The secret and children with HIV

The secrecy surrounding the disease of parents and children infected with H IV leads to psychic and affective isolation and difficulties of communicati on within the family. Can psychological management help to resolve the prob lem of secrecy between parents and children ? In. a paediatric department, we analysed the organization and dynamics of the secret surrounding childre n contaminated by their mother. The analysis was prospective and was based on semi-directive interviews and drawings. We followed up, over a period of two years, ten children (mean age 4 years, range 4 months to 12 years) fro m different ethnic and socio-economic backgrounds. In each family, the chil d was the target of the secret, the paediatrician the guardian, and the mot her (or her substitute) the keeper. The organization of the secret around t he other potential guardians varied from one family to another. Two modes o f intra-family communication existed : the secret (reserved for the younges t children) and the tacit. One child suffered from a disorder related to th e secret, the others had depressive and reactional symptoms. At the end of the study, the manner of approaching and especially dealing with the questi on of the secret had appreciably changed tn each family : disclosure to the family circle (three cases), passage of the child from the secret to the t acit (two cases), easier questioning of the paediatrician in all of the cas es. Nonetheless, in no case had the secret been completely lifted for the c hild. Four children asked to continue psychological management. The changes in, the dynamics of the secret and the easing of stress in the families ob served in this study suggest that psychotherapeutic aid should be offered t o families where a child has been contaminated with HIV by the mother.