatus.

Qualitative Analysis

Following the suggestions of Strauss and Corbin (1990), multiple readingsof the transcripts were performed to identify major themes that emerged from theparticipants’ descriptions of their situations. Important and frequently mentionedideas were grouped into coding categories. Ethnograph (Seidel, Friese, & Leonard,1995) was used to help manage the data during the coding process.

RESULTS

Mothers’ Request for Confidentiality

Over three-fourths (77%) of the mothers warned their child to not tell otherpeople about their HIV status. Of these women, 34 out of 36 (95%) warned theirchild in an explicit manner: “I told him not to tell anybody” (35-year old Whitewoman). The remaining two mothers said that they felt that they communicatedthe same message to their children implicitly, rather than explicitly. One of thesewomen did this by making sure her child overheard her having conversations with

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other people about the need for secrecy in regard to her HIV. The other womanmaintained that her child knew not to tell others because the long-standing rule inher household was to keep all family matters, not just HIV, private. This 32-year-old African-American woman stated, “I always told them you don’t talk aboutwhat goes on in our house.”

A small number of mothers (23%; 11/47) did not warn their children abouttelling others about their HIV status. In three cases mothers did not give a warningbecause their children had already decided on their own not to disclose. Severalother mothers said that they did not issue a warning about disclosure because theywanted their children to feel free to decide on their own if and when to tell others.A 30-year-old White woman stated, “I told him I have no problem with it. It’sup to him whether he wants to disclose it.” Several of the mothers who had notissued warnings also maintained that they were very open about their HIV statusand did not mind if others knew about their diagnosis. A 43-year-old African-American woman said, “If he felt like he needed to talk to somebody about it, Iwouldn’t necessarily be mad or embarrassed because I’ve come to terms with mydiagnosis. . . I’m out there, you know, as a health educator with AIDS.” Mothersalso believed that their child might be able to educate others about HIV/AIDS.A 37-year-old African-American woman explained, “Since they have been incounseling. . . they know a lot more than a lot of kids might. . . they could probablyeducate the kids. . .or adults or whoever they’re talking to.”

Limited Disclosure: “Safe” People

About one quarter of the mothers who told their children not to tell othersabout their serostatus did not make that stricture absolute, but gave their children“ground rules” about who the child was permitted to talk with about her HIV/AIDSstatus. These mothers specified certain “safe people” (family members, physicians,therapists, teachers, close friends) with whom the children were free to discuss theirmothers’ HIV status. A 35-year-old African-American mother said, “I told her ifshe didn’t want to talk to me about it. . . she could talk to our doctors. She couldtalk to her Godmother, but I didn’t want her to hold this inside.” Identifying suchsafe people gave children options. If they felt the need to talk about their moth-ers’ disease, there were certain preidentified people with whom they could safelycommunicate their worries or get answers to questions they may have.

Rationale for Secrecy

As noted, the majority of mothers in this sample issued warnings to their childregarding keeping their HIV status a secret. The reasons for their warnings fellinto four categories: (1) mothers issued warnings as a simple matter of privacy,

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(2) they did it to protect their child; (3) they did it to protect themselves; or (4) theydid it to protect other people in their social networks.

Privacy

Some mothers believed that it simply was no one’s business that they wereinfected with HIV. Respondents used the words “private,” “personal,” and “familymatter” to explain to their children why they should keep their HIV status to them-selves. A 41-year-old mother of mixed racial/ethnic heritage said, “I do tell herto . . .not advertise it. . . I just feel that. . .people should respect people’s. . .personal life.” Some mothers also felt that it was their right to disclose their HIVstatus to others; this was not a job for a child. Hence, if people asked their chil-dren about their mother’s HIV status, their children should refer these individualsto their mothers. A 37-year-old African-American woman said, “That’s nobody’sbusiness. And if somebody asks him, tell them to come ask me.”

Protection of the Child

Many mothers expressed concern with the potential “stigma by association”that their child might face if others found out about the mothers’ HIV status.They worried that if it became public knowledge, their children would suffer justas much, if not more, discrimination and ostracism than they would themselves.Some of these mothers expressed the belief that should their HIV status becomeknown, people would think that their children also were infected with HIV. One34-year old Latina mother stated, “I told him ‘Look, my son. . . if you tell that Iam HIV+, they are going. . . to be disgusted by you.. . .They are going to thinkthat you are going to infect them.” This woman’s 10-year old son echoed hismother’s fears—he said, “My friends. . .might not like me no more. They mightthink I have HIV too.” A 42-year-old mother stated, “It’s not for everybody to knowbecause. . . they might want to treat her different. They might think she’s ‘germy.’”

Mothers also worried that their HIV status would negatively taint their chil-dren’s images in more subtle ways. A 34-year-old mother said, “I just don’t wanther to bedifferent.” In addition, mothers expressed the fear that if their HIV statuswere known, their child would be bullied, teased, or gossiped about at school. A 28-year-old Latina mother said, “I told her . . . that. . .people don’t like to listen or hearthat someone is sick from HIV or from AIDS, because they discriminate. . .maybemake her feel bad by saying, ‘Oh, your moms has AIDS.’” Finally, mothers alsoexpressed the belief that their children would be shunned and lose friends as aresult of the mother’s HIV status being known. As a 32-year-old mother of mixedracial/ethnic heritage said, “I ended up telling him that it be best that he not tellanybody in school for fear that they’d end up saying. . . ‘He’s got a mom who’sinfected. . . I don’t want him as a friend.’”

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Protection of the Mother

Just as the mothers worried about their children’s images being tainted, moth-ers also worried that their own images would be negatively affected should theirdisease become public knowledge. A 30-year-old Latina mother stated: “I told himnot to tell anyone because they can discriminate against you as well as me. I toldhim if you tell them that your mom has AIDS, sometimes people don’t understandand they discriminate against you.. . .They are going to think that you are bad orthat I am bad. . .There are many people who don’t know what AIDS is, a lot. Andif you tell them, they are not going to want us.”

Mothers pointed out that there was still a good deal of ignorance and fear inthe general population regarding HIV/AIDS; therefore, they wanted to keep theirHIV status a secret in order to avoid problems. A 37-year-old Latina woman said,“People devalue you, are disgusted, they are scared. There are people who thinkthat if I use clothing and I give it to them, they are going to get AIDS.”

Protection of Others

There were several instances in the data of mothers who warned their childrento not tell others about their HIV status to help protect the feelings of members oftheir social network—most commonly extended family members—who did notknow about their HIV status. The mothers feared that such individuals would gothrough much worry and anxiety should they discover their HIV status. A 35-year-old Native American woman explained, “I told them that. . . this. . .was. . .a[immediate] family thing, for us only. . .because I don’t want to worry otherpeople, even if it is my sister, my brother.”

Children’s Responses to Maternal Request for Confidentiality

The majority of children (87%; 35/40) maintained that they had not toldanyone about their mothers’ HIV serostatus. They gave four primary reasons forkeeping this secret, the first three of which parallel the reasons the mothers gave forrequesting secrecy on this topic: (1) maintenance of privacy; (2) self-protection;(3) protection of their mothers; and (4) compliance with their mothers’ commands.

Maintenance of Family Privacy

Children also maintained confidentiality regarding their mothers’ HIV/AIDSbecause they believed that their mothers’ disease status was a private matter, onethat other people should not know about. A 10-year-old Latina girl said, “I don’treally like talk about it cause I think it’s family business, not other people’s

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business.” Similarly, An 8-year-old African-American boy said, “I think otherpeople shouldn’t know.”

Self-Protection

Many children worried that their identities would be tainted if others knewthat their mothers were HIV positive. Children believed that their peers would thinkthat they too were infected with this virus or that they were abnormal or deviant insome way. A 10-year-old African-American boy said, “They’d probably be like,‘Oh, your mom has HIV. Don’t go by him. He has it too.. . .’ I think they mightjudge me differently. That’s why I don’t tell nobody.”

Children were particularly concerned with the possibility of losing friendsand being discriminated against because of their mothers’ HIV status. A 7-year-old Latina girl said, “I haven’t told no one cause I’m afraid they’re not going to bemy friend.” An 11-year-old Latino boy said, “Kids will tease me and stuff.” Gossipwas also a big concern of children. A 9-year-old boy of mixed racial/ethnic heritageexplained, “I don’t want anybody else to know.. . .They would spread it around.”A 6-year-old African-American boy said, “Somebody might tell somebody andthen somebody might tell the other person. . .and then nobody would like me.”

Protection of the Mother

Just as children expressed worry about being ostracized or discriminatedagainst themselves, they also worried that their mothers would experience theseforms of censure. By keeping the secret, they were protecting their mothers frompossible harm. An 11-year-old African-American boy said, “I don’t think ev-erybody should know. . . they might tell somebody else and then that personmight. . . telling everybody else in the end. People might started thinking badthings about her.” These children did not want their mothers to lose friends or beteased by others. An excerpt from the interview of a 7-year-old White girl providesillustration:

Child: I should keep a secret.Interviewer: What do you think might happen if people find out?

Child: That she breaks up with our friends. That they might, I don’t know,they might tease her or something. The other adults. I’ve seen otheradults tease each other.

Compliance with Mothers’ Request for Secrecy

Some of the children had not disclosed their mother’s serostatus simply be-cause their mothers had told them not to. An excerpt from the interview of a

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6-year-old White boy provides illustration:

Interviewer: So have you told anyone about your mom having HIV?Child: No.

Interviewer: Why not?Child: Because my mom doesn’t want me to tell anybody.

Child Disclosure

Only five children disclosed that they had told someone about their mothers’HIV serostatus. In four of the five cases where the children disclosed their mothers’HIV status to others, their mothers had issued an explicit warning to keep this asecret. The remaining mother was “out” with her HIV status and had not issued awarning. Of these five children, one told his therapist, two told their friends, onetold her stepsister, and one told a cousin. Hence, in most cases, when childrendisclosed they did so to close peers, people that they considered trustworthy. A 9-year-old White girl said, “I just told one person. . .my best friend. . .but I trust her.She tell me a whole bunch of problems about her stuff.” This child also stated thather mother, after learning about her “slip,” urged her to not tell anyone else: “She’slike, ‘Ayy! It’s okay, don’t worry.. . .But just don’t tell anyone else now.’” The12-year-old African-American girl who disclosed that she had told her therapistabout her mother’s HIV explained that her mother, after learning about this matter,reaffirmed that talking to health care professionals was permitted. This girl said, “Itold my mom that I told him. . .and she said ‘yeah you could tell them. . .’ causethey always keep secrets. . . that’s like a clinic.”

DISCUSSION

The majority of mothers explicitly told their child not to disclose to otherpeople that she was HIV-positive. Of those, only approximately one-fourth iden-tified “safe people,” such as family members, health care providers, or therapists,with whom the child could mention the topic. While many mothers simply be-lieved that their HIV status is a family matter to be kept private, the majority alsofeared repercussions in the way of stigma and ostracism for both themselves andfor their child if people were to find out. Even this many years into the epidemic,HIV/AIDS is still highly stigmatized. HIV-infected mothers are well aware of thisstigma, and this study shows that they communicate their concerns about suchstigma to their children in the course of disclosing their HIV status. In addition,a significant number of mothers believed that if their own HIV status became pub-lic knowledge, it would be assumed that their children were also infected. Bothmothers and children seemed to understand this “stigma by association” to be areal possibility for children of HIV-infected mothers.

The majority of the children respected their mothers’ warnings and had notdisclosed her serostatus to anyone. While each mother-child pair does not concur

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exactly regarding this, the trend is definitely there that children heed well thewarnings that their mothers give them about disclosing. These children did listento their mothers and take their worries seriously. Although HIV-infected mothersconsidering disclosure to their young child often list as a major concern the fact thatthey fear the child will impulsively disclose to others (Faithful, 1997; Moneyhamet al., 1996), this is not borne out in the data. Even among the five children whowent against their mother’s strictures, for the most part the children disclosed towhat would be termed “safe” people (e.g., a therapist, a stepsister).

The reasons that the children gave for adhering to their mothers’ commandsand not disclosing may have been directly derived from what their mothers hadtold them about the consequences of such disclosure. However, this promisekeeping may have been partially motivated by self-interest, since many of thechildren seemed well aware of the stigma and potential ostracism associatedwith HIV/AIDS. Many of the children worried that their own identity would betainted if others found out about their mothers’ positive HIV status. They feltthey would be judged differently, and were particularly concerned about losingfriends. A large number of the children also kept the secret because they weretrying to protect their mothers, because they feared that people would think badlyof her. Mothers’ main reasons for not wanting the child to disclose to others wereprivacy, protection of the child, protection of self, and protection of others in theirsupport network. Children’s reasons for not wanting to disclose to anyone paral-leled the mothers’ reasons with one exception. Children’s reasons were privacy,self-protection, protection of their mothers, and compliance with their mothers’commands.

The burden of keeping the disclosure a secret may cause some stress to thechildren. For example, seven of the children who reported that they did not discloseto anyone else also said that they worried a lot since learning of their mother’sserostatus and that they did not want to talk to their mother about their fears. Someof the worries they described were serious, and these children have no confidantswith whom they can share these concerns. Health providers working with HIV-infected mothers who have disclosed to their children may want to encouragethem to work with the child to develop a list of “safe” people with whom they cantalk about this issue; mothers also should be encouraged to have confidants otherthan their young children. Providers might remind mothers that there will be timeswhen the children—whether it is because they are protective of the mother or justbecause they want to talk to someone outside the immediate family—may need tohave a confidant, and that such social support is beneficial.

ACKNOWLEDGMENTS

This research was supported by Grant #R01 MH 57207 from the NationalInstitute of Mental Health. We would like to thank the mothers and childrenwho were participants in the research project. We would also like to thank the

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interviewers for this project, Aida Santos, Sonia Ruiz, Adriana Molina, M.F.C.C.,Chris LaBelle, M.S., and the research assistant for this project, Tim Castro.

REFERENCES

Black, L. W. (1993). AIDS and secrets. In E. Imber-Black (Ed.),Secrets in families and family therapy(pp. 355–369). New York: W. W. Norton & Co.

Draimin, B. H. (1993).Coping when a parent has AIDS.New York: The Rosen Publishing Group.Faithful, J. (1997). HIV-positive and AIDS-infected women: Challenges to mothering.American Jour-

nal of Orthopsychiatry, 67,144–151.Marks, G., Bundek, N. I., Richardson, J. L., Ruiz, M. S., Moldonado, N., & Mason, H. R. C. (1992).

Self-disclosure of HIV infection: Preliminary results from a sample of Hispanic men.HealthPsychology, 11,300–306.

Moneyham, L., Seals, B., Demi, A., Sowell, R., Cohen, L., & Guillory, J. (1996). Experiences ofdisclosure in women infected with HIV.Health Care for Women International, 17,209–220.

Murphy, D. A., Steers, W. N., & Dello Stritto, M. E. (2001). Maternal disclosure of mother’s HIVserostatus to their young children.Journal of Family Psychology, 15,441–450.

Seidel, J., Friese, S., & Leonard, D.C. (1995).The Ethnograph, Version 4.0.Amherst, MA: QualisResearch Associates.

Strauss A., & Corbin J. (1990).Basics of qualitative research: Grounded theory procedures andtechniques.Newbury Park: Sage Publications.

Weiner, L., & Septimus, A. (1990). Psychological consideration and support for the child and family. InP. Pizzo (Ed.),Pediatric AIDS: The challenge of HIV infection in infants, children, and adolescents(pp. 577–594). New York: Williams and Wilkins.

Documents

Stigma and Ostracism Associated with HIV/AIDS: Children Carrying the Secret of Their Mothers' HIV+ Serostatus